Balance Training(1)

 

Although this chapter is titled "Balance Training/' it is not about improving equilibrium. The word balance is used to describe training designed to create movement symmetry between the right and left sides of the body and to promote a balance of mobility and stability within the body. Mobility and stability should be the starting point for a training program. Although mobility and stability may sound as if they are opposites, they must exist together to form an effective foundation for movement and activity. If testing reveals poor mobility and stability you must focus on an effective fundamental mobility and stability program before any other kind of training. This type of training, when done correctly will greatly improve movement awareness/ especially between the right and left sides of the body.

Fete Draovitch, a well-respected physical therapist/ trainer/ and strength and conditioning expert/ has worked with athletes in many sports. He has used the functional movement screen in many situations over the past few years. One of his success stories involves a professional basketball player who underwent ankle surgery for an OCD lesion (a defect in the cartilage). Following acute rehab/ he began an aggressive offseason conditioning program. The functional movement screen revealed failure on the deep squat/ hurdle step/ in-line lunge/ and active straight leg raise. Eight weeks after receiving additional clinical care and doing an exercise routine that specifically targeted balance training (mobility and stability training) to address the imbalances in the hip and leg/ the athlete was running and jumping without pain. He improved his squatting technique within two and a half weeks and was able to add weight on squats and lunges. The athlete even reported that he was jumping higher to dunk off that leg than he had in the past. If his quality of motion had been assessed earlier in his career/ he might not have required surgery according to Pete. Balancing mobility and stability is a fundamental element of both rehabilitation and performance training.

It is best to work on one movement problem at a time. It is also best to work on right-left differences before working on limitations. When there is more than one imbalance/ the imbalance with the greatest limitation or greatest difference between left and right sides should be addressed first. Frequent retesting will provide feedback on how much work is needed. Retesting can be done every one or two weeks. Frequent retesting can confirm improvement and redirect attention to another problem area. Testing can also be performed following rehabilitation of an injury or to determine whether adequate mobility and stability is being maintained through conditioning.

 

Postural Habits and Activity Habits

Postural habits and activity habits influence the way the body moves. Postural habits can be defined as the way the body is held or positioned during both rest and activity. The word posture usually is used to describe the way a person holds the spine, but the spine is not the only factor. The arms and legs also are held in certain positions. Some people stand with their knees hyperextended, whereas others do not extend their knees even to a straight position. Some people naturally hold their shoulders back, whereas others have shoulders that round forward and a head that slumps in front of the body.

Postural habits are developed in sports and activities—the way a golfer addresses the golf ball, a batter stands in the batter's box, a basketball player stands at the free throw line, or a linebacker assumes the ready position in football. The way the body is held has a lot to do with the way it moves; the starting position influences the movement that is to follow. When the body begins in a suboptimal position, the brain tries to make up for the problem by unnecessarily altering body mechanics in an attempt to catch up or to correct the movement. Simple stretching and warm-up exercises that focus on movement as well as static positions will demonstrate how postural habits can influence the way the body moves,

Activity habits are movement habits. There are many different ways the body can move. Some are efficient and some are not. Some are correct and some are not. Some­times what feels natural is incorrect and what feels extremely awkward is correct. Do not assume that what feels natural is the best way to move. Even the world's greatest athletes can develop bad habits, get sloppy, and lose their fundamentals.

Muscles do not get tight or weak for no reason. Muscles grow tight because of the way they are used. If muscles are tight it's because the athlete has chosen to use them in a shortened range, and the activities they perform do not lengthen them to their full potential. As a result, over time the athlete develops movement patterns that rely on short muscles. The brain remembers the short muscle position; just because the muscle is stretched one day does not mean that it will stay elongated. It will return to the length that it is most familiar with and that is used most often.

The same theory applies to weak muscles. Muscles that normally are not engaged effectively, that the athlete avoids using, or that may at one time have been injured can fall into this category. Following an injury, movement patterns are altered to avoid using a muscle that may have a strain, contusion, or tendinitis. By the time the muscle recuperates, a movement pattern has been developed that neglects this particular muscle or uses it less. The body has become familiar with this movement pattern and has no reason to change back.

Every muscle is opposed by another muscle in the body, usually on alternate sides of the joint. When one muscle is extremely tight, its counterpart often becomes weak and lengthened to accommodate the tight muscle. Most of this happens not for mechanical reasons but for neurological reasons. Opposite muscles often inhibit each other in an attempt to make a movement pattern more efficient. Maintaining good movement patterns keeps the muscles strong and flexible. Remember, muscles are tight because of how they are used. Muscles are weak for the same reason.

