Regaining Balance and So Much More: Interview with Anita Berlanga

by Nina

Anita's 2016 New Bed

Back in 2013, I decided to follow up on this comment that Anita Berlanga left on my post Regaining Stability for Free.

"Omgosh. I ....this took my breath away. This is exactly what happened to me! I was this vibrant, moving being....then a stupid, nasty fall (via a piece of gravel on the sidewalk) ended all that. And my subsequent life mirrors your friend's. Thank you SO much for giving us hope!"

I reached out to Anita because I wanted to see if there was something we could do to help! You can see her original story in our post Starting to Move Again. After some behind the scenes emailing with Anita, and then some consulting with Shari and Baxter, we came up with some yoga recommendations for Anita, which you can read about in our post  Starting to Move Again, Part 2, along  with some early progress reports about how she was doing now that she started to practice yoga for regaining stability. Now that a couple of years have passed—and I heard that Anita was feeling like her life had been transformed by yoga—so I decided to check in with her again and let her tell you her story in her own words.  

Nina: Tell us a bit about yourself and what things were like for you before you slipped and fell. 

Anita: I was The Strider. I would walk for MILES with a confident, strong stride. So strong, so confident, I could run up 3 flights of stairs without a break. I was relatively flexible—and pretty much fearless. Though a bad motorcycle crash had done a job on my knees I was still flexible enough to walk for miles and lift things and just, in general, feel strong and confident. In my young adulthood I would walk from work (downtown Chicago) to my Lincoln Park apartment, a distance of about 10 miles. I miss walking in the City. But I still managed to get in a 2-4 miles walk here in the sticks. Every day.  

Nina: What happened when you fell, and how did you feel afterward? 

Anita: Well, it wasn't one fall. It was two. The first one was an absurd face-plant on the sidewalk when I, striding (in GYMSHOES! for the love of Pete!), twisted my ankle on a piece of gravel. Went down like a sack of potatoes. Blew out my hip and my knee (oh, that knee-scrape burned like fire!). I think I would've managed that a lot better than I did, except that about 2 days later I split open my Achilles tendon (a vicious storm door that always had it in for me—just biding its time...evil door). Alas, that gash was on the OTHER foot. So you can imagine—I was then pretty much incapacitated, since I needed shoes with backs and, omg, do you know how much it hurts to have the seam of a shoe hit a gash on your Achilles tendon? OMG. 

By the time that healed I was very stiff—and I'd gotten used to a very sedentary life. Walking was more of a shuffle and walking 2 blocks felt like a mile. But little by little I started walking again. Alas, the first fall was in October. The really awful fall...that happened in January. We'd had some freezing rain—typical Midwest winter. Our driveway is slightly sloped and faces north so it continued to build up. I was walking to my car and did an alley oop that tore up my shoulder and hip. The fact that I am terrified of falling on the ice made this really bad. Then I found out a client fell in her driveway the day before—she died. Any tiny bit of confidence I had regarding walking on ice evaporated. At that point I was pretty much housebound.  

Nina: Why did you decide that yoga might be a good way for you to regain confidence?  

Anita: One of those weird Six Degrees things. I'd first started yoga in undergraduate school but left it there. I was always relatively limber and cardio exercise kept that going. And in the Midwest yoga wasn't as huge as it was on the West Coast so I never picked it up again. 

When I moved down here to Hooterville my nerves were completely shot—I hated this place and mostly just wanted to curl up in a ball and sleep until I was dead. A friend gave me a Rodney Yee DVD and after a whole lot of procrastination I decided to check it out. It was the AM/PM DVD and once I slowed the exercises down a bit (boy, he is FAST with the poses) I found myself really enjoying it. Then…I dunno...I think it was Facebook. Nina is Facebook friend and the algorithms must've put her posts on my feed...all of a sudden Yoga for Healthy Aging started showing up on my page. I sort of glanced at them but didn't really take it very seriously—until one day I realized not only was I not getting 'better,' I was rapidly becoming unable to do much more than walk through the house and sit at the computer. I gained 30 lbs. My spine felt compressed all the time. Omg. That was terrifying! So I started reading the blog posts and then I contacted you, Nina.

Nina: What kind of yoga did you practice? 

Anita: The three sequences you and Baxter told me practice (see Low Back Care Practice, Mini Restorative Practice, and Gentle All-Around Practice). Seriously. I am not a devotee. I just do the poses that work best for my issues and I do the relaxation poses so I don't explode. And that's pretty much it. It feels so good, though, I probably should work more diligently at it. I still do the PM yoga poses because it helps me to sleep. I'm in menopause and own a small business that is my sole income—that combination is lethal for a good night's sleep. Yoga relaxation poses really do help. You know my saying: Sleep is the New Sex. A good night's sleep is priceless!  

Nina: A few years later, how are you feeling about your body, your balance, and your life? 

Anita: OMG. SO much better. Continuing weight loss and regaining flexibility and balance. Who would've thought balance was so important—but...yep! To regain it Nina started me out by making me walk barefoot. I was SO resistant (I'm just not a barefoot kinda gal, having stepped on glass, 2 bees and a scorpion—really—and living with giant dogs has made me very leery) But here's the thing: walking barefoot—even just in the house—really does help my balance. 

