Long before I was a trainer, I saw the devastating effects of losing balance and falling. My grandmother not once but twice fell and broke both of her hips on separate occasions. Her mobility was severely affected for the rest of her life.
As a certified trainer and a Silver sneakers instructor working with older adults, I have seen what a loss of balance does to a person. It is not just the physical effects but the mental too. The loss of confidence in one’s body and its ability to move is devastating. And for some, it leads to an early grave.
Usually, not much thought is given to your sense of balance when you are young (even though it’s still important) but as you get older, it becomes a big deal. Let these facts from the CDC show why a healthy vestibular system is essential:
**Twenty percent of all falls among people over 65 cause a serious injury, such as broken bones or a head injury.
**Three million older people are treated in emergency departments for fall injuries every year.
**The most common cause of traumatic brain injuries is falling.
Not only is an inefficient vestibular system robbing older adults of their freedom and mobility, but it is costing us money too. Because when they fall, some of them cannot get up leading them further down the road of disability and added costs like increased insurance premiums and higher hospital costs.
This loss of mobility makes it two-three times more likely that they will meet their maker. (1)
Odds are you or your clients haven’t given much thought to the vestibular system when you are crushing your training but without it, lifting weights and staying upright is a problem.
WHAT IS THE VESTIBULAR SYSTEM?
The Vestibular system is in the inner ear and it’s about the size of a pencil eraser. The role of this system is to send information about the position of the head to the brain’s voluntary movement control center, the cerebellum which is located at the back of the brain.
This system ties into the visual system to stop objects blurring when the head moves, but perhaps more importantly for our purposes, it also helps you support awareness of your body’s positioning in space, otherwise called proprioception.
In addition to the visual system there are two other systems that provide important inputs to the vestibular system. They are:
THE MUSCULOSKELETAL SYSTEM
Skin, muscles, ligaments, and tendons send sensory information to the brain via the nervous system. that makes you aware of your body’s position in space and when changes happen in your environment.
For example, it is the ankle’s job to sense and respond to the ever-changing environment from stairs, cracked and even sidewalks, or walking up and down a mountain. The ankle, being the only joint near the ground, is the first joint to sense what is going on and it sends those signals via the nervous systems to the brain for processing and a muscular response. (2, 3, 4)
THE NERVOUS SYSTEM
Information from the eyes, vestibular and musculoskeletal systems travel via the neuromuscular system to the brain which then sends information to respond to changes in the environment via the central and peripheral nervous system.
For example, the vestibular labyrinths provide the detection of head orientation relative to the gravity with great accuracy and about 4–5× better than our vision. This happens because of the communication between the vestibulocochlear nerve to the cerebellum which allows for postural adjustments to help prevent falls from changes in the environment.
HOW STRENGTH TRAINING IMPROVES THE VESTIBULAR SYSTEM
Strength training is effective for improving postural control because where your head goes, the rest of your body follows.
The vestibular system is the first sensory system in the human body to develop and all other sensory systems rely on it. This is why babies work so hard to hold their heads up because without it, walking would be impossible.
The ability to hold your head up, stand and move with good posture directly affects the way your vestibular system operates and the inability to control one’s head position affects the way the rest of the body operates.
For example, due to sitting hunching over and training too much chest over back causes upper crossed syndrome which causes forward head syndrome. For every inch, the ears are forward from your shoulders, it increases the weight of the head on the spine by an extra 10 pounds. (5)
Furthermore, the muscles of the upper back get weak and inhibited, resulting in a loss of strength and mobility around the upper body area. And this posture has been linked to tension headaches and decreased lung capacity, which can cause problems with inhaling and exhaling air. (6)
Can you imagine what forward head and a weak upper back does for performance?
If the vestibular system is not operating efficiently due to upper crossed syndrome, it can affect balance and proprioception. This in turn may affect strength because force and other performance measures can be adversely affected by a lack of balance. (7)
Your balance and vestibular system is probably the most overlooked important factor in training, but it is fundamental to almost everything you do.
