Back to the Future of Balance

balance injury prevention

What is balance? is helpful, and maybe the most simple and to the point. Balance bal-uhns ] is defined as

 a state of equilibrium or equipoise; equal distribution of weight.” 

 As a physical therapist we think of balance every waking hour of every day. It is in our nature. We’re geeks for symmetry, for distribution, for efficiency, for, well, avoiding pain and wear and tear. We see what a body out of balance does. We’ve developed a skill set to help re-establish balance lost. It’s sometimes easy and small “tips” of the trade. Most of the time it’s more complex than we think. 


So what is it and why is it so complex ? 

For starters, when we discuss this goal of equilibrium and equal distribution of weight, we must accept that it involves many things. The simple ability to sit up straight, lean forward and reach for something has a laboratory of things going on inside and outside of us to make that happen successfully. Think of a baby developing head lift, then chest lift, then tummy lift, and then seemingly, in a blink of an eye, is standing on two legs. That’s balance progression.

As we age our systems may have problems, accumulated or sudden, where that beautiful developmental progression reverses and now we find it hard to get up off of the floor. So why is that ? 


It doesn’t take an expert to know that everything is connected in our bodies, and needs the other to accomplish great feats of balance. Most know it takes the following : 

1. Awareness of positions and changes

 Proprioception and kinesthesia are some things that we, as physical therapists, test. From head to toe, our body receives information about our position in space and it responds to that information to prevent injury and falls. Even having the toes impaired can be a significant factor in lost balance, no matter how strong the rest of the body seems. 


2. Vision and orientation to a horizon 

While many can walk, talk, turn their head it’s a sense of the horizon that orients us to good “uprightness”. If vision is disturbed in any way our balance can suffer. As physical therapists we often refer out to ophthalmologists/ optometrists to have things checked, and / or we work with strengthening other systems to make up for lost visual strength or depth perception deficits. 


3. Inner ear / vestibular systems

 Part of that horizon orientation but it is also equilibrium, changes of direction, along with the coordination of head / eyes and body in the intended directions to complete tasks. This may be the most complicated and fascinating. If you’ve had vertigo you know how the sensation of the room spinning and the nausea can be severely crippling. It can come out of the blue when everything seems fine the day before. There are things we can do to correct a hyper or hypo sensitive vestibular system. 


4. Strength 

It may go without saying, we need strength to fight the forces of gravity. That’s a ‘duh’ comment. But, where it gets interesting, and sort of back into the PT's ‘geekiness”, is finding out where the loss of strength is actually occurring. There are over 600 muscles and 200 bones in the average human body. Muscles work on bones to move us. That leaves a lot of things to investigate should our balance be less than desired. We love trying to figure that out. 


5. Flexibility 

Muscles too tight or too long don’t move the bones very effectively. It’s often noted that a weak or injured muscle causes less range of motion, less excursion of the bones to create a motion. A classic example is with frailty of gait. A lost sense of walking balance may create tightness in the adductors , aka groin muscles. This may be a “protective” reaction,  much like one tightening their hips together if new to ice skating. It takes strength to let the bones ‘go’ and move into various positions in space. Did you know ‘hammer toes’ or clawed toes can be a tightening of toe flexors , over time, not overnight,  due to weakness or tightness in the calf muscles or diminished sense of balance. 


 6. Posture 

While no one needs perfect posture at all times, we do need the ability to adapt to position in space and sudden or planned demands. If one has a chronic forward head, or sway back, or turned-in knees, it becomes more difficult to make even simple needed changes to maintain balance or feel confident with the demand. 


 7. Brain and beyond 

Finally, not finally, there are zillions of super computer interactions occurring throughout the brain, in the brainstem, in the spinal cord. These super computer ‘synapses’ are the bedrock of all things mentioned already and a focus of the most sophisticated of balance training programs. 


Like I said, physical therapists love to geek out on balance. Even more, the past decade, PTs at Evergreen use developmental kinesiology science to restore adult systems to efficacies of infants and toddlers. Have you been asked to ‘crawl on the floor” by your therapist? Or have they had you in ‘3 month prone’? How about, transitioning from your back, to your side, to your hands and knees, to one foot forward, to reaching up and finally standing. Congratulations, you just performed a balance sequence of a 12 – 14 month old.  Ironically, it was more natural and easier at 12-14 months than it is as an adult or even school age to teen. Getting back to this early foundation of movement is key to regaining balance.

This ‘back to the future of balance’ is why we are excited. Evergreen is pushing the envelope of better balance. Blending all of the sciences past, and present, we are embarking on a future of “smart-balance’. In past blog posts I’ve mentioned a new system coming to evergreen called Smart Fit. Here is the link to the Smart Fit website for you to take a peak. 

Adding the complexity of thinking, dual tasking, distractions, fatigue, and goal attainment is the newest frontier in performing any and all tasks with better balance. We can’t wait to invite you to join us. 

As you may know, we are moving on May 1st to 111 South Hudson. While parking and 7,400 square feet to spread out are our first lures to making this jump, if we're honest, we're also totally excited to be in walking distance from 30+ eateries, Target, Trader Joe's and our favorite, Philz Coffee. Once we are there we will invite all to experience the future of balance and performance training for yourself. Stay tuned!

 Cheers to lifetime health and better balance, 



“Everyone should have a physical therapy peace of mind”



Dave is the owner and founder of Evergreen Physical Therapy Specialists. He and his wife Tammy, an RN at CHLA, opened Evergreen over 15 years ago to provide the community of Pasadena with specialized and compassionate care. David has over 25 years of experience in orthopedics, neuro-rehabilitation, and pediatric physical therapy. 



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