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- [00:00]
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Hello. Hello. Thank you so much for tuning in today. Today I want to address something that honestly might ruffle some feathers, both with physical therapists that are orthopedically trained or personal trainers that are orthopedically trained or even maybe some people with Ms. Who are feeling a little fed up with balance exercises. So the topic is balance. And the thing that, that really gets under my skin and makes me so annoyed as an Ms. Specialized physical therapist is when I'm having conversations with my missing link members or honestly even just social media followers and they come to me and they say, Dr. Gretchen, I've been going to a personal trainer or going to physical therapy and I've been working on balance exercises but my balance isn't any better day to day. And I'll ask questions and essentially what it boils down to is they're doing certain exercises and I'll give you some examples, but they're doing certain exercises in physical therapy or with their personal trainer or even just ones they found on their own for balance, where the goal is to improve balance. But the things that they do on a day to day basis in their home or even outside of their home aren't any easier. Their balance is still just as challenging in those situations. Most of the situations that I'm hearing are things like losing their balance or feeling unbalanced while getting dressed when you're standing, so it makes you have to sit down and get dressed. Or walking in general, as well as walking on uneven surfaces, navigating crowded or busy environments with other people around, standing or walking with having to turn your head, maybe quickly, maybe not quickly. Regardless, turning your head causes you to lose balance, transitioning between lightness and darkness. If you have to go from one room to another or if it's dark outside but light in your house, that transition can also make you lose your balance. Or another common one is reaching side to side. For if you're reaching in your closet to get something or reaching for a countertop. But reaching for things can be something that also causes you to feel off balance. And then last but not least, the other most common one is bending down to pick an item up. Oftentimes it's something like something that fell or it might be a dog bowl or a cat food bowl and you have to bend down to pick it up to feed them or, or the dishwasher and bending down something with bending down and that makes you lose your balance. And so what I want to do today is share with you the typical exercises that are given for people Ms. Or not who have poor balance or are working on improving their balance. Why those don't work and then better alternatives for you.
- [03:17]
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The big question is how does someone with Ms. Actually improve their mobility, strength, energy independence? The list goes on. My name is Dr. Gretchen Holley, physical therapist and multiple Sclerosis specialist. Welcome to the MissingLink Podcast. Tune in as I share the top strategy, strategies and exercises to help you gain control over your life with Ms. Using research driven insights and advice from top industry experts. Whether you're newly diagnosed or have had Ms. For over 30 years, whether you have relapsing Ms. Or progressive MS, this podcast is for you. You're sure to feel empowered and inspired after each episode. Ready? Let's dive in.
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So some typical exercises that you might have done previously. If you've been to a physical therapist or personal trainer and you say, hey, I want to work on my balance, I feel unbalanced or wobbly. What they likely will have you do are exercises where you're standing with your feet together, like literally touching. And if you get better at this, they might have you close your eyes at the same time or they might have you. This is a super common one. Practice in tandem stance where one foot is directly in front of the other so the front foot heel is touching the back foot toes. That's called a tandem stance. Nine times out of 10, when I'm talking to the people reaching out to me saying I've done PT and I've done balance exercises but my balance is still awful, I'll ask what exercises were you doing? Nine times out of ten, the tandem stance and the feet together position are two of the ones that are mentioned. Similarly with the feet together with tandem stance, the better you get, they might have you close your eyes. Another really common one is called the Grapevine. There's also other names for it. Essentially what that one is is your side stepp, which sidestepping is a fantastic exercise. But specifically with a grapevine, when you step to the side, you put one leg behind the other leg. So you're crossing your leg and then uncrossing and then that leg comes in front and over and then you uncross and then back and uncross, front and uncross and you might do the same thing going in the opposite direction. So it's sidestepping but in a very intricate way that we just don't use on a day to day basis. Another example might be balancing on a foam pad, which is sometimes called an Airex. Those are the typical blue ones you'll see either at the Gym or in a physical therapy clinic, or a balance board, a wobble board. There's lots of different wobbly things that you can balance on. And while those might be great for someone without ms, when you have ms, your exercises, including balance exercises, need to be functional because your brain and body and nerves don't have the same carryover. Meaning you could get really great at all these exercises we're talking about, including the ones on wobbly surfaces. But you go into a real life situation like walking on uneven ground, and your balance is the same, it's just not any better. And that's because you're training for a very specific thing. You're training for a wobbly ground, and the ground isn't wobbly, it's uneven. So it'd be more functional to practice walking or exercises on uneven ground rather than a ground underneath you that is wobbly or shaking, because that, we just don't experience that in real life. So I want to go through some balance ideas that you can do that are more specific to these real life situations, because what you might be feeling right now is, yeah, I totally know what you mean. I've done one or several