Adam Zickerman and Mike Rogers discuss something the vast majority of us take for granted every day, our balance. Some of the myths and facts regarding the maintenance of our balance through the myriad of training methods practiced in gyms all over the country, some of which are downright dangerous.
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Adam: So based on current research, I, and InForm Fitness in general, does not recommend the use of unstable surfaces, outside of a rehabilitation setting, physical therapy. Exercise performed on unstable services does not transfer well to stable services or our everyday life. Nor do the risks outweigh the beneficial adaptation. Some experts even believe that there may be a reduction in stable surface performance for the same exercise. When developing training programs for clients, fitness practitioners must focus solely on safe, intense strength training.
Tim: That, of course, was New York Times’ best selling author and founder of InForm Fitness, Adam Zickerman. I’m Tim Edwards with the InBound Podcasting Network and a client of InForm Fitness. Shortly we will be joined by Adam and his general manager and trainer of the InForm Fitness location right there in the heart of New York City, just about five or six blocks East of the base of Central Park. Here in episode 46, Adam and Mike discuss something that the vast majority of us take for granted every day; our balance. They will discuss some of the myths and facts regarding the maintenance of our ever so important balance, through the myriad of training methods practiced in gyms all over the country. Some of which are downright dangerous. So how do you safely train to improve your balance? Well, let’s hear it from the experts.
Adam: So the thing about balance is that most of us take our balance for granted. I don’t think any of us think twice about walking across a gravel driveway or transitioning from walking on a sidewalk onto grass. Or getting out of bed in the middle of the night, without stumbling. It’s just things that we do and we don’t think about it. And believe or not, people that have impaired balance, activities like I just mentioned can be extremely fatiguing and hard to do. And dangerous and have falls, especially older individuals. And there’s so much confusion about balance and what balance actually is and all the myriad factors that influence balance. And our esteemed exercise industry, as usual, oversimplifies the solution to improving one’s balance. Mainly because they don’t even understand all of the parameters of balance and all of the things that go into somebody’s balance. Of course, as a result of not understanding and oversimplifying it, most of the recommended exercises to improve balance are, at best, ineffective and at worst, they can actually lead to more injury. So the story about balance that kind of reminds me of the same story about saturated fat; how it’s still bad for you to have saturated fat. The reason the balance and the saturated fat story are kind of similar to each other is because on the surface, it seems very logical that saturated fat must be bad for you. How could it not be? You can practically see the globs of fat clogging your arteries as you eat it. But still, there’s no compelling evidence backing this idea up. Yet, despite the fact that there’s no compelling evidence, researchers are still warning us against its consumption and skew the results actually to fit their argument. And we talked about that in depth in podcast, which one, Tim?
Tim: It was episode 34, titled, Is the American Heart Association Misleading Us About Coconut Oil? So we go certainly deeper into it, about some of the studies and how some of those studies are incredibly outdated. Which are telling us that saturated fats are harmful for us.
Adam: So that’s another example of this idea that it must be true because how can saturated fat not be bad for you, and we try and support our beliefs, our biases, and the same thing with balance. You see, there’s a growing trend in our fitness industry now and it’s the use of these unstable services during resistance training. If you walk through any local gym or personal training studio in the functional training gyms, you’ll see Bozudoms, Airdiscs, balance boards. And some professionals, a lot of professionals actually, are claiming that unstable services increase balance; proprioception, which is the ability of the body to know where it is and how it is moving in space and of course, core stability. Well, at first glance, as with the saturated fats story, at first glance, it’s easy to see why most of the population would believe such a claim. If you balance on an unstable service, why wouldn’t you be able to balance better on a stable service? If your core is constantly contracting, to maintain your center of mass, why wouldn’t your core stability improve? And while these claims seem logical, the truth of the matter is, current research has not been able to support any of this. So first things first, let’s define balance, as it’s truly defined in the medical world. So simply put, balance is the ability to maintain the body’s center of gravity, over its base of support. And a properly functioning balance system, allows us to do four things, really. First, it allows us to see clearly while we’re moving, our vision. It also, balance allows us to identify orientation, with respect to gravity. Three, it determines direction and speed of movement. And then, with those three abilities, it also helps us make automatic postural adjustments, to maintain posture and stability in various conditions and activities. Now, balance is achieved by a very complex set of sensory motor control systems, and that includes sensory input from several sources. Our site, our touch, which is called proprioception. And something called the vestibular apparatus within our areas, our inner ear, and that stimuli input from motion, equilibrium, spatial orientation. So already, you can