 

Getting Started

The exercises in this chapter are specifically designed to work on a particular movement problem. If you experienced pain with one of the movements during the self-screen in chapter 5, these exercises are not the cure. Have the problem checked and treated by a medical professional. However, if you experienced tightness, stiffness/ loss of balance, or difficulty during the testing, this is the place to begin.

The exercise program starts with a few helpful stretches to raise awareness of left-right differences as well as overall limitations. The foundation drills are exercises following the stretches designed to train the brain to use the new mobility and gain stability. The program will improve movement memory and provide quick access to the benefits stemming from the increase in functional movement.

Eventually the movement exercises can take the place of the stretches because they are actually a more dynamic form of stretching. Those who have significant flexibility problems may want to continue the passive stretching program and the movement learning exercise as well. Doing both provides extra reinforcement.

One of the movements in the screen may have seemed impossible; if so, that shows your weakest link. You may never have a perfect score. Work on the movement pat­tern continually because the body can use even subtle improvements to become more efficient and reduce the chance of injury.

 

Deep Squat

The deep squat is the first movement in the self-assessment. Ability to deep squat successfully is a fairly good indicator of overall movement quality. Failure on the deep squat generally means one of two things: generalized stiffness throughout the body, or asymmetry. In this context, the word asymmetry indicates an imbalance between the right and left sides of the body regarding mobility, stability, and coordination. Even though the squat does not look specifically at the right and left sides of the body (unlike the other tests), it requires maximum range of motion in both legs and both arms in the exact opposite direction of their resting or standing position.

Improving the deep squat and going deeper through the full range of motion will improve movement when shifting weight from left to right. It also will improve the ability to quickly get into the universal athletic ready position, which is somewhere between deep squatting and standing erect. If the squat is severely limited, then the ready position is not between squatting and standing—it is between standing and whatever the squatting limitation is, which may not be optimum or efficient for long periods of time or for all of the activities a sport requires.

If a restriction exists on only one side of the body (for example, the right hip), in most cases the body will learn to squat only as deeply as the restriction will allow, thus making it look like the entire squatting movement is limited instead of simply the one point of restriction. Other parts of the body will move inappropriately to try to make up for the lack of movement in the area of restriction, contorting the body in such a way that the squat will feel extremely difficult. If this is the case but the other self-assessment movements did not show a significant right-left asymmetry, the exercise progression that follows is recommended.

If the other tests revealed a significant asymmetry or earned a low score, it is recommended that the asymmetry found in the other test or tests be addressed first. Then, if a squat continues to present difficulty, progress to the recommended exercises on pages 42 to 46 to improve the deep squat movement pattern.

The following program includes some simple exercises to improve deep squatting. Most of the improvement for this particular exercise progression will be the result of enhanced body awareness and coordination. Difficulty in deep squatting is rarely a simple flexibility problem. Squatting is a complex movement that requires stability of the trunk and mobility of the extremities through constantly changing tension and position. The tension between the muscles of the trunk and limbs must coordinate perfectly—as one relaxes/ the other must contract to maintain balance and an erect spine through the entire motion. If coordination is skewed, the deep squat will feel extremely awkward and limited.

 

TOE TOUCH PROGRESSION

The toe touch progression is a simple exercise to improve body awareness [or sensory awareness) for deep squatting. The toe touch progression is a fundamental component of the exercises needed for the deep squat and shouldn't be overlooked. It simply teaches relaxation of the tension in the lower back and how to shift weight from the heels to the toes in a smooth and consistent fashion.

Stand erect with feet side by side, heels and toes touching. The balls of both feet   should be elevated onto a 1- to 2-inch platform such as a board or free-weight plate. Insert a towel roll or foam roll between the knees by flexing the knees slightly and separating them without changing foot position (figure 6.1a). The towel or foam roll should be thick enough that the knees cannot be locked backward or hyper-extended. This position will feel bowlegged and extremely awkward, but do not change it. If foot position is altered in any way, the towel roll is too large; unroll a layer or two before continuing. The back should be relaxed and without tension. You should feel tension from the outside of the knee up through the outside of the hips.

