Balance Training for Winter Warriors and Everyday Athletes

The NASM Optimum Performance Training™ model—grounded in solid, evidence-based research—offers the perfect base on which to build strength and stability in your clients so they can keep their footing on (or off) the ice and snow.

by Kyle Stull, DHSC, MS

Most people don’t realize how important balance is to everyday life. Recent 3-D analysis of human gait suggests that 40%–50% of walking is spent on one leg (Singh n.d.) and, by definition, a run allows only one foot to touch the ground at a time. Indeed, balance is a component of any upright movement.

Winter (in climes where temperatures drop below freezing) naturally adds a level of complexity by frequently introducing an unstable surface. For anyone who sets foot on a slick sidewalk, the importance of balance becomes (sometimes painfully) obvious. Yet a walk in the park (even in icy conditions) pales in comparison to racing down snow-covered mountains on two thin slats—or maintaining one’s center of gravity over a single piece of steel that is carving through ice at top speeds. Wow! What clients—and we as fitness professionals—need to remember is that all of these activities are incredibly demanding on the body’s balance mechanisms. Without the ability to demonstrate dynamic balance capabilities, the risk of injury increases dramatically, whether you’re working with a winter-sport athlete or a client walking to the gym during a “wintry mix.” Here, we’ll look closely at the mechanisms employed in balance and the ways that balance training using NASM’s Optimum Performance Training™ (OPT™) model can prime anyone’s body for such challenges.

The Basics of Balance

Balance can be defined as stability produced by the even distribution of weight around an axis. While a detailed investigation into balance would involve the intricate muscular function around the spine and all joints, this article will focus on balance as it relates to the body’s ability to maintain its center of gravity over the base of support (NASM 2018). This explanation suggests that balance is variable, because the base of support is often dynamic. Again, the seemingly simple act of walking or running makes for the perfect example of a balance miracle: During a run, not only must the body handle increased load and stress during the impact of each step, but this must occur over a base that is the size of your foot. To top it off, the center of gravity is perpetually shifting forward as you run. In essence, your object is to lose your balance—on purpose—only to be forced to regain it and re-lose it repeatedly.

We often fall into a trap of thinking that balance is purely the result of the muscular system. However, balance is largely a neural feature. As stated in NASM 2018, “Balance is often thought of as only a static process, but balance is also a dynamic process involving multiple neurologic pathways. Maintenance of postural equilibrium (or balance) is an integrated process requiring optimal muscular balance (or length-tension relationships and force-couple relationships), joint dynamics (or arthrokinematics), and neuromuscular efficiency using visual, vestibular (inner ear), and proprioceptive inputs.”

To demonstrate great balance in a variety of positions, the body must sequentially learn how to stabilize individual joints—all while attempting to accomplish a larger movement. The nervous system does this through the sensorimotor system.

The term sensorimotor system was first used in 1997 to describe the sensory, motor and central integration and processing components involved in maintaining joint stability during movement (Riemann & Lephart 2002). The sensorimotor system is able to maintain joint stability by receiving constant feedback from receptors located throughout the muscles, tendons and ligaments, and even the skin. With millions of these receptors (also called mechanoreceptors) located all through the body, the nervous system gets the information it needs to provide balance and joint stabilization, along with postural control. This cumulative sensory input is what we often refer to as proprioception (NASM 2018).

WHERE BALANCE BEGINS

Interestingly, the human body can coordinate optimal balance using a variety of strategies. For example, with walking, strategies consist of the nervous system doing one of two things: It may begin by activating muscles around the hips, then go to the knee and end with muscles around the ankle. Or the reverse may be true, with the nervous system first activating muscles around the ankle and then working its way up. Blenkinsop, Pain & Hiley (2017) determined that most of their study participants engaged a joint stabilization strategy that first began at the ankle. It should be noted, however, that the researchers were using surface EMG (electromyography) and therefore were unable to gain insight into activation of the deep core muscles. It is possible that the first muscle to contract would be specific to spinal stability. In any case, Blenkinsop, Pain & Hiley’s research supports the notion that muscles all along the kinetic chain are imperative for optimal balance.

WHEN BALANCE BREAKS DOWN

Why is balance training important for everybody? Because balance is something that decreases over time. Proprioception is subject to a natural age-related decline during a time when other necessary faculties—such as eyesight, hearing, strength and coordination—also begin to decrease (NASM 2012). Most people are aware of the frightening statistics regarding injury (and even mortality) as a result of falls. Research has suggested that balance training may prevent or reduce the risk of falling in certain populations, such as those aged 75 and older (El-Khoury et al. 2015). Other age groups can benefit, too. According to NASM 2018, “Research has shown that performing exercises that demand balance can reduce the rate of ankle sprains and other lower extremity injuries.”

WINTERTIME BALANCE CHALLENGES

Wintertime is notorious for injuries related to the environment (e.g., crossing slick surfaces, wearing skis, going head-first down mountains). While proper training and preparation can reduce winter-sport injuries, getting a ski stuck (which can aggressively rotate the lower leg, causing an ACL rupture) is tough to prevent. Unfortunately, knee injuries caused by errant skis are among the most common injuries for the portion of the general population that participates in winter sports, followed closely by rotator-cuff tears when trying to brace for a fall (DeVries 2016). Similarly, for people who don’t participate in winter sports, wrist and shoulder injuries caused by bracing for a fall are the most common in this season of the year.