My sacrum is a bit wonky and I have some pinched nerves that numb out my toes (omg I sound like a wreck!). Walking barefoot allows me to stretch my toes out in ways that shoes simply don't allow. And with that I can feel how my feet relate to the rest of my body, if that makes any sense? I still get a little unbalanced because I am frequently unfocused but when that happens I take my shoes off, stand there for a few minutes, regroup. When that doesn't do the trick I lie down and do Legs Against the Wall, which ALWAYS does the trick. Good thing I usually work from home. 

Oh, I forgot to talk about Reclined Leg Stretch when I talked about my sacrum. That pose is THE BEST for wonky hips. My sacrum gets cocked out of place and RLS helps put it back. After I do the RLS—I do the one where you gently pull the knee over—that really opens up the hips.

Nina: Anything else you’d like to tell our readers?

Anita: Too much to say here. I would just say: Do not be afraid to ask for help. Thought I was at the end of my healthy life, with a rigid body and a terrified mind. Reaching out to you and YFHA was a lifesaver. I have so much more body confidence and...well, I don't fear the onset of advancing age any more. Or at least not as much. 

Nina: Thanks so much, Anita, for taking the time to share your story with us! 

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Staying Upright: About Our Postural Reflexes, Balance, and Yoga

by Baxter

Playing at Giants by Francisco Goya

In the course of researching agility and balance, I came upon the mention of “postural reflexes.” We humans have a lot of reflexes, so I was not exactly sure what these reflexes were. But I began to do some digging. 

It turns out that you have a couple of reflexes that automatically correct the orientation of your body when it shifts from being up upright. They kick into action when unexpected events throw you off balance so your body can prevent you from falling by quickly attempting to self-correct. Imagine turning and suddenly almost (or actually) bumping into someone, walking down a slick ramp and suddenly slipping a bit, or reaching that darn crack in the side walk that trips you up. They also kick into action during everyday balancing activities, such as when you are standing on a chair in the kitchen trying to reach into the upper shelf or when you are walking on the raised edge of a curb just for the fun of it. 

Our postural reflexes start to develop when we are infants starting to sit up, advance when we are toddlers learning to walk, and continue to be refined through adolescence into young adulthood. In the early days staying upright requires a lot of conscious effort, but with time and practice, our coordinated, muscular responses to being off balance or anticipating loss of balance become more subconscious and reflexive.

These postural responses that keep you upright (or try to!) are a result of information sent to your brain from your inner ears and eyes, the pressure sensors on your feet, and your proprioceptors (the nerves that tell you where you are space). As we age, our postural reflexes may slow down due to age-related changes in one or more of the components of this complex system.

However, in studies of older stroke victims who initially show a decrease in postural reflexes after their stroke there is evidence that practicing agility exercises helps them regain some of their lost function. So although there have been no specific studies of on yoga and postural reflexes, it’s likely that practicing a variety of yoga poses to improve strength, flexibility, balance, and agility would help you maintain and/or improve your postural reflexes. For maintaining postural reflexes, I would particularly recommend strength building practices, as well as balance and agility practices, both static and dynamic variations. 

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Balance and Aging (and Yoga)

by Nina

Old Man in a Tail-Coat

At the age of 90, my father became very weak and soon after that he began to fall repeatedly, even when he’s just try to get out of bed. At that point, I literally had to hire someone to be with him 24/7 just to make sure he wouldn’t fall again and seriously injure himself. (Can I take a moment to thank once again the daytime caregiver I ended up hiring? You did so much more than keep my dad safe—your caring attention and the things you encouraged my dad to do during his last days made my dad’s life better.) Although my dad had a particular set of conditions that was causing both the weakness and poor balance, I think we all know that problems with falls—and worrying about falling—are common in older people. 

This is because aging affects all three of your balance systems (see How We Balance), as well as your ability to respond quickly and appropriately to balance challenges. But because so many factors contribute to your ability to balance, you can often compensate for losses in one area by cultivating other aspects of balance. So let’s take a closer look at how aging affects each of those factors and which ones you can influence with your yoga practice. 

In general, however, a well-rounded asana practice that includes strength, flexibility, and agility practices as well as a wide variety of balancing poses, will help you maintain your ability to balance as you age. 

Vestibular System. Our inner ear functions—including balance as well as hearing—gradually decline with age. The ear contains moving parts (hair cells), which are unable to repair themselves and gradually die off. And typically by the age of 80 around half of inner ear function is lost. Although you cannot change this, you can compensate for these losses by working on other aspects of balance, including your somatic sensory system and your four essential physical skills. 

Vision System. Age-related changes to the lenses of your eyes make it harder to focus quickly. In addition, the development of cataracts from years of sunlight exposure and a variety of other eye conditions that become more common as we age, such as loss of peripheral vision, glaucoma and macular degeneration, negatively affect vision. Of course, for eye conditions that are helped by prescription glasses, wearing the glasses when you need to/want to balance can help compensate for these losses. For conditions that glasses cannot help, you can compensate for these losses by using your vestibular and somantic sensory systems to balance yourself (after all, blind people can balance). You can also work on improving your somatic sensory system and your four essential physical skills. 

