Wobbly - Balance Workshop

Chapter 1

Introduction to Balance

Hello, welcome. I'm Mariska Brulin from fuse bodies in Washington DC. And today we're going to nerd out on one of my favorite topics, which is balance. So this is my balance workshop and I, my goal for you by the end of this is that you have a good understanding of all of the different systems of the body that play a role in balance, but that you also have some really fascinating cocktail party topics to bring up. I'm like, why cat's whiskers are as wide as they are and things like that. So just little bits of random trivia that I found along my journey to understand this topic a little bit better. Um, it's something that's personally really interesting for me because I have ms, so I have some balance issues that are neurologically related. So I know the things that I need to work on for that. But I also have, you know, members of my family who've had hip replacements and people who have bad balance for various reasons. Um, people who have done things like gone through chemotherapy and then they had, um, some neurological balance components that have, you know, come up because of those things that I thought were, you know, really interesting. So if you have questions you can just, you know, raise your hand, not if you're watching at home, obviously then you send me an email. Um, but hopefully we'll answer all of your questions and some things you didn't even know to wonder about. So the first thing to know about, um, balance is there really is no such thing as standing still. So when you're standing still balanced is still playing a very important role in what you're doing.

You're always balancing in some different position that you're in. Even if you're laying down in bed, you're balancing. Um, balance is essentially, you know, if you, if the sixth sense is your ability to know when someone's going to call, when your spouse is cheating on you, all of those things then we would say that balances your seventh sense. But I would say that more logically it's your sixth sense. Um, it is actually something that your sensory motor system, um, plays a big part in. So it is something that's like you take in information from your world, your body processes that information and balance is something that occurs from that. Um, it's a learned behavior so you get better balance if you practice it, which is great to know because if you have bad balance then you know you can practice and get better. It's extremely trainable. And if you ever wonder if that's true watch and any kind of circus act where they're doing some level of insane balance, they probably started working on that when they were like two or three years old to get as good as they are when you're seeing them on a stage.

There are many things, a balance that are reflexes, so they're not things you have to think about. They just happen. And we'll talk about those. And um, it's also really crucial for wellbeing. You could lose your sense of sight and really be able to navigate the world still. You could lose your sense of smell, you could lose your sense of taste and they would not in any way be as devastating as if you lost your sense of balance. Like you really are not able to function in the world properly if you have no sense of balance. Um, and by definition, and there's like a million definitions out there if you Google definition of balance, but the one I like is that it's an even distribution of weight that allows you or the object or whatever to remain upright and steady over your base of support. Okay.

So today we're also going to be talking about static balance versus dynamic balance. And I think a lot of times when people are working on their balance practice, they're really concerned about static balance of can I stand on one foot and can I, you know, do a handstand or something that they're working on. But dynamic balance is actually where balance is most important because most of the time when people fall, they're going to fall during a movement, so they're going to fall while walking or something like that. It's very rare that people just fall right down from, from where they're standing. So dynamic balance is something, as we go through today, we're going to talk a little bit more, we're going to go from more static exercises to more dynamic exercises because that is really how you progress. Balanced training is you go from the standing still stuff, which is actually easier to the dynamic balance, which is a little bit more difficult.

So we can't talk about balance without talking about alignment. So if you don't have proper alignment, it's going to be very hard to find proper balance. And alignment is the position your body needs to be in to work properly. So sometimes you know, we think about alignment as your upright alignment. Like is your head stacked and are you, do you have that plum line?

Are you stocked head over shoulders and as they're going straight down through your knee and middle of your ankle. So that is one form of alignment. But we're also going to talk about what is your alignment supposed to be in different exercises to find the best balance within those exercises. Like I said, alignment is a critical part of balance and that is also a reflex. And what's really interesting is alignment is a reflex that can be, um, kind of mistaken. So a lot of times you'll see people, and I see this all the time and you'll see people lying down on a mat and you're like, do you feel straight? And they'll say that they do. And you're like, really? You feel straight? And then you correct them because their head is like cocked over here.

And then you put their head backwards and they're like, I feel totally crooked. So you can learn an alignment pattern. That's an incorrect alignment pattern. So whenever you're doing balance training, it's really important that alignment training is a part of that training. When you have better balance, you're going to have better health, like the systems, the circulatory system, the respiratory system, all of the different systems of your body are going to work more effectively. Um, when you have that better alignment and better balance, you'll also better have better health and that better quality of life and you'll have a longer life. So there's, um, sort of near the end of the workshop today we're going to talk a lot about balance and aging and what happens as we get older.

And really the balance systems start to fail all at the same time. So you have multiple systems of balance and I think we were only supposed to live to like 40 and back in like the 16 hundreds we did, we only lived to like 40, because all the balance systems start to fail around the same time. So if you don't maintain balanced practice as something that you're doing throughout your lifetime, your quality of life really becomes negatively affected as you get older. Um, and the thing to know about balance is that most balance problems are preventable and most balanced disorders are treatable. So there's going to be something that you can do for almost anything that you have wrong with you in the balance world. So our agenda for today is first we're going to consider center of gravity.

So if you don't have, if can't find your center of gravity, you're not going to have good balance. And that's true for yourself or an object if you're trying to like create, you know, some stacked thing or play Jenga, you need to like make sure you have like center of gravity figured out. We're also going to review all of the different neurological components that influence balance and there's three main ones, but we're also going to go a little past that because we have to go into a discussion of other things that influence balance, which would include your flexibility, um, power, which would be like how fast can you move if you trip. So if you trip, you have to move really quickly to catch yourself back. I mean, everyone's done that trip on the curb. And then the super fast run and then you try to look cool cause you no one saw that. Um, we'll also talk about muscle strength and imbalances and where that can throw your balance off and aging of course. And then we'll overview some common balance problems like Vertigo, um, some different balance disorders and exercises for those different balance problems.

So first thing we're going to talk about is posture. Um, and I don't think you can have a balance training program without including posture as part of it because when you have bad posture, your balance is automatically affected and for um, good posture, it's the mechanical position that your joints should be set up in for their optimal use. So if you have somebody who's like very hunched over or has super forward head or their shoulders are really collapsing forward, they're already sending their weight forward. So, um, I think it's like 30 pounds of weight for each inch. Your head is forward from where it's supposed to be. So that's basically already sending you in a tilting forward, falling forward position, um, which inhibits your ability for your legs to move properly. So then you're walking becomes less hip extension and more like, um, hip flection.

It's a little bit more marching and a little bit less of that smooth controlled gate that you would want to have. Um, you also have, um, some impactors where you have some postural control things that, that happened that, and that's just reflexive. So you have sometimes a reactive postural control where you'll kind of stumble off and you'll kind of reset your posture and we'll talk a lot about how that happens. And then you also might have like an anticipatory or predictive, something that happens. So if you start to fall, you just grab for something that's near you. Hopefully not me if I'm standing near you, but you just like grabbed something and you try to steady yourself. So that would be a way that you are trying to correct your posture a little bit to keep from falling. So like I said, every balanced program should include postural corrections and like a really deep connection to alignment. Um, and that alignment needs to be correct in whatever exercise that you're in. And we're going to do some examples that will show kind of how that works. Um, and also need to think about in flexibility that can lead to poor posture.

So we'll talk about it more later, but it's like when you have tight pecs that pull your shoulders forward, that's going to affect your posture if you have very tight, um, Dorsi flexors or really tight ankles, um, that can like change your posture when you're walking so that you're more like of a toe walker and less getting that heel strike when you're walking, which also sets you off balance. And that's more in that dynamic balance thing that we're going to discuss.

Chapter 2

Exploring Center of Gravity

So first up, let's talk about one of my favorites, which is center of gravity. So we have this picture here, um, where we're seeing a person in three different positions and the little dot that you see on them is where their center of gravity is changing. So we all understand that gravity holds us to the earth, but what gravity also wants to do is it wants to topple us down towards the earth. So if you have maintained your center of gravity, that's the place where you can be balanced without falling over and it kind of changes in your different positions. So, um, our center of gravity is humans actually pretty high.

We're like designed really poorly to have good center of gravity. And then the taller you are, the higher your center of gravity is going to be. And then when you start moving closer to the ground, the lower your center of gravity is going to be. So essentially the center of gravity is the average location of the weight of an object where it's not being forced by gravity to rotate in any direction. So that rotation would be like, I could lean here, but I'm making adjustments to different things by like shifting where weight is so that I don't just like fall over to the side.

So I'm adjusting my center of gravity in that exercise. Um, because your center of gravity is going to shift. So you need to figure out, like in every exercise that you're doing or every movement that you're doing, you need to figure out where your center of gravity is. Haley, you're kind of tall. So I'm going to use you as an example. So I want you to come up and I want you to sit and you're going to sit sort of like I'm sitting with your hips down and your feet down and her knees are bent. So right now her center of gravity is just, you know, it's sort of low. It's sort of middle. And so right now, um, I just want you to reach your arms forward and then I want you to stand up.

Yeah. And her, her, um, so she, I slipped a little bit so I couldn't keep the pressure down, but that was hard, right? Yeah. So the reason that she couldn't stand up, so we'll do that again. I know this is really weird. It's like I'm just pushing my finger into her forehead. You should try this with your kids at home.

They'll find it very fascinating and she's like coming up. But the reason she was able to get up at all is she had to shift her center of gravity forward to be able to move her weight above her feet. Right. So it's like when we're standing upright, our center of gravity has to be on our base of support, which in this case, in this situation is our feet. Another little example, and it's a little bit harder to show on a Cadillac than it would be to do on, for instance, against a wall. But I want you to stand really close, so I want your right foot to be against that, um, base. You're gonna bring your shoulder against here until your head to the side. And I want you to lift your left foot up.

So now the reason she can't lift her left foot up, and I'm going to sort of do the same thing standing here. So you try to lift your left foot up and I'm going to lift my left foot up. So it's probably not even that perse, like easy to perceive. But what I'm doing that she's not able to do is I'm finding the tiniest shift over towards the side that's letting me, so I'm gonna exaggerate it, that if I'm going to lift my foot up, that I'm moving away from that foot so that that foot can lift up. So that would be like an example of where your center of gravity, if you can't find it, you literally cannot move. Right?

So with movement, you're going to have to be able to find that center of gravity. I know she's such a good support. She's just sitting there. She's like, I'm going to do this. I'm going to get my foot up. Like I will tell you, it's like a way you can do it. Actually. And this is kind of an interesting thing. This is where you'd find a compensation for not being able to find your center of gravity. Bring your right hand around the bar and Paul. So it's like I just gave her some other thing to do where she could like move her center of gravity. So now let's come over here. Since you're here, we're going to do, um, washer woman or standing pike or whatever you want to call it.

Everyone's got different name for it. So this is like a great example of an exercise where we're going to come into from position number two of that outlined man to position number three of that outline, man. And first I want to make sure that you, um, I want you to do it wrong first. So I want you to really do what your body naturally wants to do. So you're going to stand about your foot's distance away from the base here, and then come to blaze V, reach your arms up towards the ceiling and then, um, forget everything you know about [inaudible] and every platas class you've ever taken, just fold forward and push that pedal down towards the floor and then lift it back up and come all the way back up. So I want you to even exaggerate that more because this is what like an, like normal, the normal world would do with their center of gravity is you would lift your arms up again and then you would fold forward.

And she like a normal person would stick their hips way back, right? So what you're doing there is you're t you're changing your center of gravity to make the exercise easier. So it's not like people are thinking about, you know, if you just had somebody come in and they'd know apply, he's trained, didn't know about finding their core or lifting your abs or anything, they're just going to come into the most natural center of gravity adjustment that they could come into. So lift back up and now we're going to do it where we're going to have to work harder because we have to control that shift that wants to happen with center of gravity by engaging our abdominals. So round forward, you're trying to keep your butt where it is in space. And what I see there, and so I don't know if you noticed this, but I always tell people when I'm teaching like a group chair class, if your toes are gripping the floor, that's probably a good sign that you're like in the right position because you don't get to shift back. So from here you're going to press the pedal down, shoulders are down and then I'm, we're not going to do the pumps or anything and then lift the pedal back up. And then I, this is my assist, which is, I always say I would do a lot of anti assists because I basically make it harder by not letting her lean back at all. Cause I have my hips like right against her so she can't lean her butt back into space at all to change that center of gravity.

So then it's all abdominal work to lift you up to try to keep you in that position. Does that make sense? Thank you. Thank you for looking like a fool on camera for us. But everyone at home, I've, no, everyone at home is going to just go up to their wall and be like, I don't understand. I don't understand. It doesn't make any sense. So another couple of things about center of gravity that I think it really interesting is that humans are essentially really hard to balance. We have two thirds of our weight is basically like from like our hipbones and up, which means that we're, you know, like easy to just topple over. You know, most animals are also, you know, quadro peds. So they walk on all four legs. We're only walking on two legs, which means anytime we're walking, we're standing on one leg as we're walking. So we're standing on one leg and we're standing on the other leg and we're standing on the other leg.

So there's always that swing phase where we like we're balancing on one foot highly inefficient, which means we can't run across like, um, telephone lines the way like a squirrel could cause their center of gravity is Super Low. And they also have, you know, a base of support that's much bigger than our base of support. Um, we also have, um, the thing that when you have that low center of gravity, the easier it is to balance. So I posted this video, I think I posted on the please anytime page. I definitely posted it on my own webpage and it was this great video cause it's snowing where I live and it's this woman who is wearing really impractical. We'll just gonna call them stripper shoes cause that's there. They're like really high platforms. Stilettos, she's got very tight, tight, tight jeans on. And she's like this walking down ice because she first, she's lowering her and I said, I'm like, this is my workshop.

It's like the whole thing is right here cause she's lowering her center of gravity. Right. So that she's like, like you feel much more stable if you're like this. I don't know if you've ever walked down a really steep hill. Like you're just naturally going to do this. You don't have to think about it. It's like your instinct is going to say get low. You're less likely to fall. Plus you're closer to the ground. So if you do fall, it's gonna hurt less.

But people will like walk really, really slow and they'll walk like this. But this girl was also, this was amazing. She was like sliding and walk you. But she was, you know, she was reaching her arms out because your arms out. It's also gonna Change her center of gravity. Um, and you have to remember to, if you're carrying something, when you carry things, they're going to have a center of gravity too. So if you have a kid like the, most of the time when you pick up a kid, if you're a woman, you shift your weight to put the kid on your hip, right? Which is not so good for you as the day goes on, unless you balanced them and shipped your kid to the other side.

