Balancing Act

Wow, has it really been two months since my last post? Time sure does fly when you're busy!

Luckily, I have a good excuse: I was completing my clinical rotation in orthopedics this summer, and as you might expect, it was pretty involved! Unfortunately, I found little time to answer an excellent comment left in a previous post…hopefully, my response below will have been worth the wait:

Q:Hi Jon

I understand what you're saying about the principle of specificity, and I agree that way too many people do way too much training on unstable surfaces... but wasn't that pink dumbbell guy doing some balance/core stability work?

A less difficult version of this exercise is shown over at SparkPeople and it says "This is a very good balance exercise and works your core stabilizer muscles as well as your leg muscles."

http://www.sparkpeople.com/myspark/ex/exercises.asp?ID=18

I would be interested in your thoughts.

A: Well, yes and no! Basically, we’re really looking at the same issue: the specificity of the exercise. While the people that recommend those kinds of exercises with some abstract claim of improving balance and “core strength” (more on that “SparkPeople” example in a moment), once again we have to look at how that improvement might actually be utilized (or in most cases, not utilized).

In clinic, therapists use balance exercises in an attempt to correct a specific group of balance disorders, which is referred to as vestibular rehabilitation (referring to rehabilitation of the centers that control balance in the brain/body). This type of training is designed to correct a condition that is caused by peripheral or central vestibular disorders. For those patient populations, unstable surface training helps the individual to properly interpret vestibular information and to develop more appropriate strategies in maintaining balance.

A mistake that an unfortunately vast majority of trainers and coaches make (and all of the so-called “functional” proponents) is that if a technique works to improve balance in one specific condition for one particular population, it must work for other conditions and other populations, too.

It doesn’t.

That’s because for normal populations, poor balance has to do primarily with decreased muscle coordination, strength/endurance as well as possibly poor joint proprioception, and NOT because of a true vestibular condition. There is a big difference between vestibular patients that may experience dizziness, blurred vision, disorientation and/or lightheadedness in addition to a feeling of loss of balance vs. someone that's simply a bit clumsy.

Once again, this is an issue of specificity: what is the problem that we are trying to correct or improve, why is it occurring, and how do we best address it? Using balance training methods developed for patients with clinical deficits in vestibular function and applying it to a normal, healthy individual is like trying to learn how to Waltz by taking tap-dancing lessons: just because they’re both forms of dancing, it doesn't mean that they're anything alike. So if you find yourself tripping over your own feet, don’t stand on a Bosu or attempt one-legged squats: learn how to walk on solid ground without tripping by using agility/coordination drills and good old-fashioned strength training!

Now here’s the funny part about the SparkPeople example: if you look carefully, even though it’s a crude 5-frame demo, you can easily see that the individual who is demonstrating the exercise that claims to produce “good balance…and works your core stabilizer muscles as well as your leg muscles” actually has significant weaknesses in both balance as well as core and leg strength!

Taking a closer look, you will see his leg swing inwards towards the other knee as he attempts to balance himself as he squats: this is a clear indication of poor knee control stemming from weaknesses in his pelvis/hips, thighs, hamstrings and/or calves. And he’s standing on solid ground! Just imagine what he would look like if he decided that he needed to improve his balance and de-stabilize himself further by performing his exercise on a Bosu: It would be a disaster! Such an obvious weakness means that while he can figure out how to balance himself on one leg, he has actually done nothing to improve his strength, reduce his risk of potential injury at the knee or to improve his overall quality of movement because of his compensation patterns.

In fact, according to a recent Olympic Committee statement concerning non-contact ACL ruptures in females:

"(A)lmost 80% of ACL injuries are non-contact in nature. Injuries often occur when landing
from a jump, cutting or decelerating. A combination of anterior tibial translation and lower
extremity valgus are probably important components of the mechanism of injury in these
athletes."

A dynamic knee valgus occurs when the knee moves towards the midline but the shin moves away from the midline (hip adduction). Now, let’s look again at his knee and hip when he squats: His knee buckles inwards, and his pelvis moves out to the right, increasing the angle between the hip and the knee, which is exactly what is described in the paper. Because our bodies are smart, we are more likely to work around a weakness or improper movement rather than spontaneously correcting weaknesses and poor movement patterns (which is why having access to a knowledgeable trainer, coach or therapist can be so important for injury prevention through appropriate corrective exercise to spot and fix these weaknesses).

In our example’s quest to improve his balance and conditioning, he’s likely made pre-existing muscle/postural weaknesses even weaker by feeding into his natural compensatory patterns of movement, making himself more at risk for serious ACL injury! Can he balance on one leg? Yeah...sorta. Does he do it correctly with good motor control and strength? Absolutely not. And that is a recipe for future chronic injury.

And this really proves my point: exercise without specificity of function or without regard to addressing true dynamic weakness doesn’t help to improve anything other than getting better at that particular exercise...and not even necessarily with proper movement patterns, either! It’s like building an aircraft carrier in the middle of the desert: what’s the point? Yeah, it might represent a challenge, but you could have used the time and effort wasted on a useless motor skill towards something equally as challenging but far more practical and useable.

…Like learning how to properly squat and deadlift, which, according to this recent study published in the Journal of Strength & Conditioning Research, found that “...activity of the trunk muscles during (squats) and (deadlifts) is greater or equal to that which is produced during the stability ball exercises. It appears that stability ball exercises may not provide a sufficient stimulus for increasing muscular strength or hypertrophy; consequently, the role of stability ball exercises in strength and conditioning programs is questioned.”

So in regard to that second part from the SparkPeople website claiming that their example exercise "works your core stabilizer muscles...?" It might to a point, but it looks like squats and deadlifts do more for core strength and conditioning than stability exercises do, too.

Go figure.

-Jonathan