Balance, Strokes, and Brain Health

by Ram

Before reading this article, please attempt this exercise: 

1. Start with bare feet. 
2. Grab a pair of socks. 
3. From standing, bend one knee and raise that leg out in front of you, keeping your knee bent. From here, try to put a sock on your raised foot while maintaining your balance. 
4. Repeat the same procedure on the other leg.

If you successfully managed to put on both socks without losing your balance, congratulate yourself and do this exercise daily. However, if you struggled with your balance, you need to think about strategies to strengthen your balance centers in the brain as this may affect your quality of life and lifespan. According to a recent study, people who cannot stay balanced on one leg for longer than 20 seconds need to consult with their doctor as this may strongly correlate with the presence of tiny micro-bleeds in the brain that may be a harbinger for an impending stroke. The micro-bleeds can happen even when you’re otherwise feeling healthy, and if this is not stopped or controlled, it can serve as a greatest risk factor for future severe strokes.

To understand this concept better, let us take a closer look at the anatomy of the brain and the balance centers. There are three main components of the brain: the cerebrum, the cerebellum, and the brain stem. Each component has a distinct function. The cerebrum is composed of two layers. The thick outer-most layer known as the cortex aka gray matter contains the centers of cognition, personality, and coordination of complicated movements. The inner white matter is a rich network of neuronal fibers that help the brain regions to communicate with each other. The entire cerebrum is divided into right and left hemispheres, with the left hemisphere controlling the majority of functions on the right side of the body and the right hemisphere controlling most of functions on the left side of the body. Any injury to the left hemisphere produces motor deficits on the right side, and vice versa. A stroke in the left or right hemisphere of the cerebrum can lead to impairment of perception and orientation, resulting in improper balance.

The brain stem is a region of the brain that connects the cerebral structures to the spinal cord. The brain stem is responsible for a variety of autonomic functions including respiration, heart rate, blood pressure, wakefulness and arousal among others. Some common effects of a stroke in the brain stem include problems with balance, coordination, weakness or paralysis among others.

The cerebellum, the second largest area, lies beneath and behind the cerebrum towards the back of the skull. It receives sensory information from the body through the spinal cord and helps to coordinate muscle action, fine movement, coordination, and balance. The effects of strokes in the cerebellar area result in improper balance, difficulty maintaining balance, inability to walk and problems with coordination and movement.

Unlike other regions of the body, the brain cannot function if it is deprived of oxygen even for a very short time. Without oxygen, brain cells start to die. A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is either blocked by a clot or if it ruptures. In either situation, portions of the brain do not receive the much needed blood and oxygen as a result of which the brain cells die. If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that this region of the brain controls. A stroke can cause severe brain damage, long-term disability, or even death. A class of strokes called “whispering strokes” aka “silent" strokes do not result in any gross symptoms to raise concerns among victims. These strokes are often associated with tiny micro-bleeds (small blood vessel tear). Whispering/silent strokes that occur very frequently can serve as a greatest risk factor for future severe strokes and ultimately diminish patients' physical and mental functioning. But how does one recognize the presence of micro-bleeds if it does not trigger visible symptoms?

In a recent study Association of postural instability with asymptomatic cerebrovascular damage and cognitive decline: the Japan shimanami health promoting program study. published in the journal STROKE, a team of Japanese researchers noted that the inability to balance on one leg for 20 seconds or longer could be linked to whispering strokes due to micro-bleeds. The researchers recruited 841 women and 546 men who had an average age of 67. The participants were required to stand on one leg for up to one minute with both eyes open. They were asked to do this twice, and the best of the two timings was recorded. Then, the brain of each participant was examined using magnetic resonance imaging to check for any micro-bleeds. The participants were also asked to fill out computer-based questionnaires to assess any cognitive impairment. Using the brain MRI scans the researchers found that all those subjects who had micro-bleeds in their brains were also those that were unable to balance on one leg for longer than 20 seconds. Nearly 35% of those with a couple or more of micro-bleed lesions had trouble balancing, though they did not manifest any other gross symptoms. Moreover, balance problems were also associated with reduced thinking and memory skills.

According to the authors, small blood vessel damages in the brain coupled with reduced cognitive function in otherwise healthy people with no clinical symptoms can simply be observed by their ability to balance on one leg. Individuals who show poor balance on one leg will need serious attention, since this may indicate that small strokes or tiny bleeds have already occurred, which further means the risk for more serious strokes is high. One-leg standing time may thus serve as a simple, inexpensive, low-tech but powerful method to screen people for small cerebral vessel damage who are at risk for further strokes and thereby provide indication of their overall brain health.

So the question you must be asking is: what has this got to do with yoga? Firstly, how about taking preventative measures instead of waiting for the stroke (whether a silent/whispering or a major) to happen? How about strengthening the brain, the nerves, the cognitive skills and furthermore the balance centers of the brain? Remember all my rants The Power of Mental Exercise about the brain being plastic and how a combination of Yoga, meditation and pranayama helps to strengthen the neural connections that in turn improve memory, balance, speed and focus? We also need to be mindful of our relative balance abilities as we practice these modalities and look for ways to build, improve and maintain our balance.

In your regular yoga practice, you could bring in several one-legged balance poses, including, but not limited to, Vrkshasana (Tree Pose), Virabhadrasana 3 (Warrior 3), Utthita Hasta Padangusthasana (Extended Hand to Toe Pose), Urdhva Prasarita Eka Padasana (Standing Split), and Natarajasana (Lord of the Dance Pose). Baxter recently wrote about some of these balance poses in his post Featured Sequence: Challenging Balance Practice. The more complicated the one-legged poses, the greater is the work on the brain to fire up the neural circuitry, which further strengthens the brain areas. So remember this adage: “Balance on one leg and fortify your brain!”

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