STRENGTH TRAINING EXERCISES TO OPTIMIZE THE VESTIBULAR SYSTEM
The following exercises emphasize good posture and balance to give your vestibular system better inputs, which results in better outputs. Plus, if you are young or old like me, it is never too early or late to tweak your programming to emphasize this important and neglected system.
1. FRONT RACKED BULGARIAN SPLIT SQUAT
During bilateral lower body exercises your dominant side can pick up the slack for the weaker side and by improving your “weaker” side will reduce the injury risk, help increase lifting numbers, leads to better muscle recruitment and improved balance.
Most unilateral exercises do this, but front racked kettlebell Bulgarian split squat is special. The front racked kettlebells encourage thoracic extension, strengthens the upper back, encourages correct breathing patterns and is a great core stability exercise. This is a win-win for your gains and posture.
This exercise demands proper form and positioning due to the position on the kettlebells. Any technique faults will result in you losing your balance or losing your grip on the kettlebells. Improving thoracic extension, upper back, breathing patterns and core strength is not only great for your vestibular system, balance, and posture, it has great carryover to your bilateral strength movements too.
PROGRAMMING CONSIDERATIONS
This is best performed as an accessory movement after your big strength movement. Pairing this exercise with a single arm row variation is a real upper back whammy. For example,
1A. Front racked kettlebell Bulgarian split squat – 12 reps on each leg
1B. 3 point dumbbell row- 12 reps on each arm
2. OVERHEAD BARBELL CARRY
There are many forms of overhead carries, (and they all have similar benefits) but this one is the toughest. One false step and you and the floor become one. Sometimes, a little fear in your training can be a motivating experience. Carrying the barbell overhead carry works every muscle from head to toe and because of this every step is a single leg stance. This improves balance and encourages good posture because any less will result in a fail.
Overhead carries work on strengthening the upper back muscles such as the upper trapezius and rhomboids, essential for healthy shoulder function, good posture which provides better inputs to the vestibular system.
PROGRAMMING CONSIDERATIONS
This is a taxing movement, so program these near the beginning of your training, just after your big strength movement for the day. Pairing the overhead walk in a superset with an upper body movement works best. For example:
1A. Bent over barbell row, chin up or bench press variations.
1B. Overhead barbell carry- 20 steps forward, then 20 steps back.
3. SUITCASE CARRY
Suitcase carries have been popularized by strength guru Dan John, so if they are good enough for Dan, they are good enough for you. These train the anti-lateral flexion muscles of the obliques to help with better posture and a stronger support system for the lower back.
A lot of us favor one side over the other when we carry bags over our shoulders or things in our hands. This can result in tilting our body over to one side to overcompensate resulting in strength imbalances between oblique muscles, grip strength and poorer posture. Carrying a heavy dumbbell/kettlebell unilaterally can help iron those strength imbalances and helps improve posture and balance.
PROGRAMMING CONSIDERATIONS
You’re only limited by your imagination on inserting suitcase carries into your programming. However, when performing carries as part of your main training, pair them with a movement that doesn’t demand a lot of grip strength.
For example:
1A. Bench press variation
1B. Suitcase carry- heavy 20 steps one hand then 20 steps in the opposite hand.
Or:
1A. Squat or hip thrust
1B. Suitcase carry- heavy 20 steps one hand then 20 steps in the opposite hand.
4. PULLOVER DEADBUG
The standard deadbug reinforces contralateral limb movement, improves lumbo- pelvic stability, reinforces correct breathing patterns and encourages good posture.
Squats, deadlift and overhead presses and its variations are better performed with a neutral spine, which is something the deadbug trains. Adding a weight to this mix further improves the factors above while strengthening the upper back and chest.
