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Balance and Unstable Surface Training - Useful tool or dangerous gimmick?

Written by: Nick Jack
Category: 2014
on 27 June 2019
Hits: 8677

The past few years has seen a great amount of research relating to the use of unstable balance training, and many of these studies have provided conflicting conclusions as to their effectiveness. The contradictory findings have left many people even more confused and uncertain whether to use this type of training. We have covered an overview on balance training before, but this article we wanted to look more specifically at the use of unstable balance training. Previously balance was just standing on one leg and mainly used for older adults and rehab but with the introduction of equipment like the BOSU and balance boards we have seen an evolution of strength training exercises. But is this training equipment just a gimmick and is it even dangerous as some experts suggest? I am a massive fan of Dr Stuart McGill how does not endorse this type of training but I am also a massive fan of Twist Conditioning that does encourage it. Both experts have training models that prove to work and have research backing up their beliefs so who is right? In my 14 years as a trainer I have found that there is no one way or absolute answer to anything with exercise and health. And when it comes to balance training there are times when it is great and other times when it is detrimental. The key is to know when and who you are using it with and there must be an intelligent approach to how it is applied. The benefits can be astounding however, if used poorly there is definitely a point where the risk outweighs the reward. In this article I will dig deep into everything you need to know about unstable balance training and you can make up your own mind if it is useful to your training or not.

What is the Purpose of Balance Training?

The two videos shown above are great examples of the many exercises using Balance Boards and BOSU in the gym today. Some exercises are great, some are more circus tricks that provide little benefit to moving more efficiently. Before we dissect these training tools we must answer the question what is purpose of using balance training in the first place. The obvious answer is – to improve your balance. Whether it is to ride a bike, excel in sports, improve joint mechanics after an injury, or prevent falling with older adults, we know that this is a skill that must be developed and trained.

And to effectively train and improve your balance, you must be out of balance to begin with!

This is where we have seen the evolution of training equipment to provide the body with this challenge.

I remember the first time I stood on the flat side of a BOSU and started to do a squat and my whole body and my legs starting shaking violently. I just couldn’t stop the shaking it was incredible. My arms were swinging everywhere and I was all over the place. After a few attempts at this I seemed to work it out quite quickly and no longer found it difficult. Anyone who has trained people before will have seen this first hand too.

The first exposure to an unstable surface typically causes these large gross movements throughout the body that are initiated to compensate for the change in stability and try to restore your centre of gravity. However these large movements often cause the body to be even more unstable and hence a greater degree of shaking and instability continues.

The reason your body reacts like this when subjected to unstable training for the first time is that the feeling of instability generates a massive increase in muscle activation in both prime mover and stabilizing muscles to assist. The nervous system responds with a non-specific spinal reaction to attempt to bring the centre of mass back within the supporting surface. Once you have exposed the body to multiple attempts at training in unstable environments, it is able to both respond quicker to the fast reflex movements with more precise, timing and adjustments, activating only the muscles needed. This is when you find it much easier and no longer swing your arms and can maintain a steady trunk position.

Research article supporting balance training.

You do not need research or some scientist to tell you that your body has made some big changes to your balance. It is plain for you to feel and see.

The big question however is do we need unstable surfaces to achieve this? Can you achieve the same outcome by training on stable surface? And even if you improve your balance on a BOSU or balance board does it serve any benefit to improving how you move in life?

The Argument Against Balance Training

The main arguments I hear against unstable surface training is that we don't perform on an unstable surface and it compromises strength gains. Research questioning unstable training

But is that truly always the case?

The first argument is supported by many experts like Dr Evan Osar in his book "Corrective Exercise Solutions for the Hip & Shoulder" and Dr Emily Splichal in her book "Barefoot Strong" both endorse barefoot training over unstable training. Both of these experts have amazing programs and methods for improving balance and creating foot stability. Both are of the opinion that the use of BOSU and other unstable equipment can ruin your ability to create good foot stability needed for walking, running and most movements created in the gym or in life.

And without a doubt there is a huge problem in today’s world with foot instability and this makes perfect sense to me. I follow both of these experts work closely and have completed courses and read both of their books several times and constantly refer to their findings. I encourage you to read those books to see for yourself their thoughts and conclusions.

I agree with everything they say and where foot stability is a problem I tend to avoid unstable training and focus my efforts on creating optimal mobility of the big toe and activation of the foot muscles in a single leg and lunge stance on the floor.

However, I do not shut the door on unstable training and I do not agree that we never use this in life and there is no place for using it. I will give you two specific examples of how this affected me personally.