see, this is kind of complicated stuff. And there are disciplines in just this balance alone. Ears, nose and throat doctors deal with this on a regular basis. Opthamologists deal with this on a regular basis. Neurologists deal with people with balance problems on a regular basis, because that’s what balance is a part of. It’s a part of our neural system, our visual system, and our inner ear. All of these things contribute to our balance. Then, it’s the integration of all of the sensory input, and then, the motor output to the eye and skeletal muscles, that react to the sensory input. And all along this chain, things can go wrong and affect our balance. Injury, disease, certain drugs, and even just the aging process can affect one or more of these components. In addition to all of this, there are also psychological factors that impair our sense of balance. If you’ve fallen in the past and gotten hurt, now you’re nervous. There’s all kinds of psychological things that makes us think we don’t have balance or affects our balance, even though there’s nothing wrong with those sensory systems that I just mentioned. So I just want to briefly touch upon, no pun intended, some of the sensory input. I’ll try not to get too bogged down in the biology, but this stuff is really fascinating. So you have the input from muscles and joints, so this called proprioceptive information. From the skin, the muscles and the joints, and they involve sensory receptors, that are sensitive to stretch or pressure and their surrounding tissues. For example, increased pressure is felt in the front part of the soles of the feet, when a standing person leans forward. With any movement of the legs, arms and other body parts, sensory receptors respond by sending impulses to the brain. Now, along with other information, these stretch and pressure cues help our brain determine where our body is in space. So that’s the input from muscles and joints, but you also have input from what I mentioned before, the vestibular system. Sensory information about motion, equilibrium and spatial orientation, is provided by this vestibular apparatus they call it. Which, in each ear, includes something the utricle, the saccule and these three semicircular canals. You mind remember this from high school biology. But anyway, the utricle and the saccule, they detect gravity and linear movement, and the three semicircular canals, they detect rotational movement, and are located at right angles to each other and are filled with this fluid. I think it’s called endolymph, this fluid, if I’m not mistaken. Regardless, the head rotates in a direction and it’s sensed by these canals. This fluid moves in a very specific way and exerts pressure against the canals, a sensory receptor. It’s this whole change of events and the receptor then sends impulses to the brain about the movement, and the muscles react accordingly. Now, if you have an inner ear problem balance can be completely effected, and there’s nothing a trainer can do about that is where my point is going. So we also have this input from the eyes; our vision has a lot to do with our balance. The eyes have these sensory receptors in the retina, they’re called rods and cones, and they send impulses to the brain that provide visual cues. Identifying how a person is oriented, relative to other objects. So if you have vision problems or blurred vision or peripheral vision problems, that can screw up your balance. And then, all of these inputs, from the eyes, the touch, proprioception, from our ears, the vestibular apparatus. All of these sensory inputs, then they have to all get integrated, and that’s a whole system. If there’s anything wrong with the integration system, then balance can be affected. So as you can see, the human balance system involves a complex set of sensory motor control systems. And malfunction or damage to any of these components, either through injury or disease, can lead to all kinds of balance problems. With all of this in mind, doesn’t it seem rather primitive to think that people’s balance issues can be solved by working out on unstable surfaces? Or using free weights versus machines? As Dr. McGuff once said, and I don’t think this is his quote but I like it. He said that if all you have is a hammer, then the whole world looks like a nail. Trainers are not ENTs, trainers are not neurologists, trainers are not opthamologists. So when a client comes in and mentions that they’re having trouble with their balance, what does the trainer do? They turn to the tool that they have, the hammer that they have; the unstable surfaces. And knowing all of this, if you really know about balance issues, this is so primitive it’s mind boggling. So let’s start exploring the exercise industry’s claims of increased balance, now that we know what balance consists of. There are few, if any, actually, studies to date to show that the type of increased balance and core stability developed through exercises performed on unstable services transfers to stable services. Therefore, while performing exercise on unstable surfaces. While that may increase an individual’s ability to increase the exercises on that particular, it doesn’t transfer to the stable surfaces. Grass, the court, or even ice. Now, optimal balance is gained by performing a given task on the surface on which it will be performed in every day life. Matter of fact, many researchers also believe that performing exercises or sports’ skills on unstable surfaces actually decrease the ability to perform the same tasks on a stable surface. Now, I think the reason of this decrease is because, according to well established motor learning principles, the movement pattern on unstable surface interferes with the original pattern created on a stable surface. As far as the body is concerned, doing a similar exercise on a stable surface versus an unstable surface. They might as well be two completely different things, although we think it’s similar enough to kind of