Somatic Sensory System. Because aging may cause slower messaging between your brain and body, this can affect both your proprioception (your awareness of where you are in space) and your exteroception (your ability take in information about the surface you’re balancing on). In addition, a sedentary lifestyle or lack of variety in movement can reduce proprioception over time, causing you to lose balance when you make an unusual movement. And little or no time spend barefoot can reduce your exteroception, causing you to be less aware of the surface on which you are balancing (or walking). But regularly practicing a wide-variety of asanas while focusing on your internal sensations can help improve proprioception, and practicing standing and balancing poses with bare feet will help your feet become more sensitive and responsive. 

Strength. As we discussed in Latest Info on Muscle and Bone Strength, age-related muscle atrophy causes loss of strength over time. This loss of strength affects your ability to balance because if you get knocked off balance, you can’t easily move back into balance. But as you know by now, you can maintain your strength through a well-rounded yoga practice and this will help your ability to balance as well. 

Flexibility. As we discussed in  Flexibility and Aging, your muscles and joints become stiffer with age, so your range of motion is reduced. This stiffness can affect your ability to balance because you can’t easily move from one position to another, and can be knocked off balance more easily and will have a harder time moving back into balance afterward. But as you know by now, you can maintain your flexibility through a well-rounded yoga practice and this will help your ability to balance as well. 

Nervous System. Age-related changes in your nerves can cause them to pass messages more slowly between your brain and body. And this slowing of reaction time can affect your coordination and speed of movement, as well as the strength of your muscle responses, all of which will affect your balance. You can counteract this slowing of reaction times by working on agility practices, initially starting at a slower pace and gradually increasing your increasing your speed over time. 

Brain. Although balance is typically an unconscious response, practicing balancing poses to improve balance requires mental concentration. So age-related changes that cause your brain to slow down and work less efficiently can influence your ability to improve your balance. You can counteract some of these changes through practices that foster brain health, including exercise, sleeping well, and continued learning (see How to Foster Brain Health with Yoga). Meditation should be especially helpful as you can use the practice to intentionally cultivate the ability to maintain focus.

For information about improving balance, see Techniques for Improving Balance.

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What a Year of Balance Poses Taught Me

by Baxter

Vincent, Age 51, photographed by Sara Bennett

If you have been reading our blog during 2015 or following either our Yoga for Healthy Aging or my Baxter Bell Yoga Facebook pages, you know that since the beginning of the year, I have been introducing a new balance pose every week to my students in Oakland and around the country. (You can find videos of all my balance poses of the week on my YouTube channel Baxter Bell Yoga.)

I was motivated to do this after reading studies that showed the benefit of improved balance on reducing the risks of falling (see The Importance of Preventing Falls), which can be a devastating turn of events for some. Some of the new poses I made up were either closely or loosely aligned with existing yoga poses (for example, my Cypress pose was a variation of Vrksasana or Tree pose) and others were more of a stretch (Pirate’s pose 2.0, for instance!). And each week I was involved in the creative process of coming up with a new balance pose, no small feat for someone not accustomed to such endeavors. (Special thanks to those out there who shared with me their balance creations, such as 4 Corners, which took the pressure off for a week now and then). I personally discovered this process was both daunting and delightful, but more importantly I found my students were open to trying out my new inventions, even renaming them on occasion!

Through my personal studies on balance, I rediscovered the complexity of balance, which integrates many levels of the mind, both conscious and reflexive, with input from skin, joints, muscles, fascia, eyes, and ears. And in looking into recent research on balance, I discovered that a variety of scientists—from gerontologists doing research on improving balance in their vulnerable patients to sports medicine academies looking to improve athletic performance and reduce sports injuries—were looking for new ways of improving balance. From these fields of study I found several core concepts that I began to integrate into my classes and teaching, such as that of challenging or stressing a person’s limits of stability (the area outside of his or her base of support he or she can go without losing control of the center of gravity) via “controlled instability” and “cognitive distracting drills” (see The Great Balance Pose of the Week and Adding Distraction to Your Balance Poses). I found the following guidelines particularly relevant for yoga practice:

1. Moving from simple to complex (for example, doing Tree pose and Warrior 3 independently, then creating a dynamic sequence combining them (see Tree-to-3)
2. Progressing from known to unknown (for example, practicing Tree pose and then introducing Cypress pose)
3. Progressing from static to dynamic (for example, practicing static Eagle pose and then Dynamic Eagle pose) 
4. Progressing from stable to unstable (for example, Packin' the Trailer with a foot on the ground to standing on a block)
5. Progressing from eyes open to eyes closed (applicable for classic yoga balance poses, such as Half Moon pose, or any of my new poses)
6. Emphasizing quality over quantity (practicing a single pose mindfully rather than moving quickly through several poses)

By returning to the topic of balance each week in many diverse settings, I also came to discover that by and large the goal of improving balance was universally embraced by people of all ages. And many of my students reported practicing the new balance poses on their own and noted personal gains in better balance over this past year. And because of the tendency of many students to be highly self-critical and judge themselves as “bad” balancers, I made it my mission to remind them all that it is not about perfecting any one new balance pose, but that the mere engagement in trying the poses has positive benefits on long-term balance.

