Balance Exercise Booklet Two

Balance Exercise Booklet Two

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 exercise 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 physiotherapist 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.

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 physiotherapist.

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 (over shoulder rotation)

Normal stance

Feet together    

Semi tandem stand

Tandem stand

Single leg standing

Over shoulder rotation

Reaching Down

Reach down towards the floor, use an item to place and pick up if you wish.

Hold support as needed.

Stand and Reach

Move your weight onto the front foot while reaching as high as possible and looking at your hand.

You can complete this moving in any direction.

The bigger the step and reach the greater the challenge.

Arm Swings

In standing, maintain a strong stance and upright posture.

Swing your arms alternately, keeping a fluid movement within a comfortable range.

Wide arm raise

In standing, maintain a strong and upright posture – place your hands palms together in front of you.

Raise your arms high and wide above your head as though you are creating a Y shape.

Hold then lower back down bringing your hands back together.

Clock Face Balance

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 or sliding a towel under your foot to different targets.

Throw and Catch

Throw a ball against the wall and catch it or pass a ball back and forth with someone.

Challenge yourself by throwing high/low/with a bounce or even standing on one leg if able.

Extended Step Forwards/backwards/sideways

Take as large a step as you can comfortably manage in each direction and return to standing.

Forwards

Backwards

To either side

Place an object or line on the ground to note where you are stepping to as a mark/measure to target and beat.

Lunge

Lunge forward, taking as large a step as possible that requires you to bend your front knee slightly then return to standing.      

Complete the exercise as above, stepping in front, backwards and to either side.

March on spot

March your legs lifting your knees as high as possible. Try to keep an even rhythm and stay in the same place.

The aim is to complete this independent of support but build up to this if needed and use light support of a work surface if needed.

You could turn to either side as you march to increase the difficulty.

Walking

Complete with support or using your walking aid as advised by your therapist.

Practice walking:

Forwards

Backwards

Sideways

You could also complete this walking on your toes.

Tandem Walk

Walk slowly along the edge of a carpet or a line on the floor, placing one heel to touch the toes of the other foot. 

Figure of 8

Walk, with control, in a figure of 8 pattern. Use obstacles to walk around if needed.

You could also complete this walking on your toes.

Step Up

Place your whole foot on the step and step up with both legs. You can do this on the bottom step of your stairs if you have them. Use support if needed but try to reduce this support as you progress.

Step Up and Drive Up

Step up, pressing down into the step with one leg.

Maintain standing on the step with knee and hip straight.

The opposite leg drives up with knee towards the ceiling then lower back down to the floor.

Jumping

Jump up and down on the spot

Jump from side to side

Jump forwards/backwards to a target or as though you are jumping over something

Hopping

Hop with control on each leg.

As with jumping:

Try to stay on the same spot.

Hop forwards/backwards/sideways

Hop from one leg to the other.

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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