mimic. But it doesn’t work, it just doesn’t work that way. It doesn’t transfer, they call it negative transfer. In other words, the unstable surface is not specific to the movement being practiced. The time spent on an unstable surface could have been better spent just mastering the movement itself that you’re trying to improve. Another popular claim, made by proponent of unstable surface training, is an increase in what they call your core stabilization. As with balance, any core stabilization that is possibly enhanced by activity on an unstable surface, again, has not been shown to transfer to stable surfaces. Again, most research even shows that performing resistance exercises on stable surfaces requires more core activation and stabilization, then performing the same exercises on an unstable surface. Again, most likely because the ability to provide progressive overload, which means, that’s what exercise is, meaning gradual increases in weights. As you get stronger, you’re progressively increasing the weight. And because you’re on unstable surfaces, you can’t really keep increasing the weight when you’re on an unstable surface. As the individual gets stronger, it becomes too risky to increase the weight while on an unstable surface. Which is probably why those findings were what they are. So based on current research, I, and InForm Fitness in general, does not recommend the use of unstable surfaces, outside of a rehabilitation setting, physical therapy. Exercise performed on unstable services does not transfer well to stable services or our everyday life. Nor do the risks outweigh the beneficial adaptation. Some experts even believe that there may be a reduction in stable surface performance for the same exercise. When developing training programs for clients, fitness practitioners must focus solely on safe, intense strength training. And if you want to get better at a particular activity, practice that activity. I have a client for example that she has trouble walking. She’s very weak, she had a fall, she got sick, she gained a lot of weight and now, she has trouble walking. What should I do? I say, let’s do leg press, let’s get those legs strong. Let’s get strong overall and you know what, start walking. If it’s hard to walk for two blocks, walk one and a half blocks, and then keep increasing it until you can walk two blocks and then three blocks and four blocks. Well, guess what, she can walk now. She’s walking five or six blocks without a problem anymore, and all she’s been doing is doing leg press and all of the gross motor skills of developing gross motor strength and she’s walking. Another example of some of the crazy stuff that’s out there. There’s these ideas that if you start practicing walking backwards, that it will help you walk forward. Again, the only thing that practicing walking backwards does for you, is teach you how to walk backwards better. It does nothing, it’s a completely different motor skill. That’s like saying, learning how to play the guitar is going to help you play the flute. It might as well be two different instruments. And this is going on all over the place, and you know what, if some of this stuff was just benign and it really didn’t do much for you, I don’t know if I’d be making such a big deal about this. But the bottom line is, a lot of these practices are not benign. My good friend Bill de Simone just told me came back from a functional training seminar, just to see what they’re teaching and they’re having you do like, squats on one leg with weight on just one side of a barbell, over your shoulders. Just to kind of strengthen your core.
Tim: So as you know guys, in addition to the InBound Podcasting Network, I run a video production marketing company. And one of my clients is an agency that hires my company to go out and film other gyms, that, of course, aren’t InForm Fitness and practice some of these weird and crazy modalities. I literally filmed this woman standing on this ball that looked like Saturn, I’m sure that’s what you’re talking about. And while she was standing on this ball, this blue ball with this wooden outside that she was standing on, a platform, she was doing curls. She was doing some curls and it was next to some machines and I thought, well, if she falls, she’s going to hit her head. So I was thinking, that must be what you’re talking about. Some of these other facilities, offering some of these — like you mentioned Bill de Simone just came back from a conference to see what they’re teaching these days and some of these crazy exercises that some of these trainers are having their clients go through, that would cause more harm than good.
Adam: That’s a disaster waiting to happen. You get hurt doing that, you’re not just pulling a muscle. You could have a spinal injury that could set you back for the rest of your life. So these are not benign practices that are going on. They’re telling sedentary middle aged people to stabilize on these balls with one leg, and they’re damaging and getting ACL tears and all kinds of crazy knee problems as a result of just trying to improve their balance. As if they even know what balance actually is and what it consists of. So unless your goal is to perform in a circus, or balance on a top of a ball, don’t waste your time training on these unstable surfaces.
Mike: I actually work with people on their balance and try, in a similar fashion to what Adam explained, I try to explain to them what’s involved with it. I think he made a very big point especially with vision and the vestibular elements of it. If you have problems with that, there’s nothing we can do, training wise, to help those issues. Which are part of maintaining to help your center of gravity. But the tone of this is that outside of strength training, there’s nothing you can do to help your balance, outside of the actual motor skill of whatever this activity is and just strength training, and there’s nothing else we could be doing for helping our balance?