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How We Balance

by Nina

Kim Schleicher, Age 60, by Melina Meza

It turns out that our ability to balance is surprisingly complex, requiring the cooperation of three different systems in our bodies. I thought today we should have a look at all three of those systems, as understanding what influences your ability to balance will help you see what you can improve with yoga practice and what you cannot affect. The three different systems in your body that affect your ability to balance are: 

Vestibular System: The three canals in your inner ears provide your brain with information about linear and angular positions of your body with respect to gravity. For example, are you standing on a flat surface, such as a floor or a sidewalk or are you standing on an uneven surface, such as a rocky path or walking down a set of stairs? 

Visual System: Your eyes provide your brain with information about the position of your body relative to other objects in your environment, including their depth, velocity and motion. And you use that information about your environment to orient yourself. For example, when you’re walking outside, you use the horizon to tell you what an upright position is, and inside a house, you’re using the angles of the room in which you’re standing in the same way. If you have poor eyesight, have you noticed what happens to your ability to balance without your glasses or contacts? Or have you ever closed your eyes in Tree pose? 

Somatic Sensory System: Sensors in your body provides your brain with information about where your body is in space so you know how to make adjustments to keep your balance. There are two different somatic sensors: exteroception and proprioception. 

Exteroception is the ability to feel what is interacting with the exterior of your body. Sensors on your skin allow you to feel the outside environment. For example, if you are walking outside, are you walking on solid ground or sinking into mud? Even if you’re not on your feet, you take in information about the surface you’re balancing on, for example, try kneeling on a stack of blanks vs. on the floor. 

Proprioception is the ability to tell where one body part is in relation to another. Sensors in all your muscles and joints allow you to feel from the inside how your body is moving in space.The classic test for this is to have you close your eyes and then use your hand to touch your nose. And, in fact, proprioception is what allows you to walk around in the dark. 

Although you cannot use yoga to influence your vestibular and vision systems (and they do tend to deteriorate somewhat with age), you can use yoga to improve your somatic sensory system. So let’s take a closer look at both exteroception and proprioception next.

Also, keep in mind, that even with all three of these systems functioning perfectly, your body won’t be able to respond well to the information it’s receiving from your brain if you’re very weak or stiff. So working on strength, flexibility, and agility are also key for maintaining your ability to balance. Maintaining mental focus in the face of distraction—because in the real world we’re often distracted—is also key, so you can work on mental focus by practicing meditation and also by doing your poses where there is some distraction, such as at the beach or at home with some kids in the room.

Yoga and Exteroception 

By practicing your yoga asanas with bare feet you are increasing their sensitivity. That improves the exteroception on the bottom of your feet, which will improve your ability to balance. And once you are comfortable with your balance on a wood floor or a thin yoga mat, you can vary the surface on which you practice to further increase your exteroception. Try practicing on a rug or carpet a foam mat, or even a firm mattress or doing a balance pose with half your standing foot on the mat or standing on a foam block. Or practice yoga outside on the grass or at the beach on the sand. 

We also recommend practicing yoga balancing poses where you balance on other parts of your body to improve exteroception in other areas. Try Side Plank pose (Vasithasana) variations to work on hands and the sides of your feet. Try Boat pose (Navasana) variations to work on your buttocks area. Try Hunting Dog pose to work on your shins as well as your hands. 

Taking vision out of the equation also helps improve exteroception as you’ll need to work with your sense of touch to compensate for lack of sight. So you can experiment by practicing in a darkened room or keeping your eyes closed. 

Yoga and Proprioception

Doing a variety of poses takes your body into all different kinds of configurations. And practicing without a mirror—which is typically how we do yoga—helps you feel all those different positions from the inside out as you sense your own alignment without using your eyes. That will help refine your proprioception. So take some time to really feel your own alignment. Are you arms even in Warrior 2? Are you knees actually straight in your standing poses? Is your head really aligned directly over your torso?

Also, be sure to practice a wide variety of poses rather than just doing the same 10 every day. And when you’ve been practicing for a few years, you might even want to invent some new variations to keep things fresh and challenging, as Baxter has done with his Balance Pose of the Week, or at least search them out.

To take your proprioception to another level, you can try working with more subtle alignment cues. For example, you could work with your shoulder blades, your collar bones, your inner thighs, or something even more esoteric like your psoas muscles . Sometimes there is an area you are not used to even sensing and, at first, it will be hard to feel something there. But the more you bring your mind to it, the easier it will be to sense that area and eventually to move it.

Taking vision out of the equation helps improve proprioception as you’ll need to work with your sense of where your body is in a space to compensate for lack of sight. That’s how you can walk in the dark! So you can experiment by practicing in a darkened room or keeping your eyes closed.