Owing to the many high demands of competitive winter sports, injuries are not related solely to uncontrolled skis, however. Soligard et al. (2015) reported that the most common injuries at the Sochi Olympics in 2014 were ligament sprains to the knee, followed by fractures (of the foot, hand, clavicle and forearm). Seemingly simple injuries, such as a sprain, may damage thousands of important receptors, leading to a lack of quality input into the nervous system. Without the proper input (sensation), the body is unable to generate an optimal output (response), and this increases the chance of sustaining the same injury repeatedly. Thus, it is imperative to reinvigorate damaged receptors with not just balance training but progressive balance training (Sankravel et al. 2016).

Balance Training and Injury Prevention

Balance training reduces injury risk by reducing the margin of error in movement. A progressive balance training program begins stable and simple, then slowly progresses to unstable and complex. Such a program ensures that receptors are continually becoming more sensitive, thus sending better information to the central nervous system and reducing that margin of error (Sankravel et al. 2016). To be effective and progressive, balance training should push an individual’s limits of stability, but it must be completed with good form. While there are many ways to do this, Sibbala and Vamshi (2017) suggest a five-phase progressive approach:

  1. Maintain a single-leg stance on a flat surface with eyes open and closed
  2. Perform a functional activity, such as throwing and catching, on a single leg.
  3. Maintain a double-leg stance while rotating a balance board.
  4. Maintain a single-leg stance on a balance board with eyes open and closed.
  5. Perform a functional activity, such as throwing and catching, on a single leg on the balance board.

The researchers found that this progressive system improved overall knee control and function in athletes. It should be noted, however, that the integration of proprioceptive devices (such as the wobble board, DynaDisc™, BOSU® Balance Trainer) doesn’t always translate to improvements in muscle strength, power and balance (Behm et al. 2015). Thus, we see that balance training may be specific to either the environment or the surface.

Balance Training and the OPT Model

NASM suggests using a systematic and progressive balance training program throughout the levels of the OPT model. The OPT model provides three distinct levels of training: stabilization, strength and power (see below). Within each level, balance training exercises are suggested in conjunction with core and plyometric exercises, as this combination can maximize both static and dynamic joint stabilization, improving overall balance (see the balance training program below).

The NASM OPT™ model

Bringing Balance Into Focus

Being able to demonstrate optimal balance in various positions is an important part of everyday life. While balance training can take shape in several different forms and may appear simple enough, sensorimotor system function is complex. Structures that add up to “great” balance involve the brain and the spinal cord, along with a multitude of receptors located in the joints, muscles, ligaments and skin. For everything to work in an integrated fashion, these structures must be exposed to many different types of balance challenges. It is thus imperative to follow a progressive balance training program, along with other aspects of fitness and movement, such as flexibility, core work, SAQ (speed, agility and quickness) training and resistance training. This comprehensive strategy will not only improve balance but lead to a more “balanced” workout program overall.

REFERENCES:

Behm, D.G., et al. 2015. Effects of strength training using unstable surfaces on strength, power and balance performance across the lifespan: A systematic review and meta-analysis. Sports Medicine, 45 (12), 1645–69.
Blenkinsop, G.M., Pain, M.T.G., & Hiley, M. J. 2017. Balance control strategies during perturbed and unperturbed balance in standing and handstand. Royal Society Open Science, 4 (7), 161018.
DeVries, C. 2016. Common winter sports injuries. Accessed Oct. 31, 2017: sports-health.com/blog/common-winter-sports-injuries.
Doidge, N. 2007. The Brain That Changes Itself. New York: Penguin Books. El-Khoury, F., et al. 2015. Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75–85 living in community: Ossébo randomised controlled trial. British Medical Journal, 351, h3830.
NASM (National Academy of Sports Medicine). 2018. NASM Essentials of Personal Fitness Training (6th ed.). Burlington, MA: Jones & Bartlett Learning. NASM. 2012. Senior Fitness Specialization Manual (p. 5). Chandler, AZ: National Academy of Sports Medicine.
Riemann, B.L., & Lephart, S.M. 2002. The sensorimotor system, part I: The physiologic basis of functional joint stability. Journal of Athletic Training, 37 (1), 71–79.
Sankravel, M., et al. 2016. Effect of neuromuscular training on balance among university athletes. International Journal of Physiotherapy, 3 (3), 385–89.
Sibbala, N., & Vamshi, R. 2017. Effectiveness of five phase balance training program on the risk of knee injuries in adolescent athletes. Romanian Journal of Physical Therapy, 23 (39), 24–32.
Singh, A.P. n.d. Normal gait cycle. Accessed Nov. 1, 2017: boneandspine.com/normal-gait-cycle/.
Soligard, T., et al. 2015. Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games. British Journal of Sports Medicine, 49 (7), 441–47.

Balance Training: Program Design

Balance stabilization training is used to enhance static balance by not moving the stance leg.