 

 

Figure 6.1 Toe touch progression, phase 1: (a) stand with balls of feet elevated on a platform and a foam roll between knees; (b) touch the toes.

 

Reach for the ceiling, stretching the arms as high as possible with palms facing forward. Hollow out the abdomen by pulling in as deeply as possible with the abdominal muscles. This should not alter breathing. If it does, continue practicing the movement until it can be done without significantly changing breathing.

Bend forward so that the fingertips touch the toes (figure 6.1b). If the fingertips do not make it completely to the toes, remember to keep the abdominal area pulled inward. Also squeeze the towel roll slightly to help relax certain muscles in the outer thigh and back so that the toes can be reached. If you still cannot reach the toes, bend the knees slightly to reach them for the first repetition,

Return to the starting position, keeping the heels on the ground and the hands raised as high as possible overhead with palms facing forward. Keep the abdominal region pulled inward and repeat the movement. If a slight knee bend was required for the first repetition, try to bend the knees a little less this time. Reduce the knee bend with each repetition and try to go a little farther each time. Do 10 to 12 repetitions. You will feel tension in the calf behind the knee, in the hamstrings, and possibly in the lower back.

Phase two of the toe touch progression uses the same movement but from a different position. For phase two, elevate the heels on a 1- to 2-inch platform (figure 6.2a). The toes should be on the ground. Insert the towel roll between the knees without changing the foot position. Repeat the toe touch movement, reaching up to the ceiling, pulling in the abdominals, and reaching to the toes (figure 6.2b). There may be slightly greater tension in the lower back and hamstrings and slightly less tension in the calves than in phase one. Bend the knees as little as possible to allow a toe touch, and bend the knees less and less with each repetition until they can be held in a nearly straight position. At no time during the exercise should the knee hyperextend or the foot position change. You should be closer to touching your toes or doing so more comfortably following this drill. You should be comfortable touching your toes before starting the deep squat progression.

Figure 6.2 Toe touch progression, phase II: (a) stand with heels elevated on a platform; (b) touch the toes.

 

DEEP SQUAT PROGRESSION

With the heels on a 1- to 2-inch platform, spread the feet until they are shoulder-width apart or wider. Bend forward until the entire palm can be laid flat on the floor or on a 2-, 4-, or 6-inch platform [figure 6.3a). Use only what you need and gradually reduce the platform, or get rid of the platform altogether. Free-weight plates, wooden blocks, or small bricks can be used. The entire palm must lay completely flat, so it is better to use a slightly taller brick or block than to overreach and be off balance. Heels should remain flat and the knees should be extended but not hyperextended. The head and neck should be relaxed and looking downward.

Without moving the hands off the platform, slowly bend the hips, knees, and ankles and lower the body into the squat position with the knees going to the outside of the elbows (figure 6.3b). Do not change foot position during the descent. If it is hard to control foot position during the descent, hold the knees outward or widen the feet slightly, but keep the feet pointed straight ahead at all times.

With the hands flat on the platform, keep the heels in full contact with the 1- to 2-inch platform and sit deeply into the squat. Concentrate on keeping the knees outside of the elbows and try to relax as much as possible. If this posi­tion causes a stretch, maintain the stretch for approximately 20 seconds. Try pulling in the abdominals as in the toe touch progression to make this movement easier. Use long, slow, deep breaths and exhale during the stretch.

Figure 6.3 Deep squat progression, phase I: (a) bend forward and place hands on platform; (b) descend into a deep squat; (c) reach one arm toward the ceiling.

 

If you cannot achieve a comfortable sitting position, use a slightly greater heel lift and a slightly elevated hand platform.

Once the squat position is comfortable, elevate one arm as high as possible over the head, reaching for the ceiling without changing the hip, knee, or ankle position (figure 6.3c). Do not shift weight. Keep both feet flat and both legs in the same position. Follow the movement of the hand with the eyes. Turn the head to the side of the arm that is being raised. Do not attempt to take the arm straight backward; rather, reach overhead, keeping the spine as long and tall as possible throughout the entire movement.

This movement should take approximately 20 seconds: 8 to 9 seconds on the way up, 2 to 4 seconds to hold the stretch while reaching as tall as possible, and 8 to 9 seconds to return to the platform. Repeat on the other side. You should note which side is tighter or presents greater difficulty. Try to achieve equal movement by working the tighter side three times more than the other side.