of those exercises before, but my balance didn't improve when I was walking or my balance was just as wobbly when doing X, Y, Z again, nine times out of ten. The reason that occurs is because they weren't functional. They were training just general balance. But when you have ms, hopefully we all know by now, especially if you follow my podcast, my YouTube channel, et cetera, you know that functional exercise needs to be one of the key things that you're doing for all your exercises. So here's some ideas and how I want you to think about what balance exercises you should be doing for your spirit specific goals. And I can just share with you right off the bat. When people shift their mindset, people with ms, when they shift their mindset to doing this approach, they see results in their day to day life so much faster. So the first one that I want to share is one of the most common ones, which is getting dressed. My clients, my Missing Link members will tell me that getting dressed while standing is hard because they lose their balance. So let's break it down. What balance do we need to get dressed? If we're thinking about putting on socks or pants or even underwear, we have to be able to shift our weight to one side of our body and then lift our leg while we're bending over to put the thing on, underwear, pants, shoe, sock, whatever it is. So we need balance in order to do that, we need to be able to shift our weight first of all, over to one side. Not only that, we need to be able to shift 100% of our body weight or as much as possible. So one exercise that you can practice is just that, shifting your body weight over to that side, as much body weight as possible. Can you lift that other leg off the ground in some way, shape or form, and stay here and then come back and do the same thing on the other side? Because you have two pant legs to put on, you have two socks to put on. So we're just practicing side to side weight shifting. Now, if and when that becomes easier, let's add the next component. Once you have your weight on that side, what do you need to do? To put on a pair of pants, you need to be able to bend over, you need to be able to bend that knee and reach down. So can you shift your body weight with up to 100% of weight as possible on this side, while also bending down and then coming back up? And then same thing on the other side, Shift as much weight as you can onto that leg. Because this is likely newer for you. You can keep the other foot down. So it's not truly 100% of your body weight yet. You'll get there with time. But shift your body weight and reach down and then come back up. Almost kind of like a mini squat, if you will, but an uneven squat because your weight is mostly on one side. Okay, so let's say you get great at that. The next thing that you need to do to be able to put on a pair of pants or socks, shoes, underwear, is shift your weight. We've already worked on that. Bend down, we've already worked on that. But then also lift your leg up, up. So that would be the next step is can you shift your weight, bend down and lift up? Can you keep balance that whole time? Now, obviously this all requires strength as well and flexibility in certain muscle groups. But balance wise, can you do that or do you lose your balance during these? More likely than not, you're going to lose your balance, which is why we're working on these as exercises over time. So if you have difficulty with getting dressed, those are just three balance exercises that you would progress to over time that can dramatically help with getting dressed while standing. Now, in the meantime, if that's way too challenging, of course you can get dressed sitting down or leaning up against your bed or against a wall, but these are exercises that can help with that. Another example that I Want to share is going to be helpful for you if you were someone who kind of nodded your head in. Agree. Yes. Walking on uneven surfaces is challenging for me to do. And by uneven surfaces, I just mean something like grass, the sidewalk, maybe sand. If you live near a beach, cobblestone, you know, any type of surface that is not tile or hardwood floor. So again, in the physical therapy clinic, if you're working with an orthopedic PT or any gym or something like that, you might be working on standing on wobbly surfaces. But a much more functional and practical approach is going to be practicing walking and exercising on uneven surfaces. So this is going to be a little bit tricky if you live in an area where currently there's snow outside or it's raining or the weather conditions don't allow you to do this. But when the conditions do allow, it would be highly beneficial for, for you to practice slowly walking on uneven surfaces, AKA outside. Can you walk on your grass? Can you walk on a sidewalk? Can you go somewhere that has cobblestone or gravel and practice walking slowly on those surfaces. Now this will be challenging. It should be because it's uneven surface and that's something that's harder for you to do. So if you need to absolutely use a mobility aid, it can be one cane, two canes, one trekking pole, two trekking poles, a rollator, whatever you need. But practicing walking in a real life situation with an uneven surface under your feet is going to let your muscles, your brain and your neural pathways get stronger and improve their balance in that real life situation. So so much faster than practicing standing with your feet together or in tandem stance or on a wobbly surface. Another example that I mentioned earlier that a lot of my Missing link members, social media following, et cetera, have difficulty with when it comes to balance is turning their head. And a lot of the times this is in reference to them walking and someone calls their name so they have to turn and look or or even just standing in line somewhere, maybe a grocery store line, and they have to turn and look at a menu if they're at a restaurant or again someone might call their name or they hear something. So many situations in our daily life where we have to turn to look while we're either standing or moving. So a really great exercise for this would be to stand in whatever position is comfortable for you. It does not necessarily have to be with your feet close together or tandem stance, just whatever is your normal standing position and practice turning your head to one side and then to the other side. Now there's lots of variables here. You can turn slow, and that