Adam: Nope, I really don’t think there is absolutely anything you can do as trainers. We are trainers, so the best thing we can do for our balance, as trainers, is strength. A good portion of people who have balance problems are just weak; it’s weakness, it’s low muscle tone. So just strengthen their quads, but you don’t have to strengthen their quads on an unstable surface. It’s the idea, it’s the idea of unstable surfaces having some additional benefit for somebody’s balance, than just doing a leg extension. Just doing a pushup, just doing a classic exercise that’s congruent to our biomechanics. That’s going to strengthen every muscle in your body and then, if you’re having issues with your balance, walking. Or you went on a boat ride and you’re falling all over the boat. Then you know what, go on the boat more often because the more you go on a boat, the better your balance is going to get. As long as you’re strong enough. Now, if you’re really weak, if you have really weak legs, you’re going to have balance problems on a stable surface, much less an unstable surface. But learning how to stand on a boat, if you’re strong enough, can only be improved by standing on a boat. This woman I was telling you about, forget about things as complicated as that. These older people who have had injuries and they got really weak and they have trouble walking. So now, you’re telling this person to stand on one leg, which has potential issue. As if that’s going to help, standing on one leg is not going to help them walk. It’s going to help them learn how to stand on one leg. Now, unless they want to be a crane in Florida, they don’t have to do that to improve their walking. They just have to improve their quad strength Adam Zickerman to improve their walking, and then walk. Perform the skill that you want to get better at with your additional strength.
Mike: If there’s limitations and even in the simple act of walking. In the simple act of walking, just say like an elderly person who shuffles often times and obviously, you’re absolutely right. If your quads and your hip flexors are strong, then you’re going to lift your leg a little bit higher, so therefore, you won’t be shuffling so much. While you were talking, you kind of sort of alluded to where I was going a little bit. I was thinking, is there a difference between an unstable — I agree with the balance board. Creating an unstable situation, not an unstable surface, but an unstable situation. And I’m thinking, in its fundamental sense, and we’re going into the common thing is balance for walking or balance for getting up or something like that. Finding your center of gravity, let’s just talk about walking. Fundamentally, you’re switching from one leg to the next leg, to the next leg, to the next leg. And that is a skill, it’s a motor skill and it’s…
Adam: And the way to practice that skill, if it’s walking, then walking. There’s nothing you can do, other than walking, to perfectly improve that skill
Mike: But if you’re having difficulty with that already. And the thing is, I don’t do anything on an unstable surface, but I create an unstable situation, so they can have awareness of what it feels like to be on one leg. And all of the muscles that do fire which, proprioceptively, unconsciously, which guide you to shift your body slightly in each direction. If you stand on one leg, you feel like everything’s firing, in an involuntary way. To sort of give you a little bit of awareness. I guess what I’m leaning to, I haven’t done the full research although I have seen studies that exist. That there are ways to train, to improve those proprioceptive — that firing, so you can actually maintain your — even if it’s just getting on one leg, which is, inevitably, a fundamental piece that’s happening very slowly, or rather quickly, in the process of walking.
Adam: The skill, believe it or not, and this is the big misconception that people have; they underestimate the power of motor learning. And even standing on one leg, even the act of knowing how to stand on one leg, doesn’t prepare you for the action of walking because they are two different motor skills. The only thing that standing on one leg does for you is teach you how to walk on, or stand on, one le. Again, you’re much better off strengthening the legs and then learning how to walk. Now, if it is such a problem for somebody to walk, where you have to start breaking it down to the elements that you’re talking about. They’ve already disqualified themselves from working out with us as a trainer. Now, it starts getting into, they need to work with an occupational therapist if it’s that hard for them. They have to work with a neurologist possibly and really get down to why it is so — if their strength is fine, then that’s what I was talking about, all of these other things that go into balance. There’s got to be some other issue.
Mike: I think there may be other issues. And part of them are psychological, but I’m talking about — the thing is, I think sometimes, going back to progression. Walking, say, progression level ten, and now, we have a person who has no confidence in the ability to walk because they had knee surgery and they’re 68 years old or something like that.