Once the movement can be done with the lower body completely relaxed, the upper body moving freely, and the right and left sides feeling about equal, proceed to the next phase of the exercise.

Start from a deep squat position with the hands on the platform. Raise both hands into a Y position and take them as far back and up as possible, maintaining complete balance and keeping the lower body fully relaxed [figure 6.4a]. There should be no change in foot, hip, or knee position. If the hands are directly above the head, reach and then stand up out of the squat (figure 6.4b). It will feel difficult at first because this move uses the most powerful muscles of the hips and thighs in a new position. Numerous repetitions of this exercise will improve motor memory and increase coordination.

Return to the start position by bending forward and touching the 2-, 4-, or 6-inch raised platform with palms flat. Drop again into the squat, then resume the Y or overhead reach with both arms.

 

a                             b

Figure 6.4 Deep squat progression, phase II: (a) raise both arms; (b) stand up.

 

Now stand slowly. Practice for 10 to 12 repetitions. Reduce the elevation of both the heel lift and hand lift until both heels and palms are on the floor. Once you can perform this comfortably in a relaxed and easy manner, attempt deep squatting with heels flat on the floor while holding a dowel as described in the self-screen [see page 33J. Retest after at least 10 to 12 repetitions of practice.

This exercise progression may seem a little awkward, but it is one of the quickest ways to teach the body the proper sequence and muscle coordination for deep squatting. Conventional weight training rarely takes the hips below parallel, thereby reinforcing limited movement.

Ultimately it is a personal choice whether to use deep squatting movement patterns with weight training. Regardless of your preference/ work to achieve the hip mobility needed to perform deep squatting to maintain optimum joint and muscle function as well as body awareness, balance, and control. Touching the toes first relaxes the lower back. Once the lower back is relaxed, drop into the squatting position without ever taking the hands off the floor. This maintains the relaxation in the back but also puts the abdominal muscles at a mechanical advantage. Once in the deep squat, allow the back to erect itself. Tighten the back muscles only after the abdominal muscles have been properly engaged by the flexed spine-flexed hip position.

The back squat is a popular weightlifting exercise in which a barbell is held on the upper back and shoulders. It allows one to use a large amount of weight and is great for hip and leg development. However, the back squat should not be the only form of squat training used for hip, leg, and trunk development. Before the back squat was invented as an exercise, few human beings ever squatted deeply with anything on their backs. They usually bent into the squatting position, grabbed an object, held it close to the chest, and stood up. Therefore, they went into the squatting position unloaded with a relaxed spine but came out of the squatting position with an erect trunk and protected spine. When the spine is loaded at the top of the movement the erector muscles of the spine will sometimes contract incorrectly and pull the spine into too much extension. This reduces the ability of the other core muscles to create a balance of stabilizing forces around the spine. It is impractical to start the squat in the low position; however, much of this problem can be remedied by doing a front squat instead of a back squat.

A child does not learn to squat from the top down—in other words, he does not suddenly make a conscious decision one day to squat. Actually, he is squatting one day and makes the conscious decision to stand. Squatting precedes standing in the developmental sequence. This is the way a child's brain learns to use the body as the child develops movement patterns. Therefore, a child is probably crawling, rocks back into a squatting position with the back completely relaxed and the hips completely flexed, and stands when he has enough hip strength. This approach makes a lot of sense and can be applied to relearning the deep squat movement if it is lost. Someone who doesn't perform well on the squat assessment test does not know what deep squatting feels like. It's like going on a journey without knowing the destination. By relaxing the lower back and doing the toe touch and deep squat progressions, the hips, knees, and ankles get into the squatting position and then set the spine when the hands are lifted off the raised platform. This allows the squatter to feel where she is going. She already knows what the top of the squat feels like—that's standing. Now she knows what the bottom of the squat feels like. The exercise will become an opportunity for motor learning and working out the coordination between the start and finish position.

Use three or four of the stretches and drills as a warm-up and cool-down, or make them part of a workout for one week and retest. Check all movements, not just the one being focused on, and see what has happened. Sometimes the difference will be obvious; sometimes it will not. Be persistent and consistent, and you will start to see change. Follow directions and work on the asymmetries (left-right differences) first and limitations (general stiffness noted on both the left and right sides) second.

Once you improve your ability to deep squat and pass the deep squat screen, you can proceed to the supplementary work to reinforce deep squatting. (See part III on strength and endurance.)