  1. I played basketball for over 30 years and I can tell you I sprained my ankle many times from landing on another player’s foot at high speed after attempting a lay-up. While the court is definitely a stable surface, it is far from it when I land like this.
  2. I also competed in cross-country distance running for many years and would often run through forests and trails that had all types of undulating terrain with endless rocks, sticks, holes and slippery to contend with. I used to take running groups up into these trails and all the people who predominately ran on the road were the first to fall over.

While training on stable surfaces was great, it did not fully prepare me for the specific demands I needed every time I ran or played a game of basketball.

I remember when I started using the BOSU and balance boards a lot and could feel a big difference to how I played or ran on trails. I never sprained my ankle for 5 years in a basketball game after using this type of training. And in all the years I trained on trails I never once fell over and sprained my ankle as I had already used this extensively. I never had any fear running across any terrain.

The second argument I often hear against unstable surface training is that it ruins strength gains. And to be honest I can see there point when you observe people completing crazy stunts that are just circus tricks and abuse the concept of balance training. I agree in this case that strength would be more beneficial than trying to show off and the risk of these circus tricks is not worth it.

However when it comes to ignoring balance altogether I find the people on this side also believe that strength exercises are the only type of training we need. Their belief is that strength fixes everything. Stability training with this approach is usually restricted to planks and various abdominal isolation exercise. While strength is definitely essential it cannot be created if you are not stable to begin with, and you cannot create stability without mobility to begin with. We refer to this as the success formula.

As you can see these are great arguments and at times they may even be right but to ignore the positive benefits is unwise. I find it is best to look at who you are using this method with and determine if it is the best approach for the person in front of you.

When people think of balance training and who would benefit from using this the most there are three areas that comes to mind

  1. Older adults
  2. Injury and rehabilitation
  3. Sporting performance

Balance Training & the Older Adult

We associate balance training needed for older adult populations because this group is at an increased risk for fall related injuries. However many would argue it is risky, even dangerous to subject an older adult to balance training equipment and that it is unnecessary for they do not perform any daily activities on unstable surfaces.

When younger people slip they react quickly to adjust their centre of gravity, and find instantly a safer position to land. This happens really quickly, yet with an older adult or a person with poor balance you will see they have a very slow response and land in an injury threatening position.

The reaction time of a 60-year old is on average 25% slower than that of a 20-year old and people who live in extended care have even slower reaction times than those living in the community.

With advancing age, coupled with inactivity you begin to see proprioceptive, visual, vestibular and overall somatosensory capability declines. It is well known that muscle mass decreases, postural sway increases and reaction times increase, which mean the older adult has difficulty coping with changing balance challenges. This explains why the ageing population is placed at an increased risk of falling, injury, debilitation and death. Hip fractures are the most common are very common result and have a high link to fatality.

For more information on this I suggest to read our article – Preventing Falls Using Agility & Reflex Stability

To effectively train the loss of balance you need to expose their bodies to the reflex mechanism that is required during a slip or a fall. And unstable training is great for achieving this. You do obviously need to keep this safe and there are many methods you can use to do this. See the video below.

Encouragingly, research also shows that specific strength and/or balance exercises enhance stability and reduce the risk of falling, as well as increase overall physical performance (LaStayo et al. 2003;Spirduso 1995; Judge et al. 1993).

A great book to also read about this with tons of research and references is “Bending the Aging Curve” by Joseph Signorile

During our older adults training classes called Stronger for Longer we use a combination of integrated training designed to challenge balance, generally limiting visual input and decreasing the base of support. Only after this has been trained to an acceptable level do we introduce unstable surfaces. Once these are introduced the affects this has on the older adult with regards to the control mechanisms responsible for maintaining balance is astounding. At first they are scared, but over time they work it out and eventually look forward to the constant challenge. Modifying these and other variables appear to have an impact on the adaptive response that helps to improve balance.

There are two great free reports you can download below with more details on how to ensure you have great fundamentals of movement and also how we use balance training with older adults. Click the image below to get your free copy.

  

Balance Training for Injury & Rehabilitation

This is an area that can get very cloudy. Significant research has focused on injured and disabled populations. Restoring (rehabilitating) or maintaining (prevention) proprioception allows the body to sustain stability and body orientation during static and dynamic activities. During rehabilitation, proprioceptive programs are specifically tailored to each person, and as is true for any functional rehabilitation program, should include a great deal of exercises to enhance stability.  

Confusion with stability and balance is where things get messy. While they sound the same they are really a lot different.