Adam: Right and that’s why they go to occupational therapy and they work on that with them. And then, when they’re ready through occupational therapy, they come to us and we finish the process by getting them strong as shit, safely. But you did say something else…
Mike: The thing is confidence I think, is part of what…
Adam: Now, we’re getting onto something that we can agree on, because I mentioned earlier that there’s a psychological component of balance, right now. If somebody is — there are some benign things we can do, planks, birddogs. Those also help, not so much with balance but they help with the small stabilized muscles of the spine, the rotary muscles of the spine, the multifidus. So it’s not so much the birddogs and the planks that I have the problem with, it’s the unstable surfaces. Even standing on a leg, even though I don’t think it’s going to help them walk, from a motor skill point of view, standing on one leg and learning how to balance like that. Or doing a one legged lunge safely and slowly and controlled, with a [Inaudible: 23:12] possibly. I’m not going to dismiss that completely as out of hand, because if somebody learns to do that and they feel confident doing that, that confidence can kind of teach them — can give them the confidence to do other things. So even though it’s not going to actually help them walk, per se, if that’s what their problem is. It’s going to give them the confidence to try walking because they’re doing these things now. Like, wow, look at me, I can stand on one leg now; I was never able to stand on one leg. And that confidence goes a long way, it’s almost like a placebo effect.
Mike: So therefore, if it’s not something like a dangerous exercise, and is standing on one — that’s kind of what I’m leading into a little bit is A) the confidence part. The other part is…
Adam: Which can be huge, by the way.
Mike: Which I’ve seen studies that exist, but I haven’t really gotten to do the deep dive into them. That are sort of showing that there are connections between proprioception and motor learning, if practiced. And it starts with various things, like things you were talking about…
Adam: But I don’t think they’re saying it transfers to other activities, it’s just for that particular activity. Again, I have no problem…
Mike: Perhaps not.
Adam: So anyway, my ultimate point is not to bash occupational therapy and some of the modalities they use for people that have injuries and all kinds of stuff. We have to be very careful not to pretend that we’re neurologists or ENTs, and understand what our limitations are as trainers. We do something really good, we get people strong, and that goes a long way with helping someone with their balance issues. And that might be just what they need, most people. Remember Tess Nakamura? We had an old client that always used a walking stick for confidence and we got her really strong by doing — I wasn’t doing anything other than the leg press with this woman and she worked out really hard. As time went on, she felt she didn’t even need a walking stick, although she carried it just case. She felt a lot more stable on her feet, and I wasn’t doing any of this crazy, unstable surfaces stuff. I was just giving her strength and maybe even the confidence of walking again. So that’s our sweet spot, that’s what we do best. We get people strong and we get them strong without undermining their health and we make it really safe. And we don’t play around with things that waste time and that don’t transfer to realistic skills. And again, if there’s something you want to do like planks or standing on one leg, or doing some of these things that are relatively benign and really can’t hurt you. And it helps build their confidence, I’m for it, I’m for it. But let’s not get carried away with it. I’m not talking about the things that I see you do with your clients, and that I even do sometimes with clients to help build that confidence and give them awareness. Having one side of their glutes fire versus another side and things like that. Those are all confidence builders, it kind of makes them in touch with their body and those are all good, but that’s not balance, to me. That’s mind/body connection, that are different from balance.
Mike: The reason why I’m bringing it up is because I think what you just said is how people get it confused. I think they’re thinking balance, but really it is often times is a mind/body connection that sometimes isn’t pattenered correctly. Sometimes you’re either leaving something out, which is not letting you do something that you’re trying to do. And you even said it before, of course there’s a chain of things that are going on early on and something can be broken in the chain. And as trainers, obviously the strength element is…
Adam: It’s huge.
Mike: Is a big part of the whole thing.
Adam: There can also be a new medication. But the thing is, there’s a very strong motor learning principle that’s being ignored out there. And I just want people to be — buyer beware when it comes to doing all of these crazy things on unstable surfaces, as if it’s really going to do a better job for strengthening their core or do a better job of them going on a weekend trip on a boat. And they think they’re going to do better on the boat because they’ve been working on unstable surfaces and that’s really the big point. Especially the point where people are lifting weights and doing all kinds of dangerous moves on unstable surfaces. As if it’s going to help them on the athletic field or the tennis court.
Mike: That’s unfortunate what was described before. That is just horrible.
Adam: Yeah, so that’s the big point. Let’s not get fooled with this stuff.
Tim: Thanks guys. Hey, if you are new to the podcast and are just now learning about slow motion, high intensity strength training and you want to try it for yourself, simply click the link in the show notes to the InForm Fitness website. Once you’re there, click the “try us free” button right there on their homepage, fill out the form, pick your location and improve more than just your balance, with a slow motion, high intensity, full body workout in just 20 minutes for free. You’ll feel great, I promise.
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