should be a little bit easier than turning fast. You also can turn just a little bit versus a full head turn with as far as you can look and then back. You also can play around with your eyes staying forward, but your head turning versus your eyes and your head turning. So there's lots of different ways that we can change this exercise, but essentially you're just practicing looking side to side. And you can do the same thing with up and down. So you're in your regular stance, whatever feels comfy to you. Practice looking up and down. You can look just a little bit up and down, or you can look a lot up and down. You can go quicker. Now, if any of these ones make you dizzy, stop. Wait. Wait for that to go away and then continue. The goal is not to make you dizzy. The goal is to keep your balance. Our focus here is our balance. So once that becomes easier, then you can practice maybe taking a few steps at the same time. Can you turn your head side to side or up and down while walking forward slowly with a mobility aid if you want? Or instead of taking steps, you could just practice shifting your weight onto your front leg and then your back leg. And can you move your head side to side while you're doing that while keeping your balance? Or turn your head up and down, lift your head up and down. Can you keep your balance while doing that? So we're training for a real life situation where you'd have to turn your head and keep your balance at the same time. Now, I just want to share that I'm not bashing those typical exercises that I mentioned in the beginning. There's always a time and place for any exercise. It's just that when those are the only exercises you're doing, it's a huge disservice to your goals, your brain, your body, your neural pathways, et cetera. With that said, is there a time and place to practice tandem stance? Sure, if you are someone who when you are walking, you have what physical therapists call a scissor gait, meaning you walk, but as you're taking a step forward, your foot mistakenly comes across into the center, maybe due to poor balance, maybe due to muscle weakness or muscle tightness. Whatever the reason, if you find yourself quite often, or even any time in a position where you are in a tandem stance while walking, then practicing standing and holding balance in a tandem stance, it would be a beneficial exercise for you to do because you need to be safe in this position. But it would be more realistic. Instead of just standing in a tandem stance, it would be more realistic and more functional to practice shifting your weight forward and backward in that tandem stance. So, not that those exercises are bad or not appropriate ever. There are specific situations. But what you really want to be thinking about, and I talk about this frequently, is if you're working towards a goal and wondering, what exercises can I do for this goal? The best thing that you can do is do the thing that's hard as an exercise. And if it's too hard, make it a bit easier at first. So if getting dressed is hard, practice getting dressed slowly, individually, as an exercise. So as we talked about in the beginning, that doesn't necessarily mean just practice putting on clothes as an exercise. You absolutely can. And I do often do that with my clients that I work with towards the end, once they have gotten better balance, better strength, better flexibility, et cetera. But break it down. Practice the weight shifting component. Without that, you will not be able to improve getting dressed from a standing position because you need to be able to shift your body weight in order to do that. So, so do the thing that's hard as an exercise, but modify it or pare it down. Just do part of the task so that you can get stronger with that first and then make it harder from there or choose an additional exercise from there. I hope you found this helpful. As an Ms. Specialized physical therapist, I am very aware that it's easy for me to think of how to break down a movement or an exercise or a goal that you're working towards and figure out what. What exercises might be the most appropriate for that goal. And it's not always intuitive to you. So if that is you, if you're in that situation and you're like, I hear you, I understand to do the thing that's hard, but I can't do that, or I need a modification, or I'm just maybe I don't understand. Then I would highly consider you. Check out my online program called the Missing Link. Everything in this program is based on Ms. And functional exercise. Like we talked about today, neuroplasticity. Essentially, the things that you need to improve not just your muscle strength and balance, but the connection between your brain and those muscles which are your neural pathways. And that combination is truly what allows your daily activities to feel easier. Not just getting stronger at the gym or getting stronger in the PT clinic and not seeing those improvements at home or out in your community. So I'll put the link down in the show notes or the description if you want to check that out. But I hope you found this helpful and I hope you feel encouraged and motivated and excited if you were in that boat of Yes, I know exactly what you're talking about. I've done those traditional exercises and they didn't help. I was still feeling off balance when walking or in XYZ situations. Hopefully you feel like, okay, it wasn't me. It wasn't my Ms. I was just doing the wrong exercises because they weren't given to me. Now I feel confident with this approach that I can start improving.
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Thank you for listening to today's show.
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I am so grateful to have you as a listener.
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If you'd like extra resources such as a video of one of my seated exercise classes, my favorite core exercises, and the opportunity to ask me your questions, head to missinglink.com insider. That link will be shared in the show notes along with links to my social media handles. If you loved this episode and think a friend or family member with Ms. Would benefit from listening, please go ahead and text or email this podcast to them right now. Sharing this podcast will help me educate and empower as many Ms. Warriors as possible. Thanks again for joining and be sure to tune in next week for another
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episode of the Missing Link podcast.