The Difference between Stability & Balance:

Stability is where joints are perfectly positioned for movement and is not limited to the legs. This is where we look at areas like the rotator cuff of the shoulder, the feet and even the various muscles providing hip stability. This is where you often see great core strengthening exercises like the horse stance (pictured above) often used. This is not balance training, this is more about trying to find optimal alignment joints.

It is believed that impaired “joint position sense,” when overlooked in a rehabilitation program, may be a leading cause for recurrent injuries and hence this is when people look for stability exercises. Unfortunately many make the mistake that any type of balance work is good, which may cause more harm. For a more detailed explanation on stability see the article – Stability What Is It Really?

Balance we rate more as a skill and much differently in relation to use with injury as it may interfere with the joint’s ability to position correctly. If a person has trouble aligning perfectly on the floor they will be much worse if you place them on a balance board. There is nothing to be gained from using this approach while their basic positioning is faulty. This does not mean it is not useful for rehab, it may be a perfect choice for the person who can squat with great form on the floor.

You have to know exactly why you are using some balance exercises when working with rehabilitation and injury for the challenge may be too great and the exercise could cause more harm than good. This is evaluated on a case by case situation.

Where I have found proprioceptive and balance training to be useful is with leg injuries like ACL tears and patella-femoral tracking. Again I do not use this until the person can demonstrate good form on the floor, and perhaps even with load.

There has been a ton of research in this area that has shown to significantly reduce the incidence of anterior cruciate ligament (ACL) injury in basketball and soccer players. Great books to read with stacks of research and information relating to this are listed below.

  • “Knee Injuries in Athletes” by Sports Injury Bulletin
  • “Understanding and preventing non-contact ACL injuries” by Timothy E Hewitt
  • “The ACL Solution” by Robert G Marx

In the book “Knee Injuries in Athletes” by Sports Injury Bulletin the researchers found: “squat exercises performed on unstable surfaces with high levels of instability can enhance the activity of the VMO”.

From this perspective, it would make perfect sense that this type of functional and balance training would be a necessary part of any training or rehabilitation program, and be appropriate for all types of people, regardless of program goals.

Balance Board Squats

I have used the balance board squats successfully for many years with our programs for ACL injuries and various patella-tracking knee problems for this very reason. This has two benefits, it gives the client great strength gains but also provides me with important information that I cannot get with any other exercise as it exposes movement compensation.

The huge benefit to learning this exercise is two key things:

  1. Developing the ability to maintain trunk posture and stability which is crucial later in avoiding shoulder sway we see on cutting drills
  2. Identifying and correcting any leg strength difference between left and right leg that is undetected in other squats.

This exercise is unique in that in order to achieve a squat without the board hitting the floor you must be precise with your posture, stability in every joint and be even in your weight distribution. On the floor you can get sloppy and get away with it. With the balance board you cannot make any mistake as the exercise demands precision. This provides constant feed-back as to how you are going and hence the information on compensation is magnified. The risk of injury is minimal as there is no load being used, as opposed to a barbell that can exacerbate problems and even cause pain if you compensate too much.

I like to use a holding tempo when doing this exercise, 5 second hold at the bottom without the board touching the ground.

Reps of 6-8 is enough and by this stage most people are feeling the quads big time. A great exercise for any sportsperson looking to improve balance on the field or court, and one we use a lot in our sports specific programs for snowboarding, tennis, basketball and football.

Off Centre Balance Board Squats

The progression of this exercise is where we place one foot close to the middle. This makes the board much more unstable and actually turns this into a single leg squat! The reactivity and strength needed to execute this squat is much greater but the benefits to this are remarkable as it will set the foundation for the more advanced reactivity drills in the last chapter.

Here is a quick You Tube Video to see this in action.

However I say this again, a sensible approach must be taken when using these exercises and in some cases I have found this type of training detrimental. Where there was foot stability problems present I avoided using unstable balance training until the client could demonstrate improvement in this area.

In this case I would prefer to use barefoot training and emphasize single leg stance drills. The equipment I prefer to add here is the Sensa Mat. This is really a small mat you stand on that has 100 small rubber spikes in it!

This equipment is fantastic for waking up weak and lazy feet and providing improved stability up the entire kinetic chain. We use this extensively with walking impairments and serious injuries or even diseases like MS where there is a reduced neural capacity to stabilize the leg. The impact this has on the person’s ability to walk cannot be overstated.

Read our articles about this below for more detail.

