As we age, we undergo physical changes.
OK, that’s sort of a “no brainer” statement.
Although physical changes occur with aging, we have the ability to bend the aging curve. It just requires us to better understand what can affect that curve and how to go about doing the things necessary.
We need to know the “why” and then figure out the “how”.
It is likely that aging will affect our balance acuity. Research suggests that there are proactive strategies to work with this change.
THE WHY
In the scientific world of movement, “postural stability” is the terminology often used when speaking about balance.
Upright postural stability relies on several physiological systems working together: our vision, vestibular system, and proprioceptive system. These systems change as we age.
Proprioception is the body’s ability to receive input or messages from receptors (cells) in the skin, fascia, tendons, ligaments, and joints and relay that information to the brain via the nervous system so the brain can formulate a strategy or movement response.
Proprioception is really about the sense of our body segments, called joint sense position