But it's a natural weight shift to adjust for what you're carrying if you're carrying, um, groceries, like I always try to get his, I live walking distance to grocery store, always try to get them to distribute the groceries into two bags, even if they could put them all into one bag so that I could carry them and be a little bit more balanced and stable. Um, when you're moving, it's easier to maintain your center of gravity sometimes then when you're standing still because it's, you make these kind of unconscious adjustments to what you're doing. So if you're walking and all of a sudden your center of balance is changing a little bit because let's say you're carrying your kid who used to weigh just eight pounds and all of a sudden weighs 30 pounds and you're S, you know, moving to the side, it's easier to kind of make that adjustment during a motion then when you're standing still. Um, but in any case, you want to be able to tune into your foundation. So whatever the exercises, whatever the movement is, if you can tune in and ground yourself into what is your base of support, your center of gravity, basically we'll s we'll try to stabilize itself. Um, for tight rope walkers. Um, you know, how they, the Poles. First of all, I would like you to know that the official name for tight rope walking is financial financial dualism, which I just feel like everyone should like use fun, ambulate them, like ambulate them. That's fine. Even though it doesn't look fun to me, it looks pretty scary. But they have the Poles, which I just realized, um, when I was doing some research, those polls weigh about 50 pounds. So you would think that the polls would be, you know, like super light. It's sort of like when you're walking and you just bring your arms out or any kind of balance thing, your natural thing is you extend your arms because that's going to move your center of gravity a little bit lower.

But not only are they extending their arms, they've made their arms, which in the polls be, you know, four times longer than their arms would naturally be, plus 50 pounds of extra weight, pushing them down into the tight rope. So if they can maintain, um, not have a turning force, like not like turning like this and they can keep the bar like directly over their shoulders, they're going to feel much more stable. I'm still not going to try it, but I like that. I understand the principle of it a little bit better than I did previously. Um, you can also see some times, um, if you look at race cars, like the faster cars, like the formula, whatever. See, I don't even know. That's really sad before. What are they even called formula ones? Like that's sad. Okay.

So the Formula One cars are like super low to the ground and like all like the more sporty cars are super low to the ground because they have a lower center of gravity and they feel like I have a mini Cooper and they feel like they grip not like a Formula One mini Cooper, but they like grip the road. Right. So cause it's like they're lower, their center of gravity is lower until they feel like they're firmly into the ground. So anything that's lower is going to feel more stable. Same thing with like a boat. Like my dad had this really poorly built boat and I don't know if it was like how they keel was that it was just, the boat was like a little bit too much shaped like this and it wasn't like broad enough and it was just the rockiest boat you've ever been on. It just wasn't, there was no stability in it because it didn't have a good center of gravity.

So it's not just us, it's also, um, other things. So I'm, I'm borrowing this concept a little bit from Kara Reeser because I love how she explained it and I think it made a lot of sense. Um, I didn't think of it as center of gravity the way she described it, but then when, um, I was looking into this and I was like, oh, it's basically aligning things for center of gravity. So this woman here, this is a picture a friend of mine took in India like literally a couple of weeks ago. I think she has 13 crates of eggs balanced on her head. Um, which sounds terribly dangerous in so many ways, but since it's going straight down, that would be like easier wait for her to carry than if you said please carry 13 crates of eggs in front of you. That sounds like a just a for disaster. I'm not quite sure how she stacked them that high. Like, if there was a, there's a place you go into and then they just slide it on your head.

I don't know how that happened, but, um, whenever you're doing something and you have in your trying to create your figure out your center of gravity, if you consider yourself as multiple cylinders that are stacked on top of each other, you can adjust your center of gravity by adjusting those cylinders independently of each other so your torso can move separately from your legs, for instance. So if you're, you know, if you're here and you're losing your balance, you can move things over. Like you don't have to stay in this complete straight upright position. Um, it's also going to be harder for a turning force, which would be like a turning force might be me pushing you over, which would be really rude. And I would never do that to any of you. But if I was just gonna like push you like this, well maybe my husband if we were in your pool. But yeah, if I was gonna push you, that would be a toppling force. But if you're, um, if you can move like this, you can react better to that toppling force then if you didn't have the ability to move these individual parts separately. Um, I liked the idea of, um, when Carrie, I was working with her privately once and she said something about like, you know, you collect your cylinders, I think that's what she called it, but you were like literally like your next cylinder and your head cylinder and your shoulders and everything and you would collect everything together and then you would find better stability. And I thought it was a lot easier concept to think about cause they're just, you know, it seems very simple, like simple, but yet not so simple. So Francine, can I have you come up here for a second?

So we're going to look at cylinders of Francine in this one exercise that we've all done a million times. So I want you to just come into a side plank. So just right on the floor. [inaudible] I don't care which hand, I don't care if it's forearm, whatever makes you happy. Forum's going to be less comfortable. So right here. Um, she is like a nicely stacked, aligned all of her cylinders, right? So it's like her head is in line and we say Chin and line of cleavage and then her shoulders and everything is stacked.

Now I want you to take your legs so we lower down for a second and just swing your legs back behind you a little bit like further back. And then I want you to turn your head and just look down. So now I have thrown her cylinders out of like where their alignment would be. Now I want you to lift up and how balanced do you feel right now? Less so less so. Okay, so come back down [inaudible] no, or play around with it.

And we can just play around with these different positions. Like if we put your feet even more far forward. So let's go really far forward with your feet and like let your head tilt back a little bit and then lift yourself up from there. She's like, really? Seriously? Mariska I came all the way here for this. So you feel really unbalanced, right? So it does, it's not like a position that you could maintain that balance for very long.

So what we're looking for in exercise in any exercise that we're going to put somebody in is that they're going to be in proper alignment so that their center of gravity is going to be easier to find and their balance is going to be easier to hold. Okay. Thank you. You don't need to do any more of those. You're like, okay. [inaudible] so let's look at some, um, other exercises that look um, at center of gravity. So a favorite one of mine is, um, we're going to first come to standing. Everyone just so we get a sense of our center of gravity. And so you should probably feel, you know, relatively stable in the position that you're in. And then if you walk your feet a little bit closer in towards each other, that's going to feel a little bit less stable, right?

Because you don't have as wide of a base of support. And then if you go with your legs like really wide and you just kind of squat down, unless your muscles start getting tired, you could, you'd be hard to push over from this position, right? If I came over to you and just pushed on you, you'd be able to stabilize yourself. You'd be able to walk down Stone Mountain in Atlanta, which is really steep if you haven't done it really, really steep, like you walked down like this, but you'd be able to like walk down that Mountain, have you come upright and you tilt your torso over towards one side. What is the reaction that happens in your opposite leg that your hip is going to go that way? Right?

So you've moved these cylinders over to this way and it's not even like super perceptible, you know? And sometimes employees were like ground through that opposite leg so you don't like move too much, but you're still going to have like a perceptible shift in what you're doing. Um, most people here have math. So we'll just come down and do one where you're just going to come into, I'm going to call this like a short lunch. So my shoulder is going to be over my bottom knee and my front knee is forward and this should feel like a very hard balanced position, not like crazy, impossibly hard but harder than this.

So why is that? Because my base, this is a wide base and this is a short base. So I spend um, kind of a lot of time in working with Neuro Rehab people and this is a favorite exercise for the world of Neuro Rehab. So Alegra can I have you scoot up? So it's sort of for a couple of reasons. First because you have, um, so if you can down, if you want the mat you can use it. Um, you have first you have the co contraction of your quads and hamstrings of both legs working at the same time. So it's a great exercise to teach you from hyperextending. So if you're doing this, um, kneeling short lunch, which is the old, you would see a lot in like neuro rehab. Um, it's, you're getting the co contraction of the front and back, quadriceps and hamstrings, which is really essential for gait. And this is actually a good thing in terms of having people get up from a down position and also like this motion ultimately becomes part of Gait.

So if you're working on gate, but if I want to make this more challenging for her, we're going to play a game of catch, which could be really embarrassing cause we doing it on camera. Good Lord, help us. Okay, so I'm gonna throw this to her. She's going to throw it back. I'm going to throw it a little bit to different sides so that she has to adjust her center of gravity a little bit. What's not really her center of gravity, but she has to adjust her position a little bit to catch the ball and she doesn't know what's coming. And another way you can do it is let's say you don't have a ball. You could say, tap my hand and then tap my hand. Tap My hand, tap my hand. So there's a lot of actual, I'm in the neuro rehab world. There's a lot of games.

So you do a lot of playing with balls and patty cake and stuff like that. So it's just to see how we can throw her maybe a little bit off balance and sort of challenge that here. Let's um, put the mat away and then we're going to do an exercise that I think you all might not have thought about as a center of gravity exercise. But I promise you it is one. Um, and that's doing swimming and rocking on the step barrel, which I love this exercise, I love it, but much more than doing it on any other piece of apparatus because I think it's really fun cause it is that added balance challenge of you feel like you're gonna topple over. So we're gonna come lying down on your stomach with your arms reaching forward. And you have to find that happy spot where you're finding right where your center of gravity is, where you can extend your arms forward.

Let me know if you need me to move the good and that you can flood her arms and legs. So we know because of where she is that her center of gravity is at right about here. Okay. So now reach back for your ankles and then lift your legs up a teensy bit higher and we're gonna take it into rocking. So this does not always work that your center of gravity for rocking is going to be the same as your center of gravity for swimming. Um, Alegra is not a tall person. So for her it's probably a little bit easier for her to find her center of gravity. Then if you have a really long limbs or if you're maybe like more bottom, like you have more of your weight in your legs and she's very like evenly distributed, but she can play around with like, does it feel better to be further back? Like did that feel that adjustment?

Yeah. So she said it was a little scary before. So that's another thing we're gonna actually talk about a lot about balance, like kind of causing some fear, right? So it's like no one wants to fall down, especially if you've done it before, broken something. Go ahead and come off of that. So when you're talking about center of gravity, we also, we talked about a little bit about turning forces and how turning forces can kind of set you off a little bit. We're going to do stomach massage variation. We're going to do two of them.

So first you're going to have a seat and just come into your stomach massage positions. So feet are up, heels together, toes, part, arms are here. Do you feel a little congested or do you feel good here? Okay, so just do regular first. Just repressing out, lift your head up a snitch and try to get a little more extended. Three short good. Drop your heels down and up and then bend to come in. So here like we haven't done a lot. There's nothing crazy happening. We haven't moved her to a different plane, right?

She's just moving forward and back, right? Your arms forward. We're going to lose the heel, lowers, sorry, trumps forward towards me. And then you're going to press out and rotate your right arm open and then come back in and then you rotate your left arm open and come back in. And so this should feel a little bit, do you feel a little bit less? Keep going. I feel a little bit less stable, right? Cause she's added this rotation. So that's a turning force. So attorney force would be anytime that you're adding a movement that's going to send your center of gravity a little off balance. So now I'm going to give you this beautiful Gondola Pole. Um, this was probably about, gosh, I don't know, like eight or nine years ago I worked with this teacher whose name was Matt.

He was in Portland. Once you lift your arms up, bring it over your head and bring your elbows super wide. So we're going to do that same exercise so you can have it like right, kind of at the base of your spine. We're going to do that same exercise, but you're going to turn with this pole and then come back to center and turn the other way. Emily's always, she's always smiling and come back to center. Is it hard? Yeah. Okay. So what's hard about it? Um, well I'm sore from your class. Yes. She's sore from my past sister. You know, whatever it's hard to twist with. I'm having my hands out more like this with the weight of the bar and the bar is also pulling. So let's say I'm more just as an example.

So I'm gonna put you off balance just so I'm gonna give you the warning. One with three, found some person on purpose, reach out to this side. So the same thing you were doing. So push out. So let's say her body was more like that. So more like if you were doing tilt, um, on the reformer so that you feel more off balance, I'm sure. Right? So, and it's also because you're not to having this turning force.

Let's say we'll come back to center and I feel the tightness in my lower back and we're pointing out the tightness in her lower back. Yeah. So I want to, I like this, the pulse seem short compared to the one that I had to do when I did it one time and I was just sitting there like, are you kidding me? Like when I was doing it like it was so hard, so much harder than normal. So if you're adding, I'm going to take this from you if you're adding this destabilizing extra force. So if I was going to be a tight rope walker and I guess there, hold it like this, how do they hold it? Hold it here. I don't know how they hold it, but however they hold it, it's like this is going to be like a more stable thing.

I don't know how much these way but a little bit. So I feel a little bit more grounded. But you add like a turning motion and I feel less grounded. Right? Because I have weight that's pulling me to the side. And when you're twisting, you have to really work on maintaining this being at the same height the entire time. Cause once it starts turning a little bit, it's, it's cylinder is throwing you off balance a little bit, if that makes sense. Good. You were going to talk about the vestibular system.

Chapter 3

Vestibular System

The vestibular system is fascinating because it is literally literally where everything begins in terms of balance. Um, in evolution it is one of the very first senses to develop in any creature coming out of the primordial ooze. They had vestibular systems in terms of um, US developing in utero 24 hours. From the time an embryo starts forming, the vestibular system starts forming 24 hours. That's how early it starts. Um, it first begins at that time, at eight weeks, the vestibular kind of complex, the labyrinth looks almost identical to how it would look in any of us. Right now at 13 weeks, the nerve pathway develops from the vestibular system to the brain.

It is the first, um, myelinated nerve fiber in the body. So it means that means it's the first one that's going to get like a full signal from the sensory system to the brain. And it's fully, completely intact by 20 weeks. So 20 weeks. Yup. Your vestibular system is fully formed by 20 weeks. Um, does anyone have any idea why we have to have it happen that soon?

So the vestibular system, what it does in essence is it tells up from down forward from backward and velocity. So if you are a baby that's getting ready to be born, you have to know up from down because you have to rotate so that your head is down for the most, you know, easy and correct. Birthing process. As an example, my nephew, um, Jacob, who's the cutest in the world, I'm sure all of you think you have cute babies, but really he's the cutest one. Um, except my sister-in-law Joelle's gonna Watch this. So I should say that her kids are also equally as cute. Love you, Joel. Um, he was born at 25 weeks.

My sister in laws water broke at 23 weeks and he was born headfirst. So he already rotated. So babies are not supposed to rotate til 28 weeks, I think is the time where they go head down. Um, but he went head down cause he was already coming early and he went head down early. So at one pound, whatever ounces, not very many. He was born headfirst because his vestibular system was fully cooked. His lungs were not fully cooked, his eyes were not fully cooked, his hearing was not cooked. He didn't have cartilage in his ears. The number of things that when you're born that early or not fully finished is astronomical. But your risk tubular system is complete at that age.

Um, the vestibular system is a labyrinth, which that's such a great word. Um, it's an extension of the inner ear. Um, the entryway is, um, the temporal bone. And so the temporal bone is some of the hardest bone in the human body. And that's important because that indicates how important the vestibular system is, that it's got this like rock hard bone protecting it, but you do not want your vestibular system to be damaged. Um, so there's, there's a lot of fail safes to protect your vestibular system. It senses motion from both head movements and from gravity. Um, the central nervous system responds to those movements and your posture and i's adjusts, which we'll talk about in more depth. Um, the vestibular system information not only travels to your central nervous system, to your brain, to like your motor sensors and your vestibular sensors, but it's also travels to the parietal lobe, which is where your orientation is, um, put together. So like your sense of spatial orientation, which I hear some people have.

I really don't have one because I haven't can't read maps and I don't ever know where I am in space. But when, um, people come out, for instance, when you come out of a subway and you're looking around, it's like your parietal lobe system is trying to figure out where you are. Like, what is your orientation? You come out and you're sort of like lost for a minute, where you try to get your bearings and that's what, what that does. So it's all going to start with the semicircular canals. And that's the first part, like coming from out of your head into your inner ear, you hit the semicircular canals first. So those semicircular canals are um, oriented at the, approximately the three dimensions of space. So in terms of the planes, it's x plane, the y plane in the z plane. So that's basically where they are.

