“Help – I’ve fallen, and I can’t get up!” is the catchphrase of a popular television commercial promoting the use of a medical alarm system for those at a high risk of falls. Special exercise programs have also been developed to help this population, and stability training programs have been designed to improve athletic performance. Is stability training something you should take an interest in?
The importance of emergency alert systems and balance training for at-risk individuals is undeniable. The Center for Disease Control and Prevention reports that one out of five falls causes an injury such as a broken bone or concussion, three million people each year are treated for fall-related injuries, and over 800,000 people per year are hospitalized because of a fall-related injury. It gets worst.
In a 2017 study following more than 122,000 people over 12 years, the all-cause mortality rate was twice that of those who had a suffered a hip fracture. And in a study of over 320,000 hip fractures, the risk of dying after one year was about one in five! That’s the bad news.
The good news is that intervention balance training programs have been shown to reduce the frequency of falling in the elderly. One aspect of these programs is an assessment of an individual’s walking gate. For example, many elderly do not lift the ball of their foot optimally when they walk due to weakness in the muscles on the front of the shin (tibialis anterior); strengthening this muscle may be one way to improve their balance. In addition to specific exercises and gate-improvement protocols, these programs often include consultations regarding the effects of prescription drug use on balance. Incidentally, one especially safe and commonly-used type of training that has been proven to improve stability is Tai Chi.
Moving on, can stability training give an athlete an edge?
Often you’ll see many exercise programs, especially those for kids, promoting themselves as functional training. Often these programs include athletes exercising on Swiss balls, rocker boards, Bosu balls, balance disks, and other unstable equipment. This begs the question, “Is the best way to improve stability in athletes by training on unstable surfaces?” Michael Jonathan Wahl, Ph.D. attempted to answer this question in his master’s thesis, which was entitled, “The Effectiveness of Instability Resistance Training Devices for Training.”
Rather than using untrained or recreational athletes, Wahl’s study involved 16 athletes who competed at the college or professional level, including a world champion in kickboxing. Using the American College of Sports Medicine guidelines, all these subjects were ranked in the top 10 percentile for upper body and lower body strength. Testing included electromyogram (EMG), a machine that measures the electrical activity of muscles.
Wahl discovered that the brain motor patterns exhibited during these unstable exercises were the same as those exhibited while performing identical exercises on a stable surface. Because lighter weights must be used with unstable exercises, Wahl concluded that such training is inferior for producing gains in strength. In fact, one reason why weightlifters wear weightlifting shoes is that they are more stable than tennis shoes, and this greater stability increases the amount of weight they can lift. So if gaining strength is a priority, then unstable training is not the most effective use of your workout time. Further, there is the risk vs. reward question to ask.
When you train on an unstable surface, you are putting yourself at a greater risk of injury as the movements can be unpredictable and because the equipment can break – people have been seriously injured when the Swiss balls they were using burst, causing them to fall. In fact, at one seminar, the instructor was demonstrating how he could stand on the Swiss ball and still maintain his balance. Despite being an elite athlete with a background in Olympic lifting, he fell off the ball and reportedly tore his ACL! If he fell, what are the chances of recreational athletes or someone’s grandparents being able to successfully execute this skill?
Another issue to consider about many of these instability training devices is that they may deviate too much from the original skill pattern; thus, the strength developed does not transfer to athletic performance (and may even adversely affect performance in the primary movement pattern). According to Wahl, a deviation of just 2.5 percent from the original movement pattern will not transfer to performance.
If you are at a high risk of falling or have a concern about not being able to maintain optimal core stability in sports, one muscle group that should be a focus of your training is the glute medius. Research on the elderly shows a relationship between glute medius strength and the frequency of falling. Further, weakness in this muscle can affect the ability to squat maximal weights with optimal technique or run or change directions at high speeds. Among the best exercises for this muscle are the side-lying hip abduction, single-limb squat, lateral band walk, single-limb deadlift.
The bottom line for athletes is that resistance training with free weights is probably enough to enable athletes adequately deal with the disruptive forces that occur in sport. For example, a football player who squats 400 pounds has to strongly engage his core in dealing with the disruptive forces that try to topple him over. The same goes with other core exercises, such as overhead presses and the Olympic lifting movements and their variations.
Stability training certainly has its place in fall prevention, but the best ways to get stronger and “balance out” an athletic fitness program is to focus on free weight barbell and dumbbell exercises that have become the cornerstone of most athletic fitness programs.