And now can I take a moment to say that we have more than five senses—way, way more? Today I discussed two senses that are typically excluded from the big five, your vestibular system and your proprioception. And there are a lot more where those came from! 

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Techniques for Improving Balance

by Shari and Nina

Elizabeth Cooke, Age 57

Because of something I'm working on—you can probably guess what—I wanted to learn more about specific techniques for improving balance. So I turned to one of my favorite local expert on the topic, our very own Shari Ser, yoga teacher and physical therapist. I asked her a set of questions regarding techniques for improving balances, and thought today I'd share the results with you. Thank you, Shari! —Nina

NINA: Let’s say you’ve decided that you want to focus on improving your balance, where should you start? Let’s talk about the person who has really poor balance first. Then maybe talk about someone who doesn’t have balance problems per se but just wants to improve and/or maintain balance?

SHARI: I’ll start with the individual who doesn’t live with a constant fear of falling and is relatively mobile, though not necessarily agile.

We always start at the beginning and my reference point for the beginning is Mountain pose (Tadasana). Tadasana is a symmetrical pose that is never mastered and there are endless variations you can practice. Varying your foot position by bring your feet closer together challenges your balance. Start by standing with your feet hips-distance apart. Then, if your knees allow it, gradually work toward the classic Tadasana foot position, with your feet together (big toes touching, heels slightly apart).

You can also vary the pose by closing your eyes, changing the position of your head, by looking up or looking down, and by turning your head. Other movements include raising your arms overhead and side bending.

Next try changing the surface you are standing on. Try standing on a sticky mat that is folded multiple times, on a couch pillow on the floor that is very cushy, on an inflated but soft air mattress, and so—I think you are getting the picture here.

A favorite balance challenge on mine is to put a foam block on your head (like the old fashioned postural exercises some of our moms may have taught us) and first just stand in Tadasana. Then add arm movements out to the side and overhead, trying to keep the block from falling—that can be a lot of fun. For those of you who have a fairly symmetrical walking pattern, walking while in Tadasana with a block on your head is a challenge as you examine how your transferring of weight may influence your postural stability and the ability to keep the block on your head.

NINA: What types of poses should your practice include?

SHARI: I always focus in the beginning on standing poses to challenge balance because they are so much fun and very gratifying because improvements are really noticeable. The standing poses that I would recommend for balance and also to increase leg strength include: Warrior 1 and 2 (Virabradrasana 1 and 2), Triangle pose (Trikonasana), and Extended Side Angle pose (Utthita Parsvakonasana).

Something else to consider is that different yoga traditions enter into and exit out of standing poses with a prescribed sequence. To challenge this habitual pattern—mental agility, folks!—you can change how you step into Warrior 1 or 2. Stepping back from Tadasana with one leg into a Warrior pose then back into Tadasana (repeating on the second side) is a balance challenge. Likewise, stepping forward from Tadasana into the pose from then back into Tadasana, switching sides rhythmically is also balance challenge. Adding rhythm in how you move in and out of a pose from Tadasana with a metronome can be fun, changing between faster and slower tempos. The concept here is NOT to do your entry and exit the same way every single time.

Another way to not only increase balance reactions and leg strength is to link poses together in a flow sequence. Baxter has done a few posts on mini vinyasas with standing poses (see Warrior 1 and Warrior 2 Mini Vinyasas), but  you can also make them up yourself by linking poses together. For example, try going from Warrior 2 to Extended Side Angle to Triangle pose and back again (repeated on the second side) is one way to approach this idea.

I also think it is crucial to make transitions from standing to the floor and back to standing smoothly and gracefully. You don’t want to move quickly through transitions because speed can increase the risk of falling because you aren’t moving mindfully but just trying to get to the next step. If you have difficulty getting down to and up from the floor, using a chair to assist you is fine but make sure you control the descent and ascent. If initially your legs are too weak or due to orthopedic issues they don’t “bend the way they used to,” it is fine to use your arms to help support your legs.

After working with the standing poses, you should also practice traditional standing balance poses, such as Tree pose (Vrksasana), Half Moon pose (Arda Chandrasana) and Revolved Half Moon, and Warrior 3 (Virabrdrasana 3). Starting with the right amount of support is important; improvement in balancing will bring the gradual lessening of the support that you need.

I also like some floor balance poses for challenges, such as Side Plank pose (Vasithasana), which you can make accessible by practicing the variations (see Featured Pose: Side Plank Pose). Other ideas are Boat pose (Navasana) and Hunting Dog pose, both of which have accessible variations. For more experienced yogis who have been practicing inversions like Shoulderstand (Sarvangasana), Headstand (Sirsasana), and Forearm Balance (Pinca Mayurasana), just the act of doing these poses is challenging your balance, but I don’t recommend them at all for beginners.

NINA: Should we be doing leg strength poses as well as balancing poses?

SHARI: Absolutely we should be doing leg-strengthening poses. Balance is an integrative full body system, and the leg muscles are part of the system. Strong legs mean you are able to lift your body weight with your legs. That means being able to stand from a standard height chair without using your arms to help. This in itself is a training activity. A yoga pose you can use is Powerful pose, either by sliding off a chair into the shape of Powerful pose or starting in Mountain pose and moving into Powerful pose. There are many ways to vary this pose (see Featured Pose: Powerful Pose).