So you can see them on the far left of that picture. Those are the semicircular canals when tilt or move your head. So if you're tilting your head, this is called pitch. So this is the pitch of your head. Same with the boat. And when you're rotating it's called Ja. So pitch and Yall, so similar to if you're on a boat, your eyes rotation around the z axis and pitch is movement along the x and y axis. And within those semicircular canals, you have um, something called the ambula.

And there's also the Copula and they're basically like, um, you can see them. They're super tiny. Those little black dots that are within the semicircular canals, those little black dots are filled with something called Endo, lymph and endo. Lymph is a liquid that reacts to the movement of your head. So, um, for instance, if you have a bottle of water, um, if you look at my burgers, if you have a bottle of water, this is going to represent the ambula. So when you move, the water is going to move or the endolymph is going to move and push on one side. So you know that you've moved this much to one direction.

And within the ambula itself, our hair cells. And so there's a little hair cells and those are what connects into the central nervous system. So the, the amount of bend that those hair cells have had is a signal that goes to your brain where it's integrated in the cerebellum, um, with other information about past movements. So it's like I said, it's learned behavior. So you're like, oh, I know when my head moves this way, this is, you know, whatever happened. Um, and then when it moves the other way, then the hair cells are gonna move back. Or when it turns, they're going to have a slight amount of movement. So that would be Z, axis x and y, x and y. So, um, that's part one. Part two is the otolith organs. So when you go past the semicircular canals, you hit the otolith organs.

So in Greek otalyth means Iraq's, which is kind of awesome once we find out what, what they've gotten in them, um, that's the, that next part where you're going to see something called Ooh, trickle. And the saccule and the utricle and the saccule are going to give information about forward and backward movement and up and down. So the forward movement, um, the horizontal movement, like walking, that's the electrical tells you information about that. Or if you're on a reformer for instance, and you're moving out and in, right? So that's telling you information about the movement of your body in space.

That's why the reformer is so fantastic for vestibular training. And then the saccule is going to tell you vertical movement. Like, if you're going up in an elevator, you know how you have that weird moment of like sensation that you've moved or if you're you going down or up. And that's what that's going to tell you. So the reason they're called Iraq, like Iraq's or otolith organs is because within the utricle and the saccule, there are calcium carbonate crystals, which if calcium carbonate sounds familiar to you, it is the main ingredient in tums. So we have Iraq's and toms apparently in our heads at all times. And the rocks are what are going to push against the hair cells, right?

So they're going to tell the hair cells here that there's been movement within these, within these planes. So once you get that information, then it has to be processed. So like anything, um, I know some of you have seen my workshop on neuroscience and exercise and we talk about the sensory system and how things come into the body. It's processed by the brain and then motor output happens and then the brain tells the body, do this because I just got this information. So the information that you're getting from the balance system, which is vestibular plus visual plus proprioceptive, which we'll talk about as well, it's going to go to the vestibular nuclear complex, um, which is the part of the brain that's going to process it first.

And then it's also processed by the cerebellum, which like I said, is where learning is integrated into the information that's being sent. So the cerebellum basically controls movement and then that information is going to be sent out to the motor neurons. And then two things are going to happen out of the vestibular system, which is adjustment of the eyes to basically maintain your balance in your eyesight along the horizon and postural adjustments and limb adjustments so that you can maintain your balance, which is the easiest way to say how it's all gonna happen. So all that information is relayed along the eighth cranial nerve. And the only reason you would ever need to know it's the eighth cranial nerve is if you're a neuro anatomy nerd.

But also if somebody has any damage along the eighth cranial nerve, for instance, if they have ms and they have d myelination in any place along the eighth cranial nerve, it's going to affect the stipular balance.

Chapter 4

Vestibular Stimulation

One thing that we're all extremely familiar with is something called the vestibular ocular reflex. So there's one of those things you might not realize you're familiar with, but I promise you you're doing it right now. It is how we coordinate steady fixation of our eyes during movement because if we were able to, every time we moved at all, our eyes moved with us, we would be very unstable and probably fall down constantly. Um, I movements are going to be matched exactly in velocity and amplitude to head movements, but it's not going to happen in the same direction, right? So if you move your head one way, your eyes are not going to just move right along with your head.

They're going to kind of stay where they are as fast as you're moving your head. So you turn your head really fast, your eyes are going to move in the other direction. So your gaze is going to stay steady unless you make the conscious effort to move your eyes. You have six muscles in each eye. You have, um, abductors, adductors, elevators and depressors. And then you have two extra muscles that are solely interested in this reflex.

So that's all they do is make sure that the vestibular ocular reflex happens correctly. It's completely involuntary. You, you can't make it happen. You can't try to make it not happen. Um, and it sort of works. Um, I like to compare it to the internal obliques. So it's the lateral part of one and the medial part of the other are going to kind of act together so that your eyes, you know, this part of your right eye, would you be going for the more lateral side in the more medial side? So that's how your eyes going to react. So a little example of how it works.

Hold your hand in front of your face and then you're going to shake it and it's blurry, right? So it's blurry. But if you move your head and look at your hand, it's not blurry. Right? Cause you're this tibular ocular reflexes sort of stabilized it. Another thing you can do is if you try to just try to move your head and like have your eyes go right with your head, it sort of doesn't work right? You like to think it works, but your eyes will lag behind.

Second happen exactly the same. But if you give yourself something to look at like so you're going to say, I'm going to look at my finger and then you can move your head and your eyes together. So if you're going in for a neurological exam and they want to see if your vistibular ocular reflex is working correctly, there's a lot of this eye tracking kind of stuff that they want to do. So it's not, it's about the visual system. It's also about that reflex and how that reflex is happening in your brain.

And so here's just a visual representation of what happens is you have some sort of detection of rotation in your vestibular system and then the vestibular ocular reflex happens to compensate what your eyes are doing. So it's going to inhibit the muscles in one eye side. And contract the muscles of the other side of your eyes. And then secondary to that, so we have to adjust her eyes so that we don't get dizzy. We also have to adjust our posture. So that's the other motor response of that.

This tubular system, it's going to compensate for head movements, um, and it, the brain is going to send muscles along the spinal cord towards, uh, to control both posture and your distal limbs. So if you feel like you're going to fall, for instance, your arms do this sort of shoot out thing. Um, like if you trip for example, the natural reflex that you're going to have is your arms are going to shoot out and your head is going to lift up cause you're just doing this to get your face out of the way of whatever it is that you've tripped and begin to fall towards. No vistibular system also has some very, very interesting little, um, things that happen with it. Um, we actually really love stimulating our vestibular system. Almost all of us do it quite often. If you're the kind of person who likes rocking chairs, you are stimulating your vestibular system. Um, I'm one of those people who I tend to, like when I'm laying in bed at night, if I can't sleep, I rock. I just kind of like rock a little from side to side.

I tend to be fidgety anyway. Um, we rock babies and I, my good friend, um, addy just had beautiful little baby girl and I was, you know, holding her and I'm like, let's see, does she like horizontal movement? Does she like up and down movement? Cause you know, sometimes babies seem to have a preference, right? So now even the like little baby chairs, they have all the different settings and they have like the front to back and side to side and circular and up and down and whatever. And it's because, you know, different people will have like different preferences for what vestibular area they like to have stimulated. Um, it also creates excitations. So this is where we like roller coasters unless we don't like roller coasters. But some of us really like roller coasters. Um, jungle gyms like kids' playgrounds are completely geared to stimulating the vestibular system. We have swings.

They've gotten rid of a lot of the really fun stuff because it's too dangerous, which is just sad. But like teeter totters and things like that, that's all this stipular stimulation. And it's really important for children to have this stimulation because it helps to program their motor systems. So if they're not having this stimulation throughout their childhood, they're not going to get a properly developing motor system. Um, they really need to explore these different movements to learn different skills and reflexes. Now, on the darker side of the vestibular system, um, harassments Darwin, who was the grandfather, this is your first cocktail, little tidbit of information. You can go tell someone and they'll be amazed. Um, harassments, Darwin, Charles Darwin's grandfather, way back when he was alive, had this idea for this spinning chair, which is illustrated right there to pacify people who were in at that time, they were called lunatic asylums because they realized that first, you know, that the stimulating the vestibular system does have this pacifying effect. But it also, when you overly stimulate the vestibular system, it has a nauseating effect. And when you throw up, they at that time thought it was really therapeutic. So they made that chair.

And so what they would do is they would have like a, you know, orderly or whomever would basically turn, and this actually reminds me very much of a thing that was at a playground when I was a kid, that she would turn it around. And so you basically wind it up, right? And then you let it go. And An unspin is really, really fast. But they would, they would have these chairs and then they developed further over the years where they would sometimes have four people, could be in these chairs at the same time, and they would spin them up to 100 times a minute. So they would just spin them and spinning and spinning them. And then of course they would throw up because that's what happens. Um, and it was, they considered this therapeutic. Now the original lunatic asylum, where this was used was bedlam in England. So the word bedlam is actually the name of a lunatic asylum and this is the kind of stuff that they did there.

So I am going to call these people the original spin doctors because they actually did spend people to have some sort of therapeutic effect on them. Now fast forward couple hundred years, they still use rotational therapy to study the effects of like Vertigo on balance. So they still do things to people like um, if you've ever watched anything about like how they train people for space, where they put them in that like, I don't even know how to describe it. It's like something that just spins in all sorts of directions really fast. Or if they're training people to deal with like g forces who are pilots, they're basically putting people through not something totally dissimilar to what these doctors were doing back in like 16, 17 hundreds to help them acclimate to those feelings of nausea that they were going to have from all of that vestibular stimulation that they were going to get from whatever environment you would put them into. And we're going to talk in a moment about the vistibular training that you can kind of train out the nausea that you might get from, from different things. Um, so this picture is actually of me.

I'm the littlest one in there that I was five and that's my sister. And those were my Dutch grandparents. And that's this big blue station wagon. And the most important factor of this station wagon is that it had a backward facing seat. Does anybody remember? You have to be of a certain age to have the backward facing seat. Horrible idea for anybody who gets motion sick. Right?

So my sister and I were both terribly motions like this was our trip from, we lived in Virginia Beach at the time, Virginia Beach to Yellowstone with the, not just them, the two sets of grandparents. So we had like, we literally had to sit in that backward facing seat. So what happens when your vestibular system is getting information about movement that your visual system is not backing up, then you get nauseous. So the word nausea comes from the word nos, which means ship in Greek. We're gonna just kind of credit the greets for everything. Um, and whenever, whenever you have a situation where your visual information and your vistibular information don't match, you can get motion sickness and that is the most common vestibular disorder that people have. Um, you're more likely to have it when you're like a, when you haven't really been exposed to these different stimulations. But you can get motion sick from a bad prescription on your glasses because it's just the information isn't matching up quite correctly. Um, remember the Blair witch project when it came out and people were getting sick because the shaking of the camera was happening but they weren't moving in their seats like that would make you sick. In my past life, I used to do a lot of like museum exhibits and creative direct videos.

And I at one point made a motion ride. And the most important thing about making emotion ride is that the visual lines up with what the machine is doing. Because if it doesn't line up, people will get sick, right? So if you've ever been on one of those motion rides where you're just like, you know, you're getting sick because it isn't matching up, that's because you have this, this balance disorder that's happening. Um, another kind of sensation you might have is like when you've been on a boat for a really long time and you get off the boat and you feel like you're still on a boat, like you still have that rocking sensation. Like because you've become acclimated to this different thing. So my sister and I sadly never became acclimated to riding in the station wagon backwards.

And my parents literally had gallon sized Ziploc bags for like us to throw up in for the entire trip. And there was one time where I actually threw up in my grandmother's purse. It was not a pretty scene, but this was like the vestibular problems. My first vestibular problem, I was five. I'm sure I had vestibular problems since then. Um, but it actually that, that sense of motion sickness and the really on a boat is where we really first started most studying motion sickness during World War II because the World War II landing crafts were specifically designed to be solid metal, right? So you could shoot at them and nobody would get killed. However, they also can't see where they're going.

They don't have any visual information to back up what their vestibular systems doing. So once they would land on the beaches of Normandy or wherever they were, they were so sick, like, so terribly sick. It's amazing that we actually won that war at all because people would be so nauseous. So, um, like one of those things, I always say the worst thing to do is if you're on a boat and you feel sick to go under, you know, like down, you need to like be up and like looking out at the horizon so you can give yourself something to focus on. But they didn't have anything to focus on. So they started studying what were the different ways that they could prevent motion sickness. And the thing that worked best was, you know, the patch that you have like that you put like kind of behind your ear. The patch is actually made from an ingredient that's in Bella, Donna, which is a poison. Um, I'm, I think it was the poison in Romeo and Juliet, I don't quite remember, but it's a very famous, you know, old poison like in the books that were written in like the 16 hundreds and um, that ingredient is still used. Um, because what it does is, is a, and it actually slightly paralyzes that that eighth cranial nerve that gives the information to your brain about your vestibular system and what's the vestibular system being told. Um, another one that they, um, developed with Dramamine. Um, the interesting thing about Dramamine is that they don't know how it works. It's still know how it works. Much like most medicines I find.

But it was an antihistamine that they had given to someone and they gave it to a woman, which she was one of their people in their study and she had had horrible, horrible motion sickness. And then she just stopped having it when she took Dramamine. And so they decided that there was a market for it. And so Dramamine is still sold that way. Um, works really well. And then there's also the getting your sea legs. You just, once you acclimate to it, you don't get as sick.

Chapter 5

Vertigo

One of the more common vistibular problems that you'll hear about is vertigo. So Vertigo is that sense of spinning. Like a lot of people will have like a small amount of vertigo I have and most people will have vertigo in different positions. Like I get vertigo when I look up, like when I tilt my head up, I get really dizzy and when I tilt my head down, like if I'm walking downstairs, like sometimes I'll get dizzy with that. You have people, like I have clients I work with that they'll get dizzy only if they go from seated to all the way lying down. So when we do roll downs, we roll down to the point where they're about to get dizzy, but not further than that because we just are trying to avoid that position. Um, there's a lot of different neurological diseases that can cause some sort of impairment in that nerve conduction from the vestibular system into the brain.

One of them that's, that's really common is called Benign paroxysmal positional vertigo. Um, and basically the treatment for that is, um, if you go to a physical therapist, remember how we talked about the Iraq's, so the Iraq's aren't in the right spot. So they do something generally called the Epley maneuver where they have their, you know, holding people's heads and they like have them, you know, lean back a little bit and then they'll turn their head and they'll hold it in this position for a certain amount of time and then they'll move them back a little bit more and then they'll like turn their head and some other direction. And what they're doing is they're basically just trying to move the rocks back to where they're supposed to be, cause the rocks have migrated out of their proper position. And so that's why people are getting vertigo. There's another disease called [inaudible] disease. Um, and the reason I have the pictures of Vango art up is because there's the theory right now that Vango didn't have epilepsy or wasn't crazy like they thought he was when they looked back at some of his old letters that he had written, it didn't seem like he was having seizures.