You have probably seen lifters performing dumbbell pullovers, hoisting those huge dumbbells while excessively arching their low back combined with their lower ribs protruding. The pullover with deadbug will counter lumbar extension (when reaching overhead) plus help stretch the lats while preventing the dreaded rounded-shoulder look. Plus, this doubles as a core stability drill, which is an essential factor for moving big weights safely.
PROGRAMMING CONSIDERATIONS
Pairing this exercise in a superset when neutral spine and core stability is essential. For example:
1A. Squat Variation
1B. Pullover with deadbug – 12 reps (six on each leg)
Or
1A. Horizontal or Vertical Pressing variation
1B. Pullover with deadbug – 12 reps (six on each leg)
.
5. EXERCISES IN HALF AND TALL KNEELING
An underrated way to improve balance, posture and vestibular system is to train on the floor.
The Central Nervous System primary function is to reduce the threats of physical harm (real or perceived) and being close to the floor reduces the dangers the CNS senses while training balance. Plus, if you cannot keep yourself upright on the floor, you haven’t much hope doing it standing either. Lifting from your knees trains muscles that are often under used while lifting from standing or sitting: when your legs are out of the equation, you need more hip mobility, core stability, and emphasis from the working muscles.
Training in these positions lowers your center of mass and narrows your base of support compared to standing so you can potentially move your hips and shoulders without too much compensation. But the beauty of training in these positions is it dials in your technique on upper body lifts and core work because anything less than good posture and form will result in instant feedback.
For example, lower back overarching to move weight overhead which may result in a failed lift and a loss of balance. Because taking the lower legs out of your upper body standing lifts adds more core work and difficulty because of your inability to ‘cheat’ the weight up or down.
Both these positions encourage good posture and head position and therefore help support a healthy vestibular system.
PROGRAMMING SUGGESTIONS
Both have great hip mobility and core stability benefits and make for great warm up exercises, filler exercises and accessory exercises to improve your technique and strength in your main lifts while improving posture.
For example, as part of your warm up this core superset will engage the core and unlock the hips and shoulders before attacking your strength work.
1A. Half Kneeling Pallof Press -10 reps
1B. Tall Kneeling KB Halos- 10 reps
When attacking your squats, deadlifts or presses pair a half or tall kneeling exercise as a filler/recovery drill to help recover and to ensure good technique. For example:
1A. Overhead Press
1B. Tall kneeling overhead Pallof press
WRAPPING UP
Training for a healthy vestibular system does not require much change for what you are doing in your training now. A small tweak here and there with the above exercises will maintain a healthy vestibular system, good balance, and posture without sacrificing gains.
REFERENCES
1. M Hirvensalo 1, T Rantanen, Mobility Difficulties and Physical Activity as Predictors of Mortality and Loss of Independence in the Community-Living Older Population. J Am Geriatr Soc 2000 May;48(5):493-8.
2. Christiansen, C. (2012). Geriatric Physical Therapy, Impaired Joint Mobility. Chapter 13, pp 248- 262, Mosby Elsevier.
3. Gaur, K & Davinder, A (2014). Comparison of ankle joint range of motion on balance score in healthy young and adult individuals. Journal of Exercise Science and Physiotherapy, Vol. 10, No. 1, Jun: 25-30.
4. Spink, MJ., et al. Foot and Ankle Strength, Range of Motion, Posture, and Deformity Are Associated With Balance and Functional Ability in Older Adults. Archives of Physical Medicine and Rehabilitation, January 2001 Volume 92, Issue 1, Pages 68–75.
5. Kapandji, Physiology of Joints, Vol. 3
6. J:. Fortner MO1, Oakley PA2, Harrison DE3. Alleviation of chronic spine pain and headaches by reducing forward head posture and thoracic hyperkyphosis. Phys Ther Sci. 2018 Aug;30(8):1117-1123. doi: 10.1589/jpts.30.1117. Epub 2018 Aug 7
7. T Kenneth Anderson 1, David G Behm The impact of instability resistance training on balance and stability. Sports Med2005;35(1):43-53.doi: 10.2165/00007256-200535010-00004.
