Balance Exercise Booklet One

Balance Exercise Booklet One

Balance is key to independent function.

It relies on muscle strength, joint range of movement & accurate feeling throughout the body. It is assisted by all of our senses including sight.

In order to improve balance, it is necessary to challenge it. This may mean feeling unbalanced at times. This is sometimes necessary to make progress, although it is always important to ensure your own safety as much as possible when completing these exercises.

All of the exercises must be completed in a safe environment. Make sure there is somewhere to sit down should you need to and something safe and solid to hold onto either throughout the exercise or in the instance that you need support. If you are particularly concerned try to have someone present to supervise the exercises until you are more confident.

As you improve, it may be possible to make the exercises more difficult by practising them with less support. For example, progress from having both hands on a surface for support, to just using one hand and then none.

The following exercises aim to strengthen key muscle groups; improve range of movement, particularly through the trunk, hips and ankles and challenge your normal balance mechanisms. Evidence suggests that strength or resistance training is beneficial in improving balance so this should also be considered where you feel able. Many of these exercises can be completed with a weight or resistance band to increase the challenge and improve your balance further. Ask your therapist if you are unsure how to do this. Your therapist will also be able to advice how many of each exercise to complete.

If any of the exercises cause you particular concern please discontinue them until you have consulted your therapist for advice.

Posture

Maintaining a good posture throughout all exercises, both in sitting and standing, is very important.

The key things to remember are:

Sitting –

• Feet flat on the floor, hip distance apart, toes pointing forwards with your heels touching the floor throughout
• Straighten up from the bottom of your back, with strength around the waistband area
• Pull your shoulder blades back and down, opening up across your chest

Standing –

• Legs and feet hip distance apart, toes pointing forwards
• Knees and hips straight
• Tall feeling from hips and through the back, keeping upright
• Shoulder blades back and down with head up and looking forwards

Try to maintain these positions with each exercise.

Use a mirror or someone to watch you if you are unsure.

If you feel that it is difficult to maintain and you are getting tired, rest and return to the exercises later.

Exercises for ankle range of movement, strength and stability:

• Raise your heels by pushing through your toes. Maintain stable contact with the floor through your toes.
• Lift your toes, keeping your heels in contact with the floor.
• This can be completed in sitting or standing.

• Lift the arch of your foot, turning it inwards and rolling onto the outer border of the foot.
• Lift the outer border, turning it outwards and rolling onto the inner border of the foot.
• Use a weight or resistance to increase the challenge.

Seated Strengthening Exercises:

Knee strengthening:

Sit comfortably in a chair with your back straight.

Moving slowly and with control, straighten the knee, pointing your toes to the ceiling.

Hold the leg straight for a few seconds then lower to the floor.

Seated March:

Sit tall with a strong trunk. Try not to use the back of the chair or sit on the edge of your bed so you do not have support. March your legs alternately with control. Try to keep your trunk strong throughout, engaging your core muscles.

Sit to stand:

Sit in a comfortable and supportive chair.

Move in a controlled manner from sitting to standing. Ensure that you stand tall, with your hips and knees straight.

You may need to use your arms to push up initially but the aim is to be able to complete the movement without requiring your arms to propel you.

Standing Balance:

With each of these activities you may need to take hold of a work surface or aid for support, bear as little weight as you can through your hands or finger tips or you are able do it free of support if safe. The aim is to use as little support as possible or none at all when you feel able.

The below standing positions will help to build your balance and control of a stable stance. Each one presents a different and increasing challenge. Progress through them as you feel comfortable and with the advice of your therapist.

Initially try to maintain the position with as little support as possible. You can increase the challenge in the following ways:

• Turn your head from one side to the other
• Move your weight side to side from one leg to the other
• Move your weight forwards towards your toes then back onto your heels
• Lift your arms alternately as high as you feel able
• Turn your body to one side and the other to look over each shoulder as far as you feel able

Normal stance stand

Feet together

Semi tandem

Tandem stand

Single leg standing

Foot placement:

Take support as needed.

Stand on one leg, keeping your knee soft, move the other leg to different points in front, behind and to your side, return to standing and   repeat in different patterns.

You could increase the difficulty by rolling a ball under your foot to different targets.

Standing Strengthening Exercises:                                                                             

Heel Raises:

With support as needed, stand tall then rise onto your toes with control then lower back to a flat foot.

Squat:

Bend your knees to perform a small squat.

Try to bend and straighten both legs, slowly and controlled, together, keeping your knees pointing forwards

Use support in front if needed.

Hip Extension:

Slowly straighten your leg behind you, keeping the knee straight and pointing forwards.

Hip abduction:

Slowly take your leg out to the side, keeping your knee straight and toes pointing forwards. Use support as required.

March on the spot:

With control, lift your knees as high as possible and march with even rhythm.

Take support if needed but aim to build up to being able to do this without support.

Alternate Step Up:

Standing at a step, using support if needed, step on and off the step. Try to complete this smoothly with alternate feet. Maintain an even rhythm and accurate foot placement as able.

If possible try to build up to being able to do this without support.

Knee Flexion:

Keeping your knees facing forwards stand on one leg and bend the other knee, taking your heel slowly towards your bottom

Keep your chest up and shoulders back

You therapist will be able to advise you how many repetitions to complete of each exercise.

Evidence shows that building strength through use of resistance bands or weights is effective in improving and maintaining balance. As you feel able, and with the advice of your therapist, you can complete these strengthening exercises using a resistance band or ankle weight.

Functional mobility with dynamic balance:

Taking support or using your walking aid as needed practice stepping –

March on the spot:

Lift your knees as you try to march maintaining a steady rhythm and your position without moving too much.

Progress by turning to each side or round in a full circle with control.

Forwards walking:

Backwards walking: 

Sideways walking:

What to do if you have had a fall (www.nhs.uk/conditions/falls)

If you feel able to get up

1. Take your time – do not get up too quickly.
2. Roll onto your side, then use your arms to push yourself onto your hands and knees.
3. Look for something stable to hold, such as a heavy piece of furniture or a bath or sink. Crawl to it if it’s out of reach.
4. Put one foot flat on the floor. Stand up slowly, holding onto something stable to help you.
5. Sit down and rest while you recover.

If you do not feel able to get up

1. If you have a phone or personal alarm that you can reach, use it to get help.
2. If you cannot reach an alarm or phone, try to get someone’s attention by shouting for help or banging on a wall or the floor.
3. Try to keep warm while you wait for help. Cover yourself with anything you can reach, such as a towel, coat, rug or blanket.
4. Keep moving your body. Roll from side to side or gently move your arms and legs.
5. Try to change position about every 30 minutes, to help prevent pressure sores.

Additional advice regarding exercise for falls prevention and maintenance of balance:

www.nhs.uk/live-well/exercise/

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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