What it seemed like was happening to him was that he was just falling down. And so to me, like some of the better arguments for him having many years disease is the chopping off of the ear incident. My nearest disease is extremely painful. And if you've ever had a really bad earache, like a really, really bad and could imagine like living with that, that if you thought that if you cut your ear off, maybe it wouldn't hurt anymore. That seems more logical than just being crazy. And like maybe there was a girl or I don't know whatever story it is. But if you look at his, um, paintings and sort of how they evolved over time. So we have, um, the potato eaters is on the left and I started nights down on the right and a potato eaters was like when he was, you know, still living in the Netherlands and it wasn't as bright and sunny as it wasn't when he was living in France.

But the style of his art as it goes through time got a little wavier looking. So to me it looks dizzy. Right? So if you're going through life and seeing life as dizzy, like it might create more of that kind of look. Cause if you have like a Surat or something, then they're doing pointillism. It's not that kind of wavy look that Vango has.

So it's not, it's not something that's proven. I don't think that they'll ever be able to prove what he had. But I think that it's a really interesting demonstration of what he might have had because if you look at it, it does look like the world looks, if you've ever really been dizzy. When I was first diagnosed with ms and it was, this was like in 2002 but I'd had symptoms for a really long time. I remember this one incident where I was in a mall and I had such bad vertigo when I was looking down and I had to step onto an escalator and the escalator, you know how the treads are like wavy looking just normally like I remember just sitting there and like being like so dizzy looking down at it that I just held on to the side and just closed my eyes and stepped onto it. Cause I was just like, I can't even, I've just felt, I literally felt like I was going to throw myself down these stairs and it's, it's such a disconcerting feeling.

So Ruth was talking about how when she had really bad vertigo for a year, it's, it's not like you can dissociate from it. You know, you can sort of find stuff to distract yourself from like pain and you can find other things to do. But when you're dizzy all the time, it's extremely, it's demoralizing. A lot of people have vestibular problems that can't be fixed or aren't fixed, commit suicide. It's not something you can really live with. And people, like I always say in terms of working with really significant distibular disorders, this is far beyond our capacity as [inaudible] teachers. I'm like, that is definitely something you farm out to someone else because it's so complicated. And they do, I mean, they do very crazy things to work with it, but fascinating stuff where it's like, you know, you're looking at something that's like a checkerboard and then you're doing all sorts of head turns and things like that. Um, so when I think about what we can do as, as teachers to train it, is that we're trying to strengthen the vestibular system, but when you have somebody who truly has like a bad vestibular disorder, they need to be seen by somebody who's like a physical therapist that specializes in vestibular disorders. Did Yours just work its out? Yeah, sometimes they just go away, you know. So I'll occasionally have vertigo, um, but it doesn't tend to last very long and it'll just be like, whoa. Having a moment. Um, another thing that happens, um, interestingly in this, um, in the vestibular system, which is sort of where we, we cross the lines and we cross the lines a lot and the different balance systems, and this is crossing the line in, in terms of visual and vestibular and something called Nystagmus. Um, I could give anyone to [inaudible] that I want to right now I have the, I have that power.

All I have to do is put you in a chair and spin you around really fast and your eyes are going to do this little kinda shake thing, right? So what happens is, um, it's this rhythmic form of eye movement that happens from a persistent head rotation. So you might have it if you're on a roller coaster, if you've got off the roller coaster and your, your eyes might be doing this little wiggle side to side. Um, the vestibular ocular reflex is responsible for the slower part of the movement. So it's just basically your eyes trying to reestablish, you know, what the center is, what they're looking at. But they're also have a faster part, which is a rest reflex, which is actually from proprio receptors in your eyes themselves. So they're just trying to like adjust another time where you might have Nystagmus is if you said anybody ever taken like one of those like super high speed trains like that they have in like Europe or Japan where they go like 200 and some miles an hour. If you look out the window, first of all, just don't, just don't even, but you'll, um, you'll get that because you can't focus your eyes on anything. So I'm not familiar with this, but Ruth was just talking about EMDR, which I guess is a form of where they get your eyes to move in sort of a rapid motion while you're also working on some sort of emotional trauma.

And it desensitizes you from that. Um, you know, it's all connected. So, you know, I think it's fascinating when people find these ways to take these little bits of information and put them all together and create some sort of therapy from it because the things that people can come up with are so fascinating and you're like, oh, well I guess that does make sense. I didn't know that. Um, okay. So let's talk about ballet. Um, I am a huge ballet fan. Sadly. I never was like a famous ballerina, but in my next life that's what I'll be. But, um, ballerina is like, you can watch them sometimes and you're like, how in God's name do they just do 30, whatever, you know, 30 some 40 days without like falling down afterwards. And they just like stop and they land. So, um, when I was talking about in my neuroscience and exercise workshop, we talked a lot about how when you work on something, the part of your brain that handles that motion is going to grow, right? So if you're a piano player, your fine motor skills for your fingers are going to take up more space in your brain than somebody, for instance, who doesn't play piano. So as I'm, you know, like we had Albert Einstein and he played violin and so he had like this portion of his brain that was more highly developed because he played violin.

Your brain is going to want to adapt to anything you do repetitively. What's interesting and completely bizarre about ballet dancers is what happens is the opposite of in any other form of motion. So their cerebellum actually shrinks. So your cerebellum is where movement is coordinated. So for them, like if they're constantly having to deal with these signals that saying dizzy, dizzy, dizzy, dizzy, they wouldn't be very good at doing their job. So their brain is actually gonna, um, kind of have an APU ptosis or a cell death of those neurons.

So what the neurons that they have left are going to be super precise. So it's not like a ballet dancers balance is affected in any way. It's actually so fine tuned that they're not going to have this, this moment of um, dizziness that like the rest of us would have and kind of add on top of that that they do something called spotting, which is where you would like I'm looking like at the camera now and I'm going to like keep my head looking that way and then I would do a spin and I'm going to find that spot immediately again. So they're trying to find the same spot, but all of those things that they're doing are actually causing the cerebellum in their brain to be smaller than in the rest of our brains, which I think is fascinating. You know,

Chapter 6

Vestibular Training

when you're looking at a computer screen and you get a little bit sick feeling. Um, when I was, I had a flight here, I was like a couple of hours on the tarmac and then seven hours or so to get here and I was reading off of my iPad the entire time. And when I got off the plane, I swear I couldn't see, I was just like, I can't see, because when you're looking at something on a computer screen, it's got this little flicker, right.

And she was asking what ramifications does it have to your brain that, you know, you're experiencing that. And I would think that it's got to have something like they know that, um, with texting that the part of your brain that controls your thumbs is actually bigger now than it was when, you know, a generation ago. And it's from use. It's not from, you know, it's from each individual's use. So if you have somebody who's like, you know, doesn't have technology like that and isn't texting that part of their brain isn't changing, but I promise you that your brain is changing based on whatever it is you're doing. So I don't know exactly how, but it's going to change in some way. Um, I do think that's interesting because I think so many of us, myself included, it's just like, I don't buy books anymore, but I read probably a book a week, but I'm reading them on like a kindle.

So I'm reading them on a computerized thing, not like a steady page. And I never had had that feeling before this last trip where I got off the plane and I was just like, I cannot focus my eyes cause I was just, you know, reading on this computer screen for hours and hours and hours and I was just super nauseous. Like you said, it's just like, it kind of messes with things where your visual system is like kind of in hyper hyper mode. So I'm sure somebody is going to study that. Um, and it will be interesting to see what they find out and they're probably all gonna come back with the same things that I think we all know is that modern day living is bad for us. Okay. So let's talk about some this tubular exercises. So when I went to my last, or not last but recent, um, neuro PT appointment, um, one of the things that she has you do is you like walk and she doesn't tell you, tell you what you're going to do right away. But she was like, you start walking and she's like, turn your head to the right and then turn, look up, look down, look left, do whatever, stop suddenly start suddenly walk around that cone, pick that thing up or whatever. And so what she's looking for in this neuro appointment, as if I'm turning my head, am I drifting?

Am I able to maintain my motion forward? And I didn't realize at the time that I wasn't really moving my head when I was walking. And it's partially because where I live in d c it's like a minefield because it's all brick. Like it's all brick walkways and then there's the tree roots that are setting the bricks, you know, all kind of off balance. So there's always a risk of tripping. So when I walk, because my left foot doesn't want to lift up quite as high as it should, I'm always looking for tripping hazards.

So I wasn't turning my head while I was walking. And then it would just be like if I turned my head, I would start drifting. I would get really off balance. So my, um, prescription that I assigned myself was that I, I'm, I have a treadmill at home and I walk and I literally walk and I hold on because it's, I can give myself a safer environment and I walk and I look to the right while I'm walking for certain amount of time. And then I look up and left down and left side and left. You know, I just find these different head positions to be in because the only way you're gonna really train your vestibular system is to challenge it with head movements. So you have to shake, literally shake it up. So you have to shake up these rocks in your head and this fluid in your head to be able to have that vestibular system working properly. Um, there are so many existing, well all these exercises that already incorporate the stipular.

So anytime you're on the reformer, you're using your vestibular system. So it's great for Rehab, for people with any kind of neurological condition. Anyone who's aging any basically any population is going to benefit by being on something that's like adding motion beyond what your just regular motion is. You have neck roll, you have all the twists, you have saw, you have chest expansion with head turns. I mean, my understanding is that Joseph Claudia's did it to stretch your neck, but you know, in his brilliance he added in some little extra things that probably he'd be like, I meant to do that. I'm pretty sure he would. Um, so anytime you're going to have movement, you can add a head turn to it, then you're going to add like a little bit of a stipular training. So, um, there's so many exercises in this workshop that really fit in multiple categories, right? So we'll, we'll go through some of them, but I want you to think about them as like, we put them into this tubular because they had motion and head turns. But it doesn't mean they also aren't great exercises for hip and ankle strengthening or they're not good for, you know, some other form of balance.

So if I'm working with somebody who has some sort of vestibular issue, one of the things I might do is have them do footwork and add all sorts of different head turns to it. So I'm, can I have you come up and join us? So I'm just as on to reds and I'm just going to lift the head rest up and then just come lying down on your back and you can pick whatever foot position you want to do today. So you're gonna lie down and then just press yourself out and turn your head to the right at the same time as you press out. So we're going to try to time the motion. So we're doing something and adding the head turn. So press outlook, right?

So turn your head to the right and then come back to center. As you come back in, press out, look left and back to center. So you can play around with where she's looking. You can also be the thing that she's going to look at. So you're going to be like, look at my finger and then come back to center and press out and watch my finger and come back to center. And this is like super easy, right?

You can do this a million different ways. You can also do individual eye turns, um, where you are kind of keep moving, but you're gonna move your eyes and obviously this will be harder for the camera to see, but just press out and you're just going to turn your eyes to look to the right. So only your eyes move to the right and you come in and your eyes move to the left as you come in and you just kind of switch where, where your eyes are looking. So these are like really easy way to take some exercise that you're already doing and up the ante and the vestibular. So I've, and when she's got the head turns, so we're working those two things at the same time. So remember where the Otolith organs are working, that horizontal movement, which is what the carriage is doing, her head moving is working the semicircular canals because her head is moving. Does that make sense?

So I would say a great way to close your eyes or great reason to close your eyes when you're doing something. And I actually teach a lot of exercises where I purposely ask for people to close their eyes is because I want them to tune in more to how their body feels. And your visual system, which we'll talk about in a moment, it's like tends to be a little bit on the over. It works too much. Right? So it's like, I don't know why people would instinctively close their eyes unless they're trying to tune in a little bit more to how they feel. Grounds you to like close your eyes when you're doing. Um, different exercises.

So a lot of times I train people and when we start talking about vision, I'll talk about why I train people sometimes blindfolded, not just eyes closed but fully blindfolded because I want them to get no visual signal. Cause when you're not getting any visual signal, you actually turn your vestibular system on at a higher level rather than a lower level because your visual system likes to work. Right? So it's like we think that, you know, we, we overuse that and we don't want to because like ultimately that's one of the first systems to fail. So we want the other systems to be a little bit stronger. Most of the time if I'm working with somebody with a balance issue, I will do some exercises with eyes closed. Yes. Okay. So we've got, um, another one where we're gonna get the long box out. So Meredith, may I use you and your long box? See?

Oh of course four. Grab the one at the end. Huh? This one. So remember how I said I would take a treadmill and for me, adding the I turned in the head turns is actually really important. Part of my own vestibular training rehab. So if I wanted to do something that was like sort of a gate exercise that was in the [inaudible] realm, that added head turns first. I want the floor to be basically the same height. So you know how you, some people have their reformers that are just on the floor.

That's great if you're, if you don't have a reformer on the floor then you need to try to build a floor up next to the reformer. So you're going to stand sort of in the middle of of the long box and then bring your right foot up against the shoulder rest. So you're gonna stand pretty close with your left foot cause you want to be like where you would be like just walking normally and then you're going to press your left foot back straight, left leg goes back street and then bend it to come in. But this would just be like one part of the exercise. So we're working on like hip stability and hip strengthening.

But unless we add a head term, we haven't really gotten vestibular into the mix. So I want you to turn your head to the left as you push your right leg straight and then go back to center. So she has very good balance. Meredith used to be a dancer, so she's probably got a very small and beautifully developed cerebellum. So for her she's got like really exceptionally good balance and she works for me. So I know how good her balances, but she, for other people who might need to get more balanced than you could have them bring their arms out to a t. So you're pressing out and adding that rotation and you can even add a torso rotation to this. So if you wanted to make it more of a twist, so then you're also, you know, working into your beliefs and you just play around with it.

Just find ways to shake things up and do these exercises within this system. Good. And then you can come all the way off. And like I said, just you're trying to make the floor come up towards where it is. You could also do it with the standing platform. You know, the standing platform was on the machine. So they have the little bit worse, stable place to stand. And then anytime you're going to add any kind of rotational exercise, um, Emily, can you pass me that ball? I'm going to do this one because this is the most fun one.

I'm going to save it for me. So one way that I sometimes work with people in terms of balance because it totally reminds me of being a kid is um, we've, we have the out and in movement, right? So we have the one part of like the otolith organs working, but that's the forward and back. But you also need the up and down. So if you're doing something like this, you're getting the up and down thing. And I really want the, um, did you have those things when you were a kid that had the handles and you could like literally hop like along the room.

So something like this and then adding head turns to it is actually like really excellent vistibular training. And I promise you, anybody you give this exercise to is going to want to just do it all day long. So, um, the balance ball is like a good way to work to get that up and down movement cause there's not that many ways like you can do when we do going up front on the chair or something, you're getting that up movement. There's not that many places really employees where you're getting that movement in this plane. Right? So the balance ball is going to be like probably one of your better bets. Okay.