A Success Story Using This Approach

“I started training with Nick 12 months ago and the first thing he did with me was an in-depth postural assessment to see how my body moves bio-mechanically and to look for clues in my movement patterns that could explain the knee pain. With the information from this detailed assessment Nick was able to tailor an individual exercise program to correct my movement patterns by addressing basic flexibility and stability first. Nick was also the first professional to view all the muscle groups as a whole and understand that they need to work together in harmony. He identified glute activation as an area that needed to be worked on which was currently impacting on how my knee worked, as well as developing the VMO muscle to allow my knee to function in an optimal way. I begin to feel improvements in the pain within 6 weeks, and have continued to experience improvements along the way.

I am now at a point where I am virtually pain free and able to play netball and train 3 times a week something I was never able to do in the past! Nick takes a holistic approach to rehabilitation and has an intricate understanding of the anatomy and physiology of the body, and what is required to correct knee pain.” - Kate Neilson

Read hundreds of our other success stories by going to Testimonials on our website

If you are someone suffering with Knee Pain or an ACL injury the programs I mentioned earlier you can download instantly by clicking the image below.

  

Balance Training for Sports

With regard to balance and proprioceptive training for sports there is some great arguments for using it as I referred to in my own specific case earlier.

However these type of exercises should be used in combination with the strength, speed, agility and power movements needed for athletic performance. Excessive training with unstable surfaces without adequate stimulus from these other variables could compromise sporting performance.

In an extensive review and literature analysis Hrysomallis (2007) cites that traditionally balance training has been used as part of a rehabilitation program for ankle injuries and more recently that balance training has been adopted to prevent injuries to the ankle and knee joints during sport. Poor balance ability is significantly related to an increased risk of ankle injuries.

Multifaceted intervention studies that have included balance training along with jumping, landing and agility exercises have resulted in a significant decrease in ankle or knee injuries in various sports and with recreational athlete’s recurrence of ankle ligament and anterior cruciate ligament injuries.

But it also showed that balance training, as a single intervention, is not as effective when compared to it being a part of a multifaceted training program. This is where things can get messy when someone reads some information and it is taken out of context. While balance training is great, it MUST be used in conjunction with these other methods.

A great article to read about sports training is – The 8 Must Haves For Sports Training

Some examples of exercises I use with unstable surfaces for sports are shown below.

Again I must state I would not use these if the technique with the floor based movements is not perfect to begin with. These are a progression and must always be given respect to their use. I also would not use this with a sport that does not need it. For example rowing & swimming.

Some of the exercises featured earlier in the injury and rehabilitation section I would also use with sporting athletes. Used in conjunction with strength, speed, and power training these balance exercises can be invaluable in enhancing skills for athletic performance.

Sometimes we get very excited when we see the sports specific exercises shown on social media and they look very fun and challenging. But without understanding the context in what they are used for and also how well the person in the video was able to move in fundamentals are rarely discussed. Choosing exercises for sports must use a wise selection process which is summed up on the chart below. If you have not already downloaded the Functional Training free report shown earlier go back now and get it as this details the fundamentals you require.

We have covered in great detail this process before in previous articles. See How to Choose the Right Exercises For Your Sport

While I may use some balance training exercises with sports programs I tend to prefer to use a lot of plyometric and single leg landing techniques. These movements also demand reflex stability, but at the same time power and agility that is very specific to injury mechanisms as discussed earlier.

Conclusion

In summary the use of unstable balance training tools like balance boards and BOSU can be beneficial to all people. However we must ensure several things before implementing exercises using this skill.

  1. Basic fundamental movements are optimally aligned
  2. Foot stability is not a problem
  3. It is relevant to the client’s needs and current ability
  4. It is used in conjunction with strength, agility and power training

If any of these things are compromised balance training can have a negative impact on your training results. There is many benefits that balance training can provide, but we must have an intelligent approach to how we use this equipment to maximize their effectiveness.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 14 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

  • Movement - By Gray Cook
  • Corrective Exercise Solutions - by Evan Osar
  • Athletes Acceleration Speed Training & Game Like Speed - by Lee Taft
  • Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
  • Low Back Disorders - by Stuart McGill
  • Knee Injuries In Athletes - by Sports Injury Bulletin
  • The ACL Solution - by Robert G Marx
  • Understanding & Preventing Non-Contact ACL Injuries - American Orthopaedic Society For Sports Medicine
  • Anatomy Trains - by Thomas Meyers
  • Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
  • Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
  • How To Eat, Move & Be Healthy by Paul Chek
  • Scientific Core Conditioning Correspondence Course - By Paul Chek
  • Advanced Program Design - By Paul Chek
  • Twist Conditioning Sports Strength - By Peter Twist
  • Twist Conditioning Sports Movement - By Peter Twist
  • Twist Conditioning Sports Balance - By Peter Twist