Standing on one leg with adequate balance support and then over time removing the degree of support will also really work on strength, especially the outer hip muscles which help keep your pelvis level when your lift one leg off the ground.

To increase strength, increase your hold times you start to feel just a bit “uncomfortable” and there is more effort required. (I am NOT talking about staying in a pose and “working with the pain.” Effort does not equal pain, and, if it does, then you need to immediately come out of the pose.)

NINA: How often should you do the poses? How long should you hold the poses?

SHARI: I suggest practicing daily for even five minutes as a good way to begin. Developing the habit of practice is the key—what you do during your five minutes is more open. For someone just starting to work on balance, in a five minute practice you could start with Tadasana and Tree pose, which I recommend doing every day. Then add in one or two other standing and/or balance poses, which you should vary throughout the week to maintain a balanced diet of yoga poses.

As far as how long to hold a pose, I would recommend a simple approach. Hold a pose till you notice your leg is quivering and then try to hold 2-3 seconds longer. Come out and rest a few seconds before repeating on the second side. 

NINA: And when you get the basic balance poses down to long, steady holds, where should you go from there?

SHARI: The first thing I remove is vision because removing visual acuity really affects balance! So try either practicing in a darkened room or closing your eyes. Once you master the visual challenge, try adding head motions while keeping your eyes steady—find a visual focal point and keep your eyes on that object but add head rotations. 

Next, return to another visual challenge. Keeping your head steady, move your gaze around the room in every direction you can comfortably take it. Once you’ve mastered that, try moving your eyes in one direction with your head is turned in the opposite direction.

Another technique is to vary the surface you practice on. Try standing on a cushy or unstable surface—like an air mattress on the floor that is underinflated—and do standing poses like Warrior 2 or balance poses for a definite balance challenge! When practicing balance poses like Tree pose, as Baxter has recommended, try variations with moving your arms and head.

Other ways to vary your practice is to change where you do your practice. I, for one, am very partial to yoga on the beach. There is something about the movement of the air as well as the movement of the water that I find very nurturing. Watching moving objects while trying to remain still and steady is definitely a balance challenge.

NINA: Is there anything else you can do to improve your balance?

SHARI: Whenever possible, increase your foot sensitivity. Massaging the soles of your feet is important—there are numerous tools you can use for this. I also recommend stretching your toes individually and feeling all the small joints in the toes and how they move  (this also allows you to keep a close check on the state of your feet, especially if you are a diabetic).  You can also do toe exercises from a seated position, like trying to individually lift and replace each toe, which is quite challenging.

And as long as you don’t have diabetes or peripheral neuropathy, walking with bare feet in the house and in safe outdoor environments, such as at the beach or on the grass, is invaluable for keeping your feet health, supple, and responsive. So take off your shoes!

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Friday Q&A: Dynamic and Static Balancing Options

Joy Sassoon, Age 60

Q: A number of us here in VA are curious about the specific rationale for the balance sequences Baxter shared with us and is sharing with the world on a weekly basis - being first static and then dynamic. I've read Baxter's articles from the dates below and understand that “the main goal of balance training is to continually increase your client’s awareness of his or her balance threshold or limits of stability by creating controlled instability.” .... (Dec 17, 2014, Jan 26, 2015, Mar 3, 2015) ... but am curious what the underlying principles/theories for first holding a pose and then moving dynamically between a couple or more poses.

Is it the "work" the body is doing while static that is helpful (the nervous system, eyes, vestibular system, etc.) in finding balance moment to moment before challenging ourselves with movement into and out of a set of poses? From Mr. Desikachar (and others) the "dynamic then static" model has been so engrained here. Of course there may be other reasons to practice "static then dynamic"; a number of us here are curious specifically how this works for keeping and improving balance.

A: This is a great question, and one I tried to highlight in my post News on Balance, Falling, and Yoga on integrating new concepts on improving balance a while back. And the reader is correct that I am recommending a different sequencing approach to the order dynamic mini-vinyasa to static asana that TKV Desikachar recommends in his book The Heart of Yoga. Before I get why I recommend my to doing a static balance pose first, followed by a dynamic mini-vinyasa version, let’s look at what Desikachar has to say about his recommendations:

“There are 2 ways of practicing asana: The dynamic practice repeats the movement into the asana and out again in rhythm with the breath. In static practice we move into an out of the pose in the same way as with the dynamic practice, but instead of staying in continual movement with the breath, we hold the pose for a certain number of breath cycles [with a certain chosen focus]. Dynamic movements allow the body to get used to the position gently and gradually. For this reason it is always better to practice an asana dynamically first, before attempting to hold it.

“A dynamic performance of asanas therefore not only helps to prepare for difficult static postures but also intensifies the practice of a particular asana or gives it special direction.”