So the chair is an awesome place to work on some of the stimulus stuff because you can really easily add some head movement to the exercises. So Erin, would you like to do some movement? She's like, Oh God, yes she would. Okay. So I think this is reasonably heavy. We're enlightened it up later, but we're going to start with it at this level. So I'm, I just want you to step in and reasonably close so we're not really focusing, you know, sometimes we focus a little more hand on hamstrings. We're going to be just more focusing on what we're going to be doing vista below the stimulator leak. I don't know if that's a word. I might've made it up. We're going to bring your foot up to the pedal and then pull yours back a little bit. Bring your hands behind your head. You can press the pedal down and it can go all the way or halfway. I don't really care.

And then as it lifts up, you rotate towards the right. I like to rotate over the up leg. Um, I don't know why. And then you will come back to center. Good. And so you'll rotate and you can push at, I want you to, um, be in the center when you push, push in the center and then turn as you let your leg lift up. Good. Now at time it, so you press down and you come back to center. Good.

And rotate. So I'm sure you've done leg presses before. Is this more difficult? It is. You feel more, you feel more, what makes it a little bit more dynamic? Yeah, it is more dynamic. And so we're, you know, we're talking more early about moving through planes and so we have to add the rotational plane if we're working that section. So the semicircular canals of the vestibular system to have that motion.

Okay. So I'm going to lighten it up a little bit. I'm going to do one of my favorite variations. So I think I'm taking it to one spring on a three. I want you to walk back a little bit more further so that your light can be almost straight. Um, little less straight than that. So come in, I want it a little micro bent right this time. Bring your hands behind your head and we're not going to move the pedal so much with her legs is with her abs. So as you go forward, you're gonna bend forward and look down and push the pell down slightly and then come back up to standing and let the pedal just respond. Nice.

So you'll press the pedal down as you push forward. So her, you know, everything is being challenged here. She's standing on one leg. So she's having to work in the stabilizing muscles of that leg, stabilizing muscles of the other leg. And then we're also adding that forward, tilt that forward motion into challenging her vestibular system. So have you done this variation before? She has not done this variation before. What do you think? Yeah, it's, it's fun and it's just like where you're adding that forward motion. So because of how the chair is, it's really easy to add these different rotational motions.

Have you ever done yoga? Yes. Okay. So I like to basically figure out every way that I can use any piece of equipment and take inspiration from something else. So we're going to do my variation of half moon pose using the chair. So have you done that one before? Okay. So that's the one where you're going to start.

You would start like this and then you're going to reach a hand down, but you're going to come to the pedal and then you reach the other leg. Okay. And this arm is going to be straight up towards the ceiling. So first a tough balance challenge even in this position, but now you're going to push the pedal down slightly and then lift it back up. So, and this would be a good, I'm right behind you so I just want to give you that little bit of information. So here's a good example of where we're trying to keep that alignment right?

But we're also doing a motion where her head is moving, right? It's not like necessarily that her head is moving like tilting, it's just moving because the pedal is moving. But we're putting her into kind of kind of this interesting position. You can also from here rotate. So your right hand comes down and then you'll square off your hips and then you'll push the pedal down from here.

So we're a little bit more into warrior something one I think, or warrior three. Drop your right hip down more if you can. Good. So I'm gonna, I squared off her pelvis a little bit and so she's just moving the pedal. And then if we want to get super fancy when you come up, extend your right arm forward over the chair. See if you can extend your left arm forward over the chair. There was no warning for her with this exercise by the way. Awesome. So then she's come into this beautiful kind of yoga position that we've taken into a challenge for her vestibular system and hurt.

And that ending was actually really beautiful too because she came into this upright position, which again, anytime you're moving you're going to be challenging the vestibular system. And then also every aspect of balance. That's a lot of ankle stability. Demand. Yeah. Correction. That needs to be happening right at the end, the ankle. Um, so there's also a, um, a balance tutorial that's on the website, the applies anytime website that talks about like the ankle stabilizers and the hip stabilizers. And we are not talking about any of that in the same way in this. So that's sort of like an add on to this, but how her ankle was doing this inversion e version kind of thing to be stabilized. So. Great. Okay.

So moving on. So I love to use the chair for any kind of exercise where you really want to work on ankle stabilization. So it's good, a little bit closer in than you are and you're going to bring your right leg up so that you're on the tip toes of your right foot. Not quite those tip toes, not quite there. Um, so what, when you're working on ankle strength, what you want to work on, you have to work the ankle and all these different positions, right? So you want the ankle to be strong in a full point. You want it to be like if you were in a kitten heel, you want it to be, if your heel was all the way down. So from here I want you to press your foot straight down towards the floor and then lift it back up so it'd work her ankle first in this position so you can keep going.

And so we're making sure that her ankle is strong. Um, if she was choosing to wear really high heels or if she's just on her tip toes, now drop your heel down about halfway from where it is. Good. And then you'll press down from there and lift back up. So how does that feel? Is it more difficult? Less difficult about the same, which is good because you want your ankle to be strong at different levels of engagement. So now drop your heel down. Good and push down and see if you can get your heels to touch the floor. Good. And then lift it back up and press down and lift it back up.

So you can play around with what these different ankle positions are. And then you can also play around with let's, we're going to lower down all the way. Keep the pedal down, rise up to your tip toes, let the pedal lift up, push the pedal back down to the floor, lower your heel down to the floor, lift your heel back up, let the pedal lift up. How does that feel? Good. Yeah, it's like it feels really nice cause you get to go that entire range of motion. So you have this position. Then you can also switch what position your foot is on the pedals. Similar to what you would do. Let the pedal lift up, sir.

Similar to what you would do just in footwork, right? So you can be on the arch of your foot and push down. So you're working a little different part of your foot and ankle and you can do it that way and you can also press into your heel. And what I like with pressing into your heel is it fires into your glutes. And I'm kind of obsessed with like anything that works or glutes. So I'm like, let's just do these on your heels and you can, like, if you look at her standing leg two, that ankle is working really hard to stabilize her because it's doing this little like, eh, shake from back and forth so that she can get that sense of, you know, how the stabilizing leg is working.

She's doing a great job of not dipping her hips either way, but that's something you would want to look for in your client's weather. Um, and just go ahead and do it. Just like, yeah, whether they're getting a little too much sass in their, in their hip movement. Thank you. Because it's light, it is much more challenging lights. So I, I like to give it light because I love that about [inaudible] that the lighter it is, sometimes the harder it is because especially when you get like guys in there and they're just like, we're just a heavy weights and you're like, I'm gonna give you a lightweight. And then they're like, it's too light. And I'm like, no, it's just right. It's perfect for you. So that's a good way to work. Ankles on the chair.

Okay, so moon box we had, unlike it's Meredith's, it's her lounge chair. Let me see how I, like this week this is going to be what kind of light, but I think it'll be good. Okay. So do I have a volunteer victim volunteer? This is a hip stability exercise. Um, we can actually all do it together. So if you come to standing and you just lift a leg up and you let your hips dip out to the side, this is like right here to me, says somebody's got like a weak glute mead, right?

So if they're standing like this and they're dipping their hip out to the side. So what you can do is you can say fire here and like lift your hips so that your level in your two hip bones, right? So you dip and lift is the basic motion that you're doing. You also have, um, so I work a lot with people with neurological things. And so a very common neurological disorder is actually, it's still a glute mead weakness, but what happens is that the leg dips this way. So this would be, um, like when people, their hip collapses inward, which is actually I think easier for me to do on the side.

When your hip collapses inward and then people walk in, their hip goes like this. This is Trendelenburg gait. This is like too much. Um, like just hit shift. So when you have this one, it's still the same exercise, which is great because it's like basically all you're doing is leveling off your hip bones. So if you were going to do it on, um, the one to chair, you can have it set up. So you have the moon box next to the one to chair. And so you can have your hips shift from one side and then you're just going to push into your foot. And then this is really like lift the pedal up so it's basically at the same level and then you push it down. So let that hip dip out and then you push to like level things off.

So it's a dip down, lift up and it's really light and it would be much easier if it was heavy, but that's a situation where doing an exercise that's lighter is going to be better. And Ruth, um, which we can't see, she's off camera. She's basically doing it where she's on a box and she's doing it where she's just letting her foot dip this way. I like doing it with the one two chair with the pedal because it gives you that nice amount of feedback. Um, and there's other ways to do that same exercise, but it's, you know, I had a physical therapist once send me home with just standing and like making sure you were firing into that hip because if those hip muscles aren't stable, your gait balance is never going to be quite quite exactly right. One way I like to work with people when they have fear, especially fear of heights. I think going up front is probably one of the scariest exercises in [inaudible] for most people. In my perfect world, there's a high chair, but not everyone has a high chair.

So if you don't have a high chair and you want to kind of do it as a one two chair exercise, you can get one to chairs with handles. So that's going to be like your kind of first step. Um, you probably want this a little bit heavier than one spring. So I'm going to give you two springs. Do you like it on two on three? That's usually what I do it on your really small, so I think two on three. Okay. So we're going to step a foot, pick your favorite foot onto the pedal, and then you'll step your other foot kind of to the back edge.

What'd you say? Do you care if it's ball? Nope. Okay. So, and you can have your toes back a little bit. So walk your toes back a good. So they're going to be like right up against the edge. So the handles are great because the handles are going to give her something to hold on to. But the, so we're going to start her here. So I like to take balance as something that we're going to look at as a progression, right? So come up to standing from there. So you don't have to just take the pedal up to the top and try to adjust and you have shoulders, back, ribs are back some.

And then you're just going to lower down and then lift back up and then lower down. And I might give her a little bit of feedback by saying, and we're going to push into my hand. So let's, we're gonna imagine we have a high chair, even though we don't have a high chair. So I would say let's push into my hand. So that's one way to progress it, but I want her to get to where she can do at hands off and be comfortable. And so let's say she's not comfortable yet taking her hands off. So what I'm going to do is I'm going to take this dowel wall and would you slide it underneath her leg and I want you to pull back with your knee. And so now she's got, I've given her a another point of contact.

So when I like to think about balance, I think like to think about three points of contact. So if she's just one foot, one foot, no hands, that's two points of contact. Right now she's got four points of contact. Her pushing her leg into this bar is going to be a third point of contact. So go ahead and take your hands off wherever you want them to go. And then you're going to lift up from there.

Now there's two ways to do this. You can also lower this down so you can literally come down for a second, come all the way down. I just want to show how this can can be in, obviously it would have to lower these handles down because you can put this through here so that it literally just rests here. Um, which is a great way to do it, but I actually prefer the other way. And the reason is if I have it just slid to where it's behind her knee and she's coming up and down, this is going to give her a little bit more feedback. So go ahead and come up because this can move, right? So if she's like really supinate in her foot for instance, then it's going to start to tilt one direction.

That's a little light. And then I can play around too, and I'm gonna say hold it there and then just bend and extend your back like fancy, fancy. So we're working into sort of getting that, um, mountain climber, like where we would progress in, lift your arms overhead. She's like, Jesus Christ. So like [inaudible] and then come all the way down. [inaudible]. So, um, I actually had one of my students in Italy when I was teaching a workshop, do this, show me this. And I was just like, oh my God, that's so brilliant. And then I ended up getting a highchair. But um, before that, this was sort of my go to way to kind of progress people past an exercise that's scary to the point where they're like, okay, I've had my hands off, you know, I've done that. That has existed in my repertoire. So now, okay, you've had your hands off.

Once we get used to that and stronger in that position, then you're going to take this away. I would still leave the handles there cause I like the people, you know, have something to grab onto till they're really comfortable. And for me, I don't think I'll ever be comfortable enough to not, because I do get vertigo unexpectedly sometimes I don't think I'm ever going to not have handles or have somebody spotting me. I don't think that's ever going to be something I do. But for people who that's one of their goals is to do going up front where they're really comfortable, that would be a progression for it. Thank you Francine. So next we're going to talk about the visual systems.

Chapter 7

Visual System

So, um, the visual system is like part two. So we have the vestibular system, the visual system and the proprioceptive system. And those are the three neurological components of balance. And the visual system is important in that it tells you where you are in your surroundings and what is in your surroundings. So it gives you the ability to be proactive. So let's say you're walking along the street and you see a tree branch, right?

You can avoid the tree branch, you can avoid tripping over it. You can avoid stepping in the pile of dog poo that someone didn't pick up. Um, there's, you can spot some sort of threat to your balance. It is not, however, a part of the sensory system that is actually required for balance. And that's really easily indicated by the fact that blind people aren't falling down constantly, right?

It's like your visual system is actually the weakest and least important part of your entire balance system. If somebody is, um, a client of yours and they, they're closing their eyes and they're standing there and they can't balance with their eyes closed, something is seriously wrong with either their proprioception or their vestibular system. So your visual system can sort of be a, um, like a, a clue that something's wrong with one of the more important systems of balance. So Vision, um, the worst the communication is between your body and your brain, the more you're going to use your visual system. So that's why I said I like to train people with their eyes closed or even better yet blindfolded sometimes if you really need them to be able to tune in well to their visual system, your eyes do play an important role in balancing your head. However, because your eyes are always going to try to, there are always going to be stabilized to the horizon. So they always want to look at the horizon. Um, everyone is going to have a blind spot because everyone has a nose. So as long as you have a nose, you're going to have a blind spot of some sort because the bigger noses, probably the bigger your blind spot is going to be over.

Use of the eyes is actually one of the leading causes of falls, especially in the elderly because once you start losing the other systems, people really start using their eyes too much, but their visual system is starting to fail as well. Um, and I shouldn't say they, I should say we at this point because I'm actually in the age where you start to get the visual system starts failing. Um, but that you first lose your proprioception for most people and then when your appropriate assumption goes, that's really when the visual system take over becomes a problem. Um, for your eyes, just a little bit of interesting information. Part of your, um, vision that's um, called your nasal retina, which is the part that's closer to your nose actually, that part of your visual field travels to the opposite side of your brain and the part that's on more of the temporal side or is there a temporal retina is going to travel to the same side of your brain. And together all of those things are going to create what it is that you see. We also have something called orientation selectivity, um, which is just where your eyes like to focus. So you know, there's a spot where it's like if something's too far away you have to like really concentrate on it.

So you really have to work at seeing something that's in that position. Like where Alegra sitting right now is my orientation. Like I'm selective to like seeing that distance. Like that distance is a happy distance for me, but not all neurons are going to have the same orientation. Selectivities. So you have some neurons in your visual, um, in your visual system that are gonna prefer like a closer orientation and you have other neurons that are going to fire for a further away orientation.

So all these different neurons are what worked together to make site possible. They're not going to all fire at the same time. And some actually really interesting because they'll fire only for light and dark. Some are more likely to fight fire for movement. They're all gonna have their own little different rules to play. Um, stereopsis is the component of buying ocular vision that we all have that enables the two eyes to see something that's slightly different. So if you take your hands like your finger right in front of your face and you close one of your eyes and then you close the other eye, it looks like your finger has moved, right?

Because your two eyes are seeing a different picture. The further away you move that the less movement happens. Right? So it's like this far away. It doesn't move so much. It's sort of like when you're like really close to your spouse's face and it looks like they have only one eye because you're too close to their face and you can't actually really get a full picture this close. You can't really get a full picture.

