Dr. Micah Kust DPT, ATC, CSCS
Now that we have assessed if athletes need balance training and determined what kind of balance training is indicated (unstable vs stable), what are ways we can implement balance training in the athlete population?
There are unlimited options for balance training but I will highlight some options. MOST of them will not include unstable surfaces, but there is SOME value to using these surfaces so I will briefly cover some examples.
Examples are included in this instagram post. Check it out
I have personal experience with the tilt board after I tore my ACL for the second time. I decided to take myself through a non-operative protocol which included a lot of tilt board work. Ultimately, it came down to getting as strong as possible on that one leg but I will not discount the affect the tilt board had on my recovery.
Athletes who have sustained acute ankle or knee injury have shown to benefit from unstable surfaces. Much of this is due to the proprioceptive loss which occurs from a significant ligament or muscle injury. I prefer to use the tilt board he tilt board in early to mid stages of recovery for restoration of joint proprioception. This can be accomplished by having athletes find the balance point of the board, then tap an edge of the board and return to the original balance point.
The Bosu Ball…I would like to remove these from the physical therapy and performance profession but let’s discuss how they could be used. In the realm of UPPER EXTREMITY balance and stability they have a much greater benefit and application.
Load compromised athletes who benefit from this training tool the most. A load compromised athlete is unable to tolerate progressive loads in their current state due to pain, muscular inhibition or lack of force production. The bosu ball can be used to increase muscle activation without overloading the injured or painful joint due to the reduced forces produced while on an unstable surface. Additionally, unstable surfaces induce increased muscle co-activation which improves joint stability while reducing available range of motion. This can be beneficial for rehabilitating athletes who currently don’t possess the strength or ability to control a certain range of motion but still want to work on improving muscle activation.
The bosu ball fails as a pure balance tool as there are better ways to strictly train balance with the principle of specificity in mind.
Now we get to the good stuff. Most athletes with the exception of those who experience unstable surfaces often in competition can benefit much more from stable surface training WITHOUT the potential negative consequences of reduced training affects. Most athletes interact with a stable surface during their competition so they should be performing most of if not all of their balance training in this manner. Many may think the ground does not provide enough of a challenge for the most talented and skilled athletes. This is a lazy excuse many sports physios use to justify their uses of unstable surfaces but you will see there are many ways to challenge athletes without a bosu.
Foot and Ankle Function
One of the most important aspects of balance training is foot function and strength. Below are some ways to training toe foot and ankle function in order to make sure it can support the body during balance training. Once we know the foot is ready to be challenged then we can add more layers to our balance training. Once the foot is prepared for balance training this can be implemented in a variety of different ways.
Even if the feet aren’t ready to be challenged yet there is a great alternative way to challenge balance. This will be accomplished from the half kneeling position. The half kneeling position takes out the ankle from the balance equation and puts emphasis on the hip and the trunk. You will be surprised at how many athletes of all levels will be unable to stabilize in this position especially in the aligned or narrow base position. It is important to note that in this position most of the weight should be distributed to the back thigh. It is helpful to cue patients to place 80% of their weight in the trial leg and 20% in the lead leg.
Single Leg Challenges
Check the Instagram post out for ways to challenge balance in single leg stance. There are unlimited opportunities for variation of stability challenges in this position with no need for unstable surfaces. As you will see, many of them are not easy and provide an adequate stimulus to improve balance.
Dual Task Challenges
Dual task challenges reduce an athletes reliance on vision in order to challenge balance. These tasks follow the principle of specificity as athletes are always performing dual tasks during competition and rarely are focused on a single point during athletic movement. No fancy glasses are needed to reduce an athletes use of vision. This can be accomplished by simply causing a change in head position while tracking a ball.
The Kiro Core is a harness designed by Kika and Roberto Mela that can be used to train the trunk in multiple different planes of motion simultaneously.(https://www.kiroconcepts.com/)
The Kiro Core can also be implemented with balance training by creating multi-direction stability challenges on an individual during movement or in single leg stance. The rings on the harness can slide during movement constantly providing different stability challenges which don’t require the use of unstable surfaces and make it a very versatile device for balance training.
Balance training can also be challenged simply by unilateral training. Any strengthening movement performed on one leg or primarily one leg if in a supported position is balance training. All these positions provide a unique stability challenge while allowing progressive load. This can be the best of both worlds as we can provide a adequate stimulus for strength gains as we challenge balance with unilateral training.
Athletic movement provides significant stability challenges during jump landing tasks of jumping, bounding and hopping. These are conditions athletes experience during competition so principle of specificity applies extremity well with this type of balance training. Jump landing tasks can be done in all planes of movement in order to subject athletes to all stability challenges they will experience during competition.
These are only a few examples of how to implement balance training. The most important thing is to think critically when implementing these exercises, use the principle of specificity and don’t always look to an unstable surface to make a balance exercise more challenging.