And for quite awhile now I have been practicing and teaching in this way, and finding it useful and generally appropriate. Then I came across this article Integrated Balance Training by the National Academy of Sports Medicine, with their modern recommendations about improving balance specifically. (Although technical in some places, I highly recommend teachers out there to try diving into this paper.) And I am so interested in learning as much as I can about improving balance and helping my students to reduce their risk of falls over time, that I was intrigued to see what they had to add to my understanding.

In this paper, the authors recommend a practical set of steps for a given exercise session: the exercises progress from slow to fast, simple to complex, known to unknown, low force to high force, static to dynamic, two arms to one arm, two legs to one leg, stable to unstable, eyes open to eyes closed, and, most importantly, quality before quantity. Their recommendations utilize a particular training model called the Optimum Performance Training (OPT) model. The program includes three distinct phases:

• Level 1: Stabilization
• Level 2: Strength
• Level 3: Power 

The first level of this training involves stabilization, which is achieved via static held positions, and likely why they recommend starting with static poses and then sequencing dynamic after. The dynamic mini-vinyasa requires more strength and power, but build on the stabilization achieved with the static poses.

So, in making these suggestions to you and using these techniques in my balance videos, I am attempting to meld some modern sports medicine concepts around improving balance with some longer standing sequencing guidelines from the yoga tradition. If I were you, I would utilize the dynamic to static recommendations when designing a balanced asana class, and if I were going to focus on a few balance poses or practices, I would then utilize the static to dynamic option recommended by the NASM for those specific poses within my sequence. And, of course, I would track the results of these sequencing choices for over time. And if the static to dynamic approach to balancing poses proves helpful for improving functional balance (both static situations and real life dynamic situations), I’d consider using that approach for balance poses as part of my sequencing options.

—Baxter

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Adding "Distraction" to Your Balance Poses

by Baxter

A Beauty Holding a Ball by Toyohara Chikanobu

My 2015 (healthy) obsession with balance is in full swing, and as a result, lots of folks have been sharing their personal yoga-related balance poses with me. Thanks, everyone! In addition, I get forwarded a lot of articles about balance from Nina and others as they show up in the media these days. Last week, Nina forwarded a New York Times article Training the Mind to Ward Off Falls that really piqued my interest. 

Noting the well-known connection between falls, fractures, and dysfunction and death in the elderly, the article reported on an experiment in balance taking place in Wichita, Kansas with a group of elderly exercisers. Their exercise program, designed by an exercise physiologist who heads Wichita State University’s Center for Physical Activity and Aging, includes a balance section in which the participants stand on 3-inch spongy squares of foam padding to require them to pay more attention to their balance than normal. Then, they add in “cognitive distraction drills,” such as simultaneously dropping a ball from one hand to another while gradually moving the distance between the hands further apart. There are other techniques employed as well. And the reason for this is explained as follows: 

“Incorporating mental exercises into a physical fitness class is based on the idea that so-called cognitive distraction drills can help improve balance — particularly when it’s needed most.”

The theory is that improving a person’s ability to “dual-task”— in this case balancing while attending to other stimuli (the cognitive distractions drills)—can improve overall balance. Since falls often happen when we are inattentive to the environment we are moving through, if you could keep good balance while doing other tasks, like these drills, it might translate into improved underlying balance ability for when you encounter some unexpected situation, such as an uneven sidewalk while your dog is running in front of you or a slippery sidewalk while you're talking on the phone. Their on-site experience in Wichita seems to support this assertion, with their program participants reporting improved balance, but formal studies or identifying which distraction drills work best is still a ways off. 

In some ways, we already do this in many yoga class settings. For example, getting into Tree pose might initially involve lots of close attention to the foundational stuff that is needed to balance well in the pose, such as the work for the bottom foot and leg and the alignment of the torso and spine. But your instructor will often then ask you to move your attention, while still in Tree pose, to some other focus, such the movement of your breath in a certain way, or a particular area of the body that may not be directly related to maintaining balance, or even the addition of sound or chanting work.

The Wichita techniques also blends nicely with the idea of “controlled instability” that I wrote about in my post News on Balance, Falling, and Yoga, where you add variable changes to your balance poses to make them gradually more challenging. Inspired by this new info, this week my Weekly Yoga Balance pose combines the hand-to-hand ball drop with a one-legged standing balance pose (coming soon to the blog). In my classes this week, students have already reported that it was easier to balance after they added the ball drop drill than when we did it simply by balancing on one leg…very interesting! 

I’ll be excited to see any future formal results from the work coming out of Wichita, but in the meantime, try adding some cognitive distraction drills into your yoga balance poses and see how you do. For example, try counting backwards from 100 by subtracting 7 each time: 100, 93, 86, etc., while doing King Dancer (Natarajasana)! 

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Yoga and Balance: An Overview

by Baxter 

Tree Pose with the Wall

Because the ability to balance changes as we age, and poor balance is at the top of the list of risk factors for an increased chance of falling, it is obvious that maintaining and improving balance is a worthy endeavor! For almost everyone I talk to about their goals as they age, staying independent in function and lifestyle is at the top of their list. Sadly, at the extreme, poor balance often leads to unexpected falls, which can result in devastating fractures and loss of both physical function and being able to live independently. But deteriorating balance can just as easily erode the ability to go about your daily activities with ease and to engage in healthy physical activities. I am sure many of you have friends or family members whose changing ability to balance gradually kept them home bound and had a negative impact on their quality of life. That's why we consider balance as one of the four essential skills of Yoga for Healthy Aging.