These exercises usually begin with standing on one leg on stable ground. It’s imperative that proper alignment be used during this phase, as the goal is to train the nervous system to coordinate the stabilizer muscles. Exercises in this phase can be comparable to those in the Sibbala and Vamshi (2017) study.

Once an athlete has mastered standing in one place on one leg, she can begin to challenge the balance mechanism by shifting her center of gravity. She will do this not by moving the stance leg but by moving anything else. For example, a great first progression is reaching the floating leg to the front and then to the side. After this, the athlete can add complexity by integrating upper-body movements, such as throwing and catching a small medicine ball or performing something like a cable row or press—all while maintaining balance on the stance leg.

Given that balance may be surface-specific, using a device such as a balance disc may be appropriate for someone who will be moving on slippery surfaces. However, a device of this type should be introduced only after the athlete has demonstrated great balance on stable ground.

Balance strength training is used to improve dynamic stability by beginning to introduce movement in the stance leg.

These exercises can begin with a single-leg squat and then progress to box step-ups in all planes of motion Moves may include external resistance, such as dumbbells. As in balance stabilization training, unstable surfaces and devices may be introduced here, but only after the client is sufficiently adept on the ground and with stable devices.

Balance power training is used to improve the ability to reduce force by adding a degree of complexity, such as a hop.

Two common balance power exercises are multiplanar single-leg hop with stabilization and single-leg box hop with stabilization. Or the athlete can hop over a small hurdle or piece of tape to perform a proprioceptive single-leg hop to stabilization. Upon landing, the individual must stabilize for 3–5 seconds. During these few seconds, the fitness professional must provide feedback on form and have the athlete adjust position if necessary.

Balance Stabilization
Single-Leg Balance on Balance Disc
Balance Stabilization
Single-Leg Throw and Catch
Balance Strength
Step-Up to Balance, Transverse Plane
Balance Power
Hop With Stabilization, Sagittal Plane

Balance: It Hinges on the Ankle

“When I work with an Olympic athlete, there’s a high motivation for the athlete to get better. I’ll be at an event and something will happen, and I’ll have 10 minutes to fix it,” says NASM Master Instructor Craig Couillard, a chiropractor, massage therapist and corrective exercise specialist in Minnesota.

When time is of the essence, Coulliard knows the wisdom of the NASM OPT model and of working his way up from the bottom—specifically the ankles. “I can quickly do an overhead squat assessment, and I can tell if the ankles are involved. Usually, if you can get those ankles flexible and stable, that athlete is going to be happy.”

In his clinical practice, Couillard has seen ankle issues at the root of a wide array of problems, including groin pain, hip pain, sports hernia, back pain and more. “A lot of medical professionals don’t want to touch feet—or smell them—but the ankles are my first go-to. Everything starts at the ankle. If the ankle is not bio-mechanically correct, everything above it is going to fall apart.”

While ankle issues abound in every season, winter athletes have an added concern: The boots worn for sports like skiing and skating alter ankle biomechanics drastically and, further, give athletes a false sense of stability, leading them to believe that the boots make up for any deficiency in ankle strength. In truth, says Couillard, shoring up those ankle muscles and having better range of motion and stability in the boot will reduce injury risk and improve performance.

HERE ARE A FEW OF COUILLARD’S FAVORITE TOOLS FROM HIS OPT TOOLKIT:

Start with assessments. Some trainers skip to the workouts, but Couillard does assessments on “literally everybody” to help him set aside assumptions and see what’s really going on. He starts with the overhead squat assessment and single-leg squat assessment, followed by range-of-motion assessments of the ankle, knee and hip. Common problems he sees in the ankles of ice hockey players are external rotation, dorsiflexion and eversion

Ask about ankle injuries and surgeries. According to NASM 2018, these events can decrease neural control to muscles in the gluteus medius and gluteus maximus, as well as to ankle muscles and joints. Many noncontact knee injuries stem from dysfunction in an ankle or a hip, since the knee lies between these two within the kinetic chain.

Build strength where it’s needed. Couillard recommends the three ankle-strengthening exercises below for everyone from Olympians to soccer moms (or ice hockey moms) who spend more time on the sidelines than on the ice.

While it’s important to begin clients on stable ground, Couillard says, “I highly encourage the fitness professional to introduce a proprioceptive or balance component” to the routine when appropriate. In addition to improving balance, this gives ankles an extra workout. In the meantime, clients can start with the exercises listed. Couillard recommends 2–3 sets, with 15–20 reps per set, or to fatigue. To progress the moves, increase the level of resistance.

Anterior Tibialis
Balance Exercises for Ankles
Posterior Tibialis
Balance Exercises for Ankles
Step Raises (Peroneals)
Balance Exercises for Ankles
Do 2–3 sets of 15–20 reps of each exercise (or to fatigue).

Meet our experts

AFM-Author-Stull Kyle Stull, MS, LMT, NASM-CES, Kyle Stull is the Senior Master Trainer for TriggerPoint Performance Therapy, a Master Instructor for NASM and for Equinox Fitness Clubs and an international presenter.

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