Balance

Some people with a concussion feel like they are lost in space. This feeling is caused by the injury to the brain. The injury can cause your brain to have difficulty processing information from your eyes and ears. It can make it hard for you to judge where objects are when walking through a room. It can also affect your balance and cause you to be overwhelmed and anxious. Remember to check with a health professional before trying any of these exercises.

Balance test:

  • Can you balance on one leg?
  • Can you balance with your feet in line (one in front of the other)?
  • Can you close your eyes when trying 1 or 2?
  • When you go down a flight of stairs, can you do it without being anxious?
  • Can you walk and turn your head?

If you answered no to any of the above, you need to practice improving your balance.

What can help?

Core and leg strengthening exercises can help improve your balance. Challenge your balance by:

  • standing on one foot for 15-30 seconds
  • walking in a straight line heel-to-toe
  • turning your head and closing your eyes while trying to balance on one foot

Try wrapping a TheraBand or resistance band around your arms and across your shoulders. Hold the ends of the band in each hand and practice balance tasks such as lunges or squats.

Exercises to help your balance

One-legged balance routine

Purpose: The one-legged balance routine is helpful because it gradually becomes more difficult. It may help determine which part of your leg is most affecting your balance. While you complete this routine, listen to your body. These exercises require your body and mind to focus. Practicing this routine will help you with your daily living activities.

Keep in mind, in all positions – except when completing the hip extension – keep your upper torso (from your waist to your neck) erect (upright). Engage your core muscles by pulling in your belly button. Imagine you have a string tied to the back of your belly button and it is being pulled inwards towards your back. Your supporting leg (the worker) should be bent slightly at the knee. Focus your eyes in one place straight ahead of you. Complete the entire routine without letting your raised foot touch the ground. Start with six repetitions of all positions (except step seven) and progress to 10 repititions. Give the supporting leg a good “shake out” after its work.

How to make it harder: Move your head or eyes while completing the tasks.  Try adding a cognitive task such as counting backwards from 100 by three’s.

Exercise:

1. Hip flexion – raise your foot to knee height and balance on your other leg. Bring your knee into your to chest while keeping your thigh horizontal. Do this six times.

2. Hip extension - bend your upper torso forward and move your raised leg backwards (keep your leg bent) (six times).

3. Hip adduction - standing tall, lift the raised leg in front of you. Lead with your heel (like you are about to kick a soccer ball) and use inner thigh muscles (six times).

4. Hip abduction – move the raised leg away from body, leading with toes (six times).

5. Hip rotation – raise your knee to hip height, rotate your hip outward 90 degrees, lower your pointed foot almost to the ground, back up, then rotate your hip back in (six times).

6. Curtsey - cross the raised leg behind your body towards the opposite shoulder. Bend the supporting leg. Please your arms on your hips. Bring the same leg up again in front of you raising the knee and bring your arms over your head.

7. One-legged prayer squat – cross the ankle of the raised leg over the opposite knee. Squat to horizontal or as close to horizontal as possible, hold for 10 seconds. Repeat six times.

Change to the other side and repeat steps 1-7.

Static balance training

Purpose: The static balance training exercise will help improve your balance and stability

Starting position: Start in a standing position. The more narrow your support base (closer your feet are together), the harder the exercise will be. Here is a list from easiest to hardest starting positions:

  • feet close together
  • feet in stride stance – one ahead of the other
  • feet in tandem stance – like you are standing on a tightrope
  • single leg stance

Pick a position that is challenging and practice until you can hold it for 20-30 seconds, then add movement and or pick a harder challenge. Combine different options but remember – safety first – don’t fall. Take a break if your symptoms increase.

Pick a surface:  Increase the challenge by balancing on an unstable surface such as grass, a pillow, a couch cushion, a foam pad (Airex pad is best), wobble board, rocker board or BOSU ball (A BOSU Balance Trainer or BOSU ball is a specially modified stability ball cut in half.)

Add movement: Balance requires more than just standing still, you need to be able to move other body parts and still maintain balance. Here is a list from easiest to hardest movements:

  • alternate between lifting up one arm, then the other, then both arms at the same time
  • move your eyes up and down, then left to right
  • turn your head up and down, then left to right, then diagonally

Single leg stance exercises:

  • slowly move your free leg forward and back like you are running
  • turn your knee out without rotating your body
  • move your opposite arm and opposite leg like you are running
  • same as step six but add a head turn

Dynamic balance training

Purpose: Once you have improved at balance training while standing still you can try dynamic balance training.  This means doing activities that require you to balance as you move through the environment. Choose an activity from the list below that is challenging but that you can perform safely. Take a break, if any of your symptoms start to increase.

Exercise:

  1. walk forward and look from left to right, or up and down – stop in the middle to refocus and minimize dizziness
  2. walk forward with your eyes closed
  3. walk backward – try this with your eyes closed or turning your head left to right, or up and down
  4. walk heel to toe forward then backward – try with your eyes closed or turning your head left to right
  5. walk sideways crossing one leg in front and then behind you (grapevine), do this both directions
  6. kick or throw a ball against the wall – try to make sure you have to move left and right to return the ball
  7. stairs – practice going up and down without using a railing and without looking at your feet (if you feel safe doing this). Use a normal pattern with only one foot on each step

Compression

The Parkwood Institute Acquired Brain Injury Outpatient Program team has designed a neoprene vest that combines weights and compression to help patients with a concussion know where their body is in space. The vest fits snugly to the body and feels like a big hug. This helps the brain focus on tasks such as talking while walking.

Using a weighted compression vest, eases anxiety, which may help with tolerating busy environments and improve your balance.

When should you wear a weighted compression vest? A weighted compression vest can be worn to help with balance or when you need to navigate a busy environment. It can also be worn when you need to decrease your anxiety during activities such as driving. The vest should not be worn all of the time. It should fit snugly but not restrict breathing or be uncomfortable.

People referred to Parkwood Institute Acquired Brain Injury Outpatient Program can purchase vests through our program. Individuals who have not been referred to our program have options available to them in the community. Some people have also found benefit from wearing athletic compression garments such as Underarmour or EC3D compression wear or body shaping garments, such as Spanx.

How to deal with dizziness after a brain injury

After a brain injury, your balance can be affected when you feel dizzy. Try these tips to help:

  • don’t avoid movement – this will make you more dizzy
  • practice movements that make you a little bit dizzy
  • try these movements:
    • while walking practice turning your head side-to-side
    • bend forward and return to standing/sitting upright
  • let your dizziness settle between movements
  • see a physiotherapist with expertise in treating dizziness
  • see your family doctor to make sure there isn’t another medical reason for your dizziness