Aging Changes to Our Balance System

Before getting into the ways yoga can maintain and improve balance, it is worth reviewing how balance changes as we age, in an honest light. In our post Aging and Balance, Shari Ser, who both a physical therapist and a yoga teacher, said:

“Unfortunately decline in ability to balance is part of ‘normal aging.’ Physiological changes inevitably occur in aging; the composition of the muscle fibers changes from fast twitch to slow twitch, which means our reaction times decline. There are changes in peripheral nerve conduction speeds, and we may either overcompensate or under compensate when our balance is challenged. The smooth modulation of our central nervous system is affected as we age. There are intricate feedback systems between our cerebellum, brain stem, cranial nerves, and basal ganglia that need to be working smoothly for us to easily execute our locomotion and peripheral body through space. 

Our proprioception (the ability to sense where we are in space) also changes as we age as well as our vestibular system (the balance system that is our inner ear). Some hypothesize that this is due to circulatory changes as we age. There are changes in our auditory and visual systems as we age. We get stiffer in our joints and muscles so we loose the full range of motion these joints may have had previously. Cognitive changes occur in our brain also slowing down the in streaming of information. Balance is a reflexive activity, an unconscious response to a change in stimuli, but to improve balance also requires mental concentration.”

How Yoga Helps

In that same post, Shari suggested some ideas on how yoga helps maintain or improve our balance: 

“The maxim “use it or you loose it” is so true with balance! But if we stand in Tadasana (Mountain Pose) we are integrating every single one of our balance systems. Our eyes orient us to midline and to the horizon, and they tell us where up and down are. Our vestibular system tells us that the surface is stable and there is no spinning or tilting to compensate for. Our proprioceptors in our joints, muscles, and skin send feedback to the resistance of the floor, and our conscious mind sends information to elongate here, relax there, shift to the right/left, etc. Our brain is never quiet in Tadasana, always tweaking a little bit here and there. The act of standing still is a full body isometric activity, and it is work that is making our bodies stronger.” 

We can challenge our bodies even more when we stand on one foot, balance on one foot and a hand, such as with Half Moon pose (Arda Chandrasana), or move through a series of connected postures, as in Sun Salutations, because balance and agility are intimately interconnected. In fact, agility requires balance in motion. As Leslie Kaminoff observes, as we move through our day, it is as if we are almost falling and self-correcting moment by moment, and our balance system is what keeps us upright. 

By engaging in stimulating all aspects of our balance system to work at optimal levels, a regular yoga practice has the potential to influence all of the aging changes Shari outlined above. With yoga, you can:

• Stimulate the pressure receptors and proprioceptors in your feet by working barefoot in balance poses barefoot.
• Stimulate the mechanoreceptors in our joints, ligaments, tendons, and muscles above the feet via the various positions in which you place your limbs during yoga asana.
• Improve mental focus by training your minds to return again and again to the balancing task at hand. You notice shifting sensations, the feeling of being on or off balance, when extraneous thoughts take you away from your focus on balance, and so on. Even the pranayama and meditation practices you do can lead to improved mental focus when you find yourself doing balancing poses or walking around the house. 

And yoga can address the sports medicine concept of “controlled instability” News on Balance, Falling, and Yoga) by initially introducing someone new to yoga and previously inactive to the basic yoga poses and dynamic sequences, then adding more challenging poses and practices for the advancing practitioner, and finally, when balance poses are mastered, enabling the practitioner to challenge the edge of stability by creatively modifying poses.

For those that already have balance issues when they start yoga, yoga has great ways of making the exploration of poses for balance safe, and minimizing the chance of becoming fearful. One of the first tools that can help these people is the wall, which they can use by standing close to it, either facing it, standing sideways to it, or having their back to it. 

By simply getting you out of your shoes and socks, yoga helps you wake up the balance and pressure receptors in your feet in general, whether you are ready or not for full balance poses. So even practicing standing poses in general is helpful for beginners. And for more advanced practitioners, yoga helps wake up the balance and pressure receptors in your hands when you practice arm balance poses, such as Side Plank pose (Vasithasana), Crane pose (Bakasana), or Handstand. 

Other factors that affect balance and safety are our individual levels of flexibility, strength, and endurance. And since we know that yoga can improve these factors, their improvement will contribute to improved balance as well.

Our mental attitude towards balance and the risk of falling can also have a huge impact on our success or failure, our progress or lack thereof. The yoga practices of mindfulness without judgment that we try to cultivate can change a habitual negativity around balance, such as “I suck at Tree pose,” to a more neutral mental input, like “I am typically wobbly in Tree, but let’s see what I can do today….”

So, your yoga toolbox provides a number of tools for improving balance, from the physical tips of your toes to the ethereal influence of your thoughts.

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