 

Hurdle Step

When performing the hurdle step test, it is important to note whether an asymmetry exists between the right and left side. If an asymmetry does exist, you will need to do approximately three times more work on the weaker side. It is important to do at least some work on the more proficient side simply to feel the more refined activity, improved coordination, better stability, and better mobility present on that side compared to the other.

For example, if the right leg down and left leg over the hurdle presents difficulty but the left leg down and right leg over the hurdle is normal, start training in the left leg down and right leg over position to improve awareness of what is normal. Then do the majority of work in the other position (right leg down and left leg over) to reduce the asymmetrical difference between the left and right sides of the body. Do not try to simply isolate this test to a single muscle weakness, muscle tightness, or joint stiffness. Work the pattern.

The hurdle step involves many muscles and joints working together in unison to create a balanced and stable body while one leg moves through a nearly full range of motion. Difficulty could be due to inappropriate balance on the down leg or inappro­priate mobility in the up leg. Unless there is pain or a history of injury, the location of the problem is not as important as the understanding of the difference between the left and right side while performing the hurdle step. With practice, the problem can be resolved. Knowing which muscle is tight or weak or which joint is stiff will simply distract from the problem at hand—a movement problem, not a structural problem.

 

Advanced Stretches

Although these may look like stretches, this group of movements require more than simple stretching. You must hold a stable position with your spine. Unlike most stretches, focus should be on not only the area being stretched but also the area that is holding you stable. You will be required to hold your spine and one leg stable while you relax and stretch the other .leg, You will soon learn to focus on the parts of your body that are stable.

 

TABLETOP STRIDE

Stand next to a table or a bench that comes to mid-thigh level. Place one foot on top of the table or bench, leaving the other foot on the floor with the heel flat. Slightly bend the knee of the leg on the floor and maximally bend the knee of the elevated leg. Feet should be in line and pointing forward at different elevations. Keep the spine erect, allowing the body to sink down by bending the knee of the lower leg, elongating the stride between the left and right leg. Remain tall and elongated through the spine and pull in the abdominal muscles to reduce stress on the back. Pulling in the abdominal muscles should not affect breathing. If it does, practice pulling in the abdomen and breathing normally before continuing the stretch. Hold the stretch for 30 seconds and then return to the start position with both feet on the floor. Repeat the stretch three times. Staying balanced and relaxed are the keys to performing the stretch well.

For a more advanced stretch, add a torso twist. With the spine erect and tall, put the arms out to the side at 90 degrees from the shoulders with palms up and rotate the torso toward the elevated leg. Shift weight when rotating the torso, making subtle changes to maintain balance. Let these changes occur naturally; do not force them. Hold the stretch for 20 seconds, return to the start position, and repeat the stretch two times. This stretch places equal emphasis on both legs. It also emphasizes relaxation and balance, not simply forced muscle stretching. Learn to relax the muscles and let them lengthen. Remember, don't contract the muscle you are trying to stretch.

 

TABLETOP HIP STRETCH

This drill isolates the elevated leg. Use the same table or bench as in the tabletop stride. Place one leg on the table. Rotate the hip outward and lay the leg flat on the table. To protect the elevated knee, place a towel between the lower leg and knee and the table, Keep the ankle in a neutral position or flex the foot as much as possible. If the knee does not lie flat comfortably, use a larger towel until the towel roll supports the leg so that equal weight is on the knee and ankle. Adjust the position of the hip so that all the tension is in the buttocks and lower back. The thigh should be moved inward so that it is in line with the foot on the floor. Twist the torso toward the elevated hip using the arm on the same side as the elevated hip to hold the stretch. Hold for 20 seconds, then return to the start position. Repeat two times.

 

STANDING QUAD STRETCH WITH HIP EXTENSION

Stand erect on one leg and grab the opposite ankle with the knee maximally flexed and pointed forward. Slowly extend the hip back and hold for 30 seconds. As you extend the hip the knee should point downward. Maintain balance for the entire stretch. Learn to relax the thigh during the stretch. Hold for 30 seconds and repeat with the opposite leg.

 

STANDING QUAD STRETCH WITH HIP FLEXION

Stand erect on one leg and pull the other knee to the chest. Hug the knee with both hands and squeeze the thigh toward the chest. Hold for 30 seconds, balancing the entire time. Do not let the spine bend or round when the hip is flexed. Perform two to three times per leg. Work toward symmetry. Perform more repetitions on one side if necessary.