It's really like the further away that you're going to get like a more accurate, you know, three dimensional. Um, a picture, your [inaudible] is going to have a slightly different visual space that it sees and your right and left eyes are going to have their own peripheral vision, right? So you're not going to have, be able to see anything in the peripheral vision that's to your right with your left eye. Right? So if you lose peripheral vision on one side, you can't, you just can't see it unless you would obviously turn your head. So the neuronal pathways for vision, um, there's a couple of different ones. You have different ones cause they do different things. So you have a pathway that gives you the where, which is going to be spatial relations. So it's like I know that this reformers here and about 10 feet away is that long box and you know, 15 feet away or so we have, you know, other people.

And so that's what is giving the where also within the where is what we're going to call the notion of motion. So if you like I'll be able to see that somebody is like writing or somebody moving their head or that, um, the beach, you could see the ocean and you can see the, the waves and whatever. So that's all handled with these where neurons, you also have what we're going to call what neurons, which is a more of a learned thing. So it's like I learned that along box is in the shape of a rectangle because that is what society has decided. It is. We call it a rectangle. We call that color blue. Unless you've seen this dress online, in which case it's definitely white and gold unless you're in the blue and black family. Um, this is probably going to come out way after that.

And then people are going to have flashbacks and be like, Oh yeah, that thing that was floating around the Internet. But it's also textures and colors and it's, it's all these what things that we've learned. And then we have a whole other system that is what handles your circadian rhythms. And that's what, um, really sees light and dark. So this is where we kind of screw up. Like what I said, we like, we're not living, we're primitive creatures living in a modern world and we're like messing up our circadian rhythms because we have light past when there's light outside. So that literally does affect your brain because you're, you have sensors in your eyes that only see light and dark.

So they would say there's definitely, you know, something, it's, it's still light. So this part of your brain should be functioning in this particular way. When I said that, I like to train people blindfolded. The reason is because if you shut your eyes, you can still see shadow and still see movement because you still have those parts of your, your visual system that sees light and dark. So you can even be blind and see light and dark.

Cause a lot of people who are blind can still see that. So if you want to train that, you would want to, you know, play around with um, having complete darkness. So your body always wants to go where your eyes go. So I'm, when I teach classes, a lot of times I, I give people places to look. I say, I want you to look at where the ceiling and the wall come together because we want an upward motion and that would be upward. Um, I don't necessarily want you to move your head that way, but I want you to look in that direction. If you were to go into like an old carnival fun house where they had the room full of the different mirrors, the ones that make you look really fat and really skinny and really crooked, they sometimes have ones that are tilted. So if you're looking at a mirror, like you're in this fun house and there's a mirror that's tilted, you're going to tilt yourself to try to align yourself to that already tilted mirror to make yourself feel like you're straight. Because you've gotten this visual feedback that saying like, Oh, you're not straight because you see yourself as crooked.

So you're gonna compensate by tilting yourself in the other direction to try to make yourself straight. So you try to make yourself straight in the mirror because your visual system is actually really easy to trick. Um, which is not so good because if you're over relying on your visual system and it's so easy to trick, then you have this risk of, um, in some cases, very catastrophic things happening because of a failure of visual system. Um, an example of that would be in flight. Your proprioception and your visual system don't necessarily give you the same information. So, um, for instance, I flew into Santa Barbara a couple of days ago and I looked out the window and I was like, oh, the plane is completely tilted to one side, but I didn't feel it. Right. Because it's like in addition to the forces of gravity when you're flying, you also have centrifical forces, which are like the forces within a turn that you would not necessarily feel like you're not feeling like the plane move, but you don't feel like you put extra pressure into your left hip cause the entire plane had moved.

So this is where people get in trouble when they're flying. So, um, I don't even know how long ago it was now where John F. Kennedy died in a plane crash. John F. Kennedy Jr and he was not trained to be an instrument instrument flight. He was trained as visual flight. So visual flight is actually super dangerous if you, if it gets dark, if it gets cloudy, if it gets anything, because your eyes will tell you that you're s you're s what you're seeing. It doesn't have to line up with your visuals or your vestibular system or your appropriate septic system, but your visual system is telling you, you, you are like still upright and you might have flipped your plane all the way upside down, which is what had happened to him. So most pilots, especially if you're on a commercial plane, they're completely flying by instruments, right?

The instruments are telling them if are level or not because you will not feel whether your level or not, your eyes will say, yeah, maybe your level or maybe you are. But if you're in a cloud, what's up and down, you know, you don't actually even know. Um, so you do need vision. Um, birds will not actually fly in fog cause they fly completely based on vision. Um, if you have somebody who has a completely non-functioning, um, the stipular system, um, for instance, if you have somebody who is deaf and like literally just does not have a properly functioning vestibular system. If they, um, have their eyes closed, it's their proprioceptive system that can tell them where they are in space cause they don't have their vestibular to give them feedback. Your vestibular doesn't give you proper feedback in a non correct gravitational scenarios such as flight. Um, we've all experienced this really amazing visual trick called vection. If you're ever at a stop light and there's a very big car next to you or a tractor trailer and it starts to move and you feel like you're moving backwards, you have just experienced infection and vection is when a very large part of your visual moves. So right now my visual field includes every single thing in this, um, studio, but it's not like the whole left side of the studio is just going to take off and move without me. Because if it did, I would feel like I was moving backwards. Right?

So when that tractor trailer or train is right next, that was great timing. Um, or the train is right next to you in the train or a tractor trailer starts moving. You're going to feel like you're moving in the opposite direction. And if you're like me, you've occasionally slammed your brakes harder because you just thought you were moving when you weren't moving at all. Um, that's actually really important thing to know or these visual cues when it comes to the next thing we're going to talk about, which is fear of heights. So I just want to cry looking at this bridge. I mean, I don't know about you. I don't, I always say I don't have a fear of falling. I have a fear of plummeting to my death.

So I think they're completely different things. Um, but I definitely have, um, not, not a fear of heights, but if you're falling, so the fear of heights comes from a loss of your visual orientation of things that are like normal sized, right? So it's like even if you are doing going up front on the chair, you are used to the floor looking a certain way when you're seated or when you're standing, but not when you're standing. Whatever that is, two feet off the floor, two feet off the floor. All of those visual signals that you're used to of like, this is how high this I am towards the ceiling. This is my normal visual field is different. Right? So that's why it's disconcerting to us.

It's not because we all of a sudden became like, have crappier balance because we're higher up. That's not the problem. The problem is that the visual information is different. So when we're seeing different visual information, it all of a sudden becomes disconcerting and confusing. So, um, for someone with bad balance, you could put them on a Cadillac and ask them to do rolling like a ball and that's going to be scary because you're just going to be like, I could fall even though it's like, but why would you fall over? You ever like just randomly completely rolled to the side and like tumbled ever? No, but it's like you've put them in a different position where the world looks a little bit different than it does where they've learned that exercise.

Um, have you, has anybody seen the pictures? They're like from, Gosh I don't even know the forties or 50s, and it's the native Americans building the skyscrapers and they don't have any of the, they don't have like anything holding them on. Like I actually looked that up because every time I even, I can't even watch it. I can't even see video where the people who are doing that cause I just like, my heart starts beating too fast. I go into like this pure panic mode and I was like, what is it about, you know, these native Americans that they had such good balance. And um, there were two things I found. One was that they actually, um, just their normal was a slightly narrower gate, so it was more of a foot in front of foot gate. And so I don't know if any of this is true. This is just random internet search.

Like why was it that they weren't scared of falling to their deaths on top of these skyscrapers? But there was also a, another theory that it was actually a machismo thing. So it was just like, I'm a bad ass native American and I'm not going to fall down. And so that it was more of a cultural thing that it was just like they weren't, they were like not going to allow themselves to feel that fear. Ruth was just saying that the, um, the native Americans, and she also doesn't know if it's true. This is all just conjecture, which is making this all up as we go along. But, um, that they're visual, their normal visual field would be something if like, you know, you're in the Arizona Mesa and it's just like you're higher up. Right? So your perception, like imagine if you were always looking down on something, then that wouldn't seem so scary. Right? As if I live in a city and I'm never looking down on anything unless I'm in a tall building. Right? So it's, it's really about what you have become adapted to and what you're used to seeing and what would be scary or what wouldn't be scary.

So in terms of visual exercise, there really isn't a lot of exercise for vision. You know, it's like, it's, first of all, it's the slowest thing to react to any kind of balance things. So if you start to fall, it's not like your vision is going to stop you from falling. It's your other systems are going to kick in to stop you from falling. So in terms of fall prevention, where it's useful is more of a, your ability to pay attention to what's in your space and like your understanding of trip and fall versus slip and fall, which we'll talk about. But it's not so much that your vision is going to stop catastrophic things from happening to you other than like you walking off a cliff. Um, it's not so much something we can train, but we can change our focus.

So we can do things like we can train blindfolded. Um, I always say like, the only visual training that I see people doing constantly is walking while texting. Like, because then you're like, you're focusing on this and you literally have tuned out pretty much everything else that's around you while you're, you know, you're texting your friend, I'll meet you at this corner and whatever. Um, but that is like one visual exercise would be that you would hold something like a pen and that you could walk or move and you're just looking at the pen and you're trying to let the rest of the visual field sort of dissolve. And then it would be things like acclimating to being comfortable at these different heights. So if you're doing an exercise that's scary because it's, you're higher up than you would be. It's getting like acclimated to that. Um, or just getting a sense, which is also a more appropriate substitute for getting a sense of where you are in space. Like if you're doing any of the flips or whatever on the Cadillac. I know like one of my biggest problems is I have no idea where my hips are. Like I'm like, are my hips over my head on my, I know it's like, and that's just as going to be something that takes practice because you need to get more of the proprioceptive sense of like the feeling of where, where it is that you are, which moves us into proprioception.

Chapter 8

Proprioceptive System

Um, which proprioception, it literally just means one's own perception.

And, um, it's a sophisticated feedback, um, system that comes from the nerves and the muscles, the joints and the tendons. And it constantly determines your position in space. So we had done this actually really briefly in the neuroscience workshop. Um, or if you've ever had a neurological exam and something called Romberg sign. So if you all want to stand up for me, we're gonna stand with your legs all the way zip together. And if you ever go to a neurological exam, they're gonna make you do this and it is a test of your appropriate assumption.

So what they're going to test for is how much sway do you have once you close your eyes and you're in kind of an unstable base, so you would reach your arms forward and you close your eyes. And if you have like a huge sway from side to side, and I'm now looking at all of you to see what kind of sway you have. And so there's a couple of people in here and I'm not going to pick on anyone that could use a little bit of this, of more appropriate sensitive training. So if I'm looking, most of you are like rock solid. I'm probably not super rock solid because I do actually have a neurological disease. But if you have like a big sway, like if people are like this, and I've seen people who were like, you know, theoretically perfectly healthy and like within fully intact proprioceptive system who had crappy appropriate assumption, you know, they're the people who don't have any idea where their arm is, where you're just like, move your arm inch and they're like this, you've taught these people. Um, so you would see that a lot where there's like people who like don't have this, this sense of where they are. So in the world appropriate assumption, we're also going to talk about kinesthesia. So kinesthesia is more of a sense, um, of conscious movement.

Like it's what allows us to get dressed in the dark. It's what would allow you to know, like if you're playing tennis. And so it's learning. It's a very much learned thing. So I see this ball coming, I need know that I need to step in about this far to hit the ball because I have an understanding of this as an extension of my arm and this is how far away I need to be to hit that ball. So that's going to be more of a kinesthesia. Um, proprioception is more of a subconscious thing and it's more of a positional sense. So the jobs that proprioceptors have are a sense of position and movement. So it's where your limbs are, where your trunks, where your trunk is, a sense of effort. So it's like how hard is it to do something, a sense of force, how heavy is it to do something in a sense or a sense of course, how much force you need to do something. And then a sense of heaviness.

So like I'm sitting down right now, so I feel like the into my sits bones. So I, I am getting that appropriate subject feedback. We also have something that I think is totally fascinating, which is called a body Schema. And your body Schema is a neural representation of, um, your body in the brain. So it's sort of a central map. So if you looked at, um, we talked about it in the neuroscience workshop about the homonculus and it's like, it like literally is a visual representation of your brain, but your body Schema is more like how your proprioception works so that you're able to move through your environment. Cause you know how big you are, right? So, you know, it's like I can fit through that space or I can like, I'll need to like move away from that a little bit.

So it's like you have this idea of your body and like where it's interacting in your environment. So it's basically your pilot, it's an entire sensory map in your brain. And what's really fascinating about it is it doesn't automatically change when your, when your brain does, right? So if you, um, for instance have a hip replacement, you don't have the joint, right? The joint isn't there, but you don't lose your body Schema. You don't lose the idea of you have a hip and that's where it is. You still understand that, um, you can also have it in the other way where an amputee can still feel their lost limb because it still lives in their brain right there.

The sensory map for their brain, for their arms still exist in that space. And you can also adapt to something becoming part of your body Schema. So if you're carrying a book bag and you're walking through a crowd, your book bag becomes part of your body Schema. You understand that your book bag is taking up space without even having to really think about it. You know that you've gotten a little bit bigger and you'll be kind of conscious of it. Um, so we, we generally know our size. Um, it gets into this whole body scheme also gets into something called the Perry personal space.

And the Perry personal space is a distance of about an arms length away from you that you don't have to have somebody, um, actually touching you for you to sense or feel that they've invaded your personal space. Right? So the reason you have a peri personal space is it's reflexive. So let's say you're walking or riding a bike or something, all of a sudden there's a tree branch and it is within an arms distance of your face. You're gonna need to react to that to get your face out of the way and you don't have the time to wait for that thing to hit you in the face to actually have a reaction to it. So it comes into the, where close talkers are like really disconcerting because it is an actual reflex that you have to want to not have them in your personal space. I don't know the science behind close talkers and why they don't seem to have the same personal boundaries that the rest of us have. So, um, Haley, come up here for a second.

Okay. Did they did a study years ago and it's culturally in the farm. Yeah, the Co she was talking about the cultural definition of like how much space you need. I need, I'm Dutch. I need a lot of space. Like it's a small country, but we're very like stoic and we like to keep to ourselves. But like this distance is like for Americans, like this feels like a comfortable distance. Right? And so let's say I was like just talking to you and I was like, this close does it, do you feel like a little bit like, yeah, uncomfortable.

Now what do you want to do? You want to step away from me? Right. Like she wants to, she's gonna re-establish her peri personal space and like, um, I've been on the definitely on the receiving end of close talkers and that you feel like you're just like doing this the entire time until all of a sudden you're like practically it's like against a wall and you've like been pinned. But it's all about like you trying to reestablish your space and kids love to like screw around with this Perry personal space. I'm not touching you. I'm not touching you, not touching you not touching. And that's like another thing that kids will do, right? Cause they're like, and they know there's a reaction.

They don't necessarily know why there's reaction, but my sister totally did that. Like where you were in the car and my parents would be like, you are not allowed to cross over from this spot to this spot. Like you, like keep your hands within your own side of the car or whatever. And I don't know your sister if you had kind of the same thing. I think that's just part of like having like sisters. I can sit down. Thank you. Thank you for letting me invade your personal space. Um, in the animal world, I just have to throw this out there because I think it's so fascinating. Um, cat's whiskers actually feed directly into their brain.

So their whiskers have sensors basically on the end of them, it's almost like the hair cells in your muscular system, those hair cells feed directly into their brain. But a cat's whiskers is the width of a cat. So they can kind of gauge if they're gonna fit into that box that they're going to sit in for some inexplicable reason based on whether their whiskers can get through. So it's the whiskers that are going to give them their body Schema and like tell them where their body is in space, which I just thought was like really interesting. They won't eat out of a small bowl because they don't know that their face can really fit into it.

So cats are actually better fed on a plate than in a bowl because they don't like their whiskers touching. So if like you see a cat and it's doing like this, it's because it's very disconcerting to a cat to have it basically be like eating next to a close talker. Like it would just not be, it wouldn't be a good time. So, um, once we have appropriate assumption, we, we get these sensations, but then we have to move them to action. So you have sensors, which are your muscle spenders and your Golgi tendon organs, um, that are sensitive to stretch your pressure. And they're going to tell you how the brain, um, it's going to tell the brain how the feet are positioned, what kind of movement is happening. These proprioceptive, um, are going to send movement along the spinal cord to the cerebellum or it's going to be processed along with the vestibular information and the visual information. And then it's going to kind of create this entire movement thing. Um, it's constantly being updated. So whatever's happening with you is going to be fed through the system so your appropriate sectors are constantly telling you where you are.

It's going to create this image of your body and it's always also going to tell you how much pressure to use. So it's basically the difference between tapping somebody or punching somebody. It's like, you know, how much force you use because of centers or, um, I think we use this example in the neuroscience workshop about like if you're going to do like lift your drink to your face, like there's a point at which you need to stop lifting your drink or you're going to just punch yourself in the jaw. So you need to have, you need to have that, the feet. I'm, uh,

Chapter 9

Proprioceptive Problems

I'm very obsessed about barefoot stuff because in your feet, um, you have 33 different joints and every single one of those joints is giving you information about the floor of the terrain that you're on. Like how you're standing, how you're walking, no step is going to be the same as the last step you took. So every time those joints are moving, you're going to have a little bit of a reaction to what's happening unless of course you're preventing those proprioceptors from working.

And people do this all the time because they wear these extremely thick, clunky tennis shoes because they actually think that that's going to give them better balance. And I had one of my students, um, who has ms come in and she had these really thick sole tennis shoes and she said her doctor had recommended them. And I'm just sitting there like, hold your breath, hold your tongue. Do not say anything. I was just like, well, and she's like, and you know, it's weird. It's like, I actually feel like when I'm barefoot I have better balance. And I'm like, well yeah, because you do have like a lot of feedback coming in. So an analogy that I like is like if you have somebody that doesn't understand or can't understand that wearing fixed, sold shoes is detrimental to their proprioception, give them a shirt with buttons and a pair of Mittens and tell them to button that shirt. Because that is essentially what you're asking people to do when they're walking around in shoes all day. And you're expected to like get any kind of signal from the ground that you're walking on. You should be able to create an entire, um, visual picture of the floor with your feet. But most of us don't walk around barefoot. Um, when I was a kid, we were not allowed to wear shoes in the house like ever.

And I carried that into my adult life. I really hate having shoes on. So for me, I've always had really decent proprioception and I think that even though, you know, I've had a neurological problems, proprioception has never been one of them. And I really think it's because I had a highly trained proprioceptive system. Like it was just like no shoes allowed. I grew up in a beach town. We walked barefoot a lot on the beach. So you really got used to having your feet move, um, and really feel the floor that you're walking on. Um, I don't know if this is true and they don't give me any money so I'm not advertising for Nike free. But, um, I was teaching a course in Rome and a woman there said they had done a test on all the different barefoot shoes and she said that the Nike free had the best proprioception of the barefoot shoes. And um, you can Google that and see if that's true. I'm not sure if it is, but I know that, um, I always feel like if you go to a [inaudible] conference, it's like you just check out the different brands and barefoot shoes people have because I think we've basically got that concept down that barefoot is a little bit better. You can also have a lot of proprioceptive problems.

So if you're ever numb, you get really confused about where you are and you you don't like, like numbness is actually a terrible sensation. So if you go to the dentist and you have dental work done, you spend the entire rest of the day until it wakes up checking to see if you still have a face cause you're like I don't feel my face. And you're just like, is it still there? Is it still there? And I had my, one of my early ms symptoms was my, the bottom of my feet of both feet was numb for six months and I can tell you, you do not get used to it. It's like numbness is like a very weird sensation. It's like it just messes with your brain and it's not like you get acclimated to it. So if you had to have some sort of nerve surgery or whatever and you lost sensation somewhere, it's always going to be a little bit disconcerting. Sort of like has anyone fallen asleep and woken up with some dead person's arm in their bed? You know where you're just like, what is this? Dead arm is your arm, but you're not connected to it at all because you have no sensation in it and you touch it and you don't feel it cause it's completely fallen asleep and it's so creepy because you're just like, oh my God, who's dead?

Arm Is this and it's your arm is still attached to your body. That would be like a problem with proprioception. You can also have problems with any kind of tight muscles. So tight muscles are gonna cause if the muscles are tight around the joint, the joint isn't going to give the right feedback through the whole proprialceptive system of how much movement is happening. So if you have somebody, and a lot of times in neurological problems, people with really tight ankle Dorsi flexors and really tight joints, their balance is always going to be impacted by that tightness because the proprioception isn't going to quite feedback correctly.

You could have damage to neuropathways. When you have poor alignment, which we talked about at the very beginning, you're going to have poor appropriate perception just because you're not getting the right feedback through the systems because your alignment isn't correct. Um, there's age-related proprioceptive decline. And then there's situations where that I think really interesting where you don't have proprioception in water, so it's your vestibular system tells you if you're up or down. So if you are somebody like we were talking about earlier who is deaf and can't get this, um, you know, we were saying that the stipular system wasn't necessarily working and this is like, um, people, and I do not know if this is like culturally appropriate or politically accurate to say, but who are deaf mute. So they have never heard anything in their life. So they have a fully non-functioning and it's usually the whole inner ear complex that isn't working. They have a high risk of drownings swimming in the ocean because if they get turned around by a wave, they don't have their properly functioning vestibular system telling them up or down and in water.

They don't have their proprialceptive system working telling them up or down. Right? So it's like you could conceivably swim the wrong direction, right? So you wouldn't want, that would be a very dangerous thing to be swimming in a situation. It can be tossed around a lot. You also have age where children's proprioception just is not fully formed yet.

And if you've ever tried to work with a kid around the age of 10 and they have no idea where they are in space, then they have, you know, just a non fully formed proprioceptive system. And then, um, and I'm going to take a term that was coined by my neurologist, not by me, that you have people who are motor morons and they just do not have a good sense of proprioception. They just don't know where they are. Um, there's also some really interesting studies on overexertion and the impact on proprioception, which I think is really important, especially when you're working with anybody who has balance problems. Um, if anybody has ever done intense exercise, you actually feel like you might feel like you worked out really hard, but you also feel really clumsy right afterwards because you've had a negative impact on your appropriate sectors. So um, fatigue in and of itself can disrupt your proprius sectors, but it's also in terms of concentric force, you lose concentric force and that's usually due to like metabolic factors like you just, the sarcomeres are worn out, you have too much lactic acid, they're not quite firing correctly and that's gonna recover pretty quickly. But East centric forest is actually slower to return and can actually take a couple of weeks and that's going to disrupt your movement sense. So like you're like, don't, I feel like kind of weird walking. You'll see sometimes that people are, have run marathons, they like their central pattern generators in their spinal cord that's going to keep them going for just that repetitive motion. And then once they stop, they can't even walk. They just literally stumble and fall across the finish line, which is always really fascinating cause they managed to keep running but then they're appropriate sectors are completely shot.

They don't know where they are in space and that's actually gonna take quite some time to recover. Um, and you can also have, um, just some changes in how you move. So if you're like me and you're somebody who's knees really liked to hyperextend, the more tired you are and the more tired your appropriate sectors are, the less aware you are of that hyper extension happening in your body. So the basic proprioceptive exercises are going to be honest surface that's going to be flat, right? So you would always take somebody who has poor proprioception and you want to give them the most orientational accurate surface you can give them, which would be the floor. So the floor with no move with nothing on it, like a wooden floor is something that's going to like really work well for like proprioceptive training. We're going to call it like beginner appropriate septic training.

Once you get into like the more advanced stuff, that's when you start adding in unstable surfaces, wobbly things, things like that where you're appropriate receptors have to like react and send the signals up to your cerebellum where then the motor signals can go out and say, we were going to react this way, but you don't start people there. So it's really, I think a lot of, when you're looking at 'em advanced balance training, to me it's like circus tricks. I mean like really how useful is that? Are you really going to be needing to do that in your life? Probably not. But you're going to need to be able to walk on an unstable surface or if you have, you know, the road is like crooked or whatever, you're going to need to work up to being able to adjust to those kinds of things. So proprioceptive exercises are going to incorporate balance, coordination and agility, um, to make the appropriate aseptic proprioceptors work and then you're going to progress to something more dynamic. So let's all come to standing. And first one we're gonna do is, um, called tandem stance.

And so you're just going to stand with one foot completely in line with the other foot, which I actually think is like looks like it should be super easy and it's actually really hard because it's [inaudible]. We've created an less stable center of gravity at less stable base of support. And you're also, you can tell a lot, I like to use this as sort of a diagnostic tool because you can tell a lot about what's going on with people's hip stability and you can tell a lot with what's going on peoples' ankle stability. And you'll also have some times where people like you can put your weight entirely back in your heel, but that's not the exercise. The exercise is to try to evenly distribute your weight through your heels and then you would see what the next side is like.

So for me, what's really what, what you'll run into, like maybe if you're working with neurological clients is my left leg tends to have a lot of muscle spasticity in it. And so my left ankle is really tight in terms of Dorsey flection. So for me to have my left heel back is actually throwing me off balance because it's harder for me to keep my heel grounded. So you'll get like some bits of sort of visual information like that. You also can progress to the single leg stance. You know, any one leg is usually going to be better than the other legs who we're going to go on to single leg stance and then you would add the, okay, let's close your eyes and can you stand in that position with your eyes closed and you, if you are having trouble then I'm thinking proprioceptive training should be on your agenda, right? Have something to do. Um, any standing plots, exercises like, um, you have people do like single leg poles or stuff like that where it's sort of a standing exercise is going to challenge your proprioception and then anything you're doing with your eyes closed is going to challenge that.

I have a Bose too over here. Um, so both of those are nice because you have the ability to have two surfaces. So let's find somebody who has gotten better balance than me to stand on this. So volunteer, who wants to stand on a Bosu? Aaron? Good. So I think they're totally different situations, right?

So you have flat surface, right? So flat surface, more accurate to the floor when you have a turned this way. Right? So it's not going to challenge your ankle stability maybe as much as more of like your hip stability from the wobble. Um, so if you want to stand on it, I can actually help you by holding it a little bit more steady. Um, we're gonna sit both feet on, do you know what she just did right there? Can anyone, she just lowered her center of gravity so her balance would be better in that situation. So here, just standing on it I think is hard in and of itself. And then you would add movement to that. So we're going to do a squat. So you're bending down. Does that feel more balanced? Lower? I'm not upset.

Yeah, cause he's also moving. So it's a dynamic motion. And then you could progress somebody to doing single leg on this. If you wanted to get super fancy, so if you narrowed your feet. So here like we're also having to, we're also having to adjust your welcome. We're also having to adjust for the, the roundness right of the Bosu. So if she was going to come to a single leg stance, she's going to have to work one foot and you can hold onto me.

She's going to have to work on one foot moving closer to the center. My bounds today is really odd. That's because you're on camera. Yeah, there you go. And what I'm doing is actually something I'm, I'm going to talk to you about when we talk about assists. I'm not holding her. She's holding me. I don't want to become a destabilizing force for her and I'm also letting her hold me closer into my center of gravity rather than having her hold my arm because I also don't want her to knock me off balance.

So they're standing in that way and let's see if it's easier this way, which I actually think it's going to be, cause that way is you have more of a wobble this way. You have more of a squish. So the squish is going to be two feet. Yeah, totally an easier scenario. But we're getting a lot of like your appropriate sectors are telling you your ankles moving this way and you have to adjust and like there's all these little things happening kind of up the chain and then her brains sending information back down and saying like, oh, we'll just adjust a little bit this way or we'll adjust a little bit this way and then you can go ahead and step down and then we're gonna put this to the side for now we're gonna do a couple of exercises. I'm using the reformer. So we have also, like we talked about earlier,

Chapter 10

Perturbation Training

you have static balance and static balance is, you know, where you're not moving. But dynamic balance is actually more important because dynamic balance is usually where people end up falling, right?

Just not like you're standing there and just collapsed to the ground unless you've got some serious issues. So in terms of walking what we had as dynamic balances, you're generating continuous movement. So you're moving and then you just keep moving. You have to maintain your balance through that movement. Adapt to any changes in the environment such as the terrain is different.

Like you might have like some rocks here, like it's uneven and you also have to get started and stop, right? So you have to initiate movement in terminate movement. You get sort of into initiating movement being an issue with certain things like um, if you have Parkinson's disease, like kind of the getting going is like a neurological problem that they might have when you're going into more advanced proprioceptive training. We're going to get into what I'm going to call perturbation training. So a perturbation is anything that's going to be an outside force that's going to affect your balance or movement in any way.

So that could be anything from you're walking and there's a huge gust of wind that all of a sudden like knocks you to the side a little bit. It could be some jerk that's walking behind you that bumps into you because he doesn't have a sense of his peri personal space or his body Schema. Um, perturbation training to me is fall prevention training. And so this is really where you want to work people into, um, because you want, especially your fall prone clients to have strategies and to like have ways to adjust and a practice being in these unbalanced situations that they don't have much control over. So you have to throw in unexpected movements. Um, because that's what happens in real life. That gust of wind, you don't necessarily see it coming. They have to be focused on something logical, like walking, like walking is a s a thing that we're all hopefully going to do for a long time. And then if you're training an athlete, you want their perturbation to be sports-specific. Okay.

So going into perturbation exercises, um, let's go ahead and we've got a couple that we're going to do on the reformer. So, um, when we were doing scooter before Meredith, can I have you come up and we're going to have you do it and I'm gonna do two different perturbations for the same exercise. So the first one is I'm going to give you an unstable ground surface to stand on. We're on one spring. We're still on one red spring. So you stand on that. Bring your other foot up. So the first one I'm going to have her do is bring your foot back and you can be, um, kind of any position won't let, we'll do the external rotation cause think it's a little easier.

Put a little bend in your standing leg and then you'll press your right leg out in it. So this is a little bit less stable than if she was standing on the floor, right? Because if she was standing on the floor, she would have the ability to, um, have her foot be a little bit less unbalanced. The next one I'm going to do is I'm going to use this theraband to give her an unexpected perturbation. She's like, what? So I'm going to wrap it around her kind of upper thigh and I'm not going to tell her when I'm going to do something, but you're just going to keep going. Do a little faster.

I'm trying to, I'm waiting. So I'm just pulling like I'm coming in and I'm just going to pull on her leg to like give her something. Let's, let's say she stepped on something that was gonna pull her onto the outside of her foot. So if you watch what her foot stewing, so I'm gonna pull her to the side. So do you see how her foot just supinated a little bit and then it's going to come back into like more balanced position. So weird. Right? And then I could also do this. So let's keep going. So let's have pull her that way, right?

So she's going to have to react to whatever kind of destabilizing force I'm going to put on her. Okay. Thank you for not falling down. It's a very important part, very important part of the lesson. So, um, you could also do, if you're on any kind of wobbly surface, the same deal. So does anybody want to stand on the really wobbly side? Haley, this would be a, please don't fall on me situation. So we'll stand.

Lowered her center of gravity. So she's gonna stand in, I mean fitness instructor, I'm going to move this, so I'm just gonna push it a little bit to the side. And so she's going to have to react to whatever different force I'm giving it. So that's going to make her not necessarily know which direction am I going to push it. Maybe I'm going to push it more backwards. Maybe I'm gonna push it a little bit more forwards, but she's going to have to react to whatever I'm throwing at her in that scenario. So you could do either the squishy surface or the hard surface, the hard surface is going to be a little bit more difficult.

He can go ahead and step off of that, which would, that was not a fall. That was a step. So gracefully stepping off of it first, we're going to do an easier one. So we're gonna face in so you can stand on this squishy surface and you're going to grab this bar and I'm going to lift it up a little bit higher because we want to have it, have some tension on it. Yeah. And then you're just going to pull the bar down towards your legs and then let it lift forward and hold on actually on the outside of the spring.

So you're gonna pull it down and reach it for it. Now pull it down and we're going to do a squat at the same time. So pull it down, squatted down, taking the bar with you. Whoa. Stand it back up and reach it for it. And the reason I love to add this springs to this is because the springs sort of offer you, I mean, they're sort of destabilizing and stabilizing at the same time, which is weird, but you can have 'em.

They give you a little bit of something to hold on to and they're gonna give you a lot of feedback. So you pull it down and then you're going to do a squat down and lift back up. Good. Now we're going to turn around. So I do one 80 and this bar is going to go over your head. That will give it to you. Hold onto the outside of the buckles.

Okay. Okay. And then you're gonna just push your arms straight. Okay. Ish. Can you push them forward a little bit? Yeah, yeah, no. Do you need to be closer? Okay. It's just because I'm short. Well, let's also lower this a little bit. Let's try this. So we're standing on this surface and then you're pushed your arms out. Okay.

And Ben to come back. But way harder, right? Than if you're just doing this on the floor because you're getting all this like feedback of how much the floor is moving. So you're having to work a little bit harder into this. Right? Okay. So let's go ahead and we're gonna come back and I'm gonna take this off. I'm going to change what the springs are. Do we have any skiers in here?

I feel like you ski. I feel like I've seen that on Facebook. Okay. So let's say, did you moguls Whoa, perfect. That was not even set up. So Haley, the mogul skier, we're going to say we're training Hailey because she's going to the Olympics or you know, just to vale. So we're going to move this a little bit further back. You're gonna stand on it. I'm going to give you your ski poles and you can hold on, kind of high up. Um, we might need to move this back a little bit. Yeah. And you're going to come into a squat.

And what I want you to do is start moving like in the same kind of positioning that you would do. And if you need to hold on higher up or have me lifted higher up, we can do that. Okay. So moguls are probably the most like unstable thing. You have no idea where they're going to go. I want you to it down like you're doing. And then just let your, you can pull down with your arms a little bit.

So you're getting a little bit of tension there and you're gonna let your legs go. So we're kind of double squats to the side. Yup. Perfect. So if she was doing her mogul prep training, so she doesn't blow her knees out when she goes and does that, this would be a perfect sports-specific exercise for her proprioception to do something like that. And I might want to play around with a little bit with where the arms are, but just for, for a difference, I'm going to have you br tennis player now. Okay. So you're going to turn around and face the other direction and you're just going to hold onto the right spring. Good.

I want you to squat low and we're going to take your right arm out to the right and then you're gonna swing it forward. Good. And reach your arm out to the right and swing it forward. Good. A couple more like this. Reach it out to the right and swing it forward. Last one like this, reach it out to the right and swing it forward. Where I'd come all the way back up.

Let's say we're getting her ready for the Olympics. Another way you can like make people have to work harder for balance is to give them a cognitive challenge at the same time as they're doing a physical exercise, especially when you get into the older population, which of course she isn't, but we'll just pretend. So she's, let's say going to the PGA tour, um, and she's going to be practicing her golf swing this time. So you're going to hold on, um, as if you're a golfer. Um, but she's going to do the swing and I want her at the same time as she's repeating this exercise to start going through words that began with each letter of the alphabet. So you're going to do like apple, banana, whatever. So at the same time as you're doing like a swing, so you're going to rotate and give me your words. So totally still up here. Hi Jambi KOD. I love it for the animals.

Definitely doing animals. Oh perfect. Okay. So you can gain come all the way up. So you get what I'm going for here. Right? So we're adding on progressions of challenge for her and you can come off to standing. Good. So now I just need to check what's next. I think that might actually be that for that section. Ah, okay. So another one you can do for perturbation, I'll just do it because of time is you can do things with the legs spring.

So I'm just going to lower this way down so that it's at a level that the leg springs are at a more appropriate level. So the leg spring is going to pull me in a direction. It's gonna want to pull me back to here. So say I wanted to do something where I'm like, okay, I need to work to strengthen my, um, Luke meat. I won't need to work my outer hips so I can do stuff where I step out into a lunge and come back or step out into a squat, some stepping out, holding it back in, stepping out, pulling it back in.

So each time I step out first I have to like work harder than normal because the spring wants to pull me this way. Um, you can do all sorts of fancy things. I do like sort of a standing skater where you're standing on one leg, let your leg come across and reach it out. You can leave it out and do like little leg circles anytime that you're standing and you have the spring wanting to pull you in one way, that would be a great way to do one of these perturbation exercise challenges. Okay. So just a quick reminder. Um, you also have to have power to have balance.

So if you start tripping, you need to be able to move out of it really quickly. So I think one of the best ways to train power is jump board and not to necessarily do it really light cause I think a lot of times we do it really light because we're, you know, working on like our abdominals or whatever. But you need to have those legs ready to like fire and move quick. And so unless you're doing quick power moves, you're not really, again, you're not training that motion. Okay.

Quick, quick muscle reactions are going to prevent falls. Um, and like again, I said jump board in the plays row is probably best. You also really need to make sure you have good flexibility cause again, flexibility is going to impact how your joints work and how your proprioception works. I especially am concerned about flexibility of the feet cause you see a lot of people and I especially get older people whose feet are like solid blocks, like their toes don't have any ability to like spread or move or anything because they're so used to being in shoes. So I want to look for, can we improve foot flexibility? And it's usually a combination of like myofascial work where we're rolling the feet and doing foot exercises where you're like moving your feet, um, moving your toes individually, making sure that they can spread. And then in terms of foot and ankle, you want to make sure that the ankles are properly aligned. Left side, no Bueno, bad PR, bad. Um, pronation, right side more what you're looking for.

And I always try to cue people to remember that they're keeping their weight evenly distributed to the four corners of their feet, but with an active pressure down into the big toe mound to lift up the arch. Because a lot of times, and I'm, those are my feet, so I am a horrible pronator. Um, which is, um, I think manufacturer's standard. I don't think that has anything to do with any neurological condition. I think that's just how I am.

So I really have to work hard to make sure that I'm not rolling my ankles in. Foot.

Chapter 11

Balance and Aging

Stability is key because 25% of the bones and muscles of your entire body are located below the ankle. I mean, I feel like I should say that again. 25% of the bones and muscles in your entire body are below your ankle. And yet we have feet that don't move.

Like we have feet that are completely like locked in space. So you must have proper function for good balance and you really have to have the intrinsic muscles guiding the motion of the ankle. So if those muscles aren't working, you're not going to be able to work properly. Um, your feet also have light touch sensors. So in addition to the sensors, appropriate sectors, they have so much feedback that you can get, but not if you're wearing shoes all day long and like minimizing the ability of your feet to like move properly. Ankle stability. Remember, ankles are the first keeper of balance. This is where you want to really do ankle stabilizing exercises. And we've actually gone through one of my favorite exercises here already, which was, um, one of my favorite exercises in the ankle stability exercise is the chair.

We're going to push the pedal down lower and lift your heel. Other things you can do is hold a theraband and do the alphabet with your foot. And the reason that works so well is because it takes your ankle through all the planes of motion. And it doesn't matter which alphabet you use, it could be the cyrillic alphabet or alphabet because all of them are gonna just move your foot in all these different directions. And I like to load it from like where you have to into planter flection and load it where you have 200 Dorsey flection cause you want to balance your planter endorsee flexors as well. Um, one um, thing that's incredibly difficult is to put your foot on a wobble board and put a ball on it and try to roll the ball back and forth without having the ball fall off, which my physical therapist gave me and I don't do it because it's too hard. Um, and then any ankle liens. So anytime you're doing the roll up bar kind of leaning out, you're gonna feel that motion, your hip stability is going to be your next keeper balance after your ankles.

And um, I have the saying, I say it's always the glute need because it's 99% the glutamate, it's like the glute meat is weak. It causes your hip to either go out or in, but glutamine, strengthening closed chain exercises and open chain, but really more close chain are going to be where it's at. And this is where you do like the pelvic listing where you do the hips dipping from side to side. And we've shown some of them. So we did the pelvic listing on the one to chair. You could do the same thing on the reformer. You just dip your hip. Um, any kind of skaters, things like that are going to work great.

And I really like where you do sideways walking with the therabands. So if you had a theraband and you tied it around your legs and just straight leg walk, it's like one of those things that you do like three reps in your will all of a sudden like why am I sweating? This is actually way harder because it's just working on like keeping the weight evenly distributed. It's going to really fire into your glute mead. Now let's talk about balance and aging. Um, the stats are actually kind of scary in your thirties is when your muscle strength starts diminishing in your forties is when your vision generally starts to decline and your visual monitoring actually starts to increase. So your vision is getting worse, but then you're relying on it more, which is completely counterintuitive. But what happens, um, you have less hair cells in your vestibular system, so your vestibular system stops working as completely as it could.

Your appropriate sectors decline. And then some of the scary statistics are one in every three people over the age of 65 fall at least one time a year of those falls. Um, 90% of the hip fractures that people get come from falls. And another thing that's a major contributing factor in aging and weakness is quite odd. East centric control. So in addition to people falling while walking, there's falling while sitting.

So if you don't have the east center control to like slowly lower your hips down to a chair or the toilet or whatever, like this is where people like end up falling backwards, right? So it's, it's about the strength of their quad. So if you're working with older people and you have a reformer, load it up, put the springs on. It's like, just because somebody is older doesn't mean you want to give them lighter weight. You want to build their bones, you want to make sure that their quads are strong east Centrica Lee. Um, and then you also have all the extrinsic factors like bad sidewalks, tripping over laundry, whatever other things make people fall. There's also something called Sarcopenia. And sarcopenia is the loss of muscle mass that people have when they get older. Um, it's usually greater in the lower limbs, so in the legs.

And you also have a decline of the end of the muscle spindles, which actually decreases proprioception. So at the same time you're losing the visual system, you're also losing a little bit of the appropriate assumptions system. But the good news is exercise can help prevent the decline in either of these. Now in terms of falls, if you have people that have had experienced falls, there's really two different types. There's trip and fall and slip and fall. So trip and fall, his back leg catching on something behind you and then you trip and then that case you fall forward. If you have a slip and fall, this would be ice.

You step your heel lands and you slip backwards. So if you have people who've slipped in different ways, you can like help them get comfortable in knowing what the problem is. So a lot of times if it's trip, it's not enough use of their hip flexors to get their leg through or their Dorsi flexors to swing their leg through and on the slip. It's a lot of times, um, like if they're walking on ice, for instance, the heel strike needs to actually be more flat so that you're not setting yourself up to like go out that way. And then you also have diseases impacting balance and there's several of them.

So pretty much any neurological disease can impact balance. So for your neurological clients, be really cognizant of what they have that might affect it. And then when you're assisting somebody who is wobbly, you want to make sure that you're not a destabilizing force for them. So offer them your elbow instead of your hand because that's going to be more stable and don't hold them, have them hold you. And if you're offering an assist, I like to assist from the side because I'm not very big.

And so if somebody starts to fall forward, I'm going to have a lot easier time catching them if I'm at the side of them than if I'm forward and their weight is going to knock this wobbly person more off balance than I would be. So you need to make sure that you are also bracing yourself. And then finally we're just going to talk about progressions and the progressions are really about changing base of support. So for instance, you go from four points to three points to two points or two points is a plane, three points is a triangle and a triangle is going to be much more stable. And so like if you were doing reformer, you could do stuff where your hands are on the foot bar, right? And you're doing a lunge and then you progress to where your hands are off the foot bar. But maybe your back knee is down and then you progress in.

You're like, okay, well hands are off, but we're going to be honest standing platform. And then remember when we were talking about how the visual system, the cues that you're used to like are more scary. So when people do the Russians splits and they're doing the backward facing one, that's more, that's more scary for most people because you're not used to looking at the reformer from that angle when you're standing up as much as you are looking towards the foot bar side. So for me, actually it's the reverse because I can get more of my heel down and grounded in the reverse position because you're in that turnout of your back foot. So it's really gonna depend on the person, but you look for what is their scarier thing or doing going up front on the chair and playing around with that. So that is pretty much all I have.

Do any of you have any questions that I can answer that we didn't go through? So Francine's question was if I have somebody that comes in and there they have some distributor stuff in, they're already feeling dizzy. I'm not going to add to their dizziness by working their vestibular system in any particular way. I wouldn't be doing bouncing on anything because, um, my physical therapist put it really well. They will throw up on you. I don't want anyone to throw up on me. So I am very like aware of making sure that like, I'm going to try to prevent dizziness, not caused dizziness.

So it's like I'm more likely to train vistibular with somebody who isn't presenting dizzy that day. Okay. So Amy asked about inflation of the Bosu. So anytime, um, it's more inflated. It's like, it has a different level of stability. So it's, if it's fully inflated, it's gonna have a little bit more like the rock from side to side. But if it's more deflated, it's actually harder for your ankles, right? Because it's squishier and it moves in different ways so you can always play around with that. Um, sometimes I think you have kind of fun with the Bosu just based on the fact that, oh, it's Kinda deflated today and I don't have time to blow it up. So we're going to be doing it on a less stable thing. But if you flip it over, the more deflated with the t, the flat part on top is going to feel much more stable.

So it's really difficult to balance when it's super inflated. And this one we had today was really like blown up like a balloon. We'll hopefully go forth, do not fall, walk barefoot, practice your balance, have your clients practice their balance, workout with your eyes closed. And um, thank you so much for coming. I really appreciate it. Give yourself the hand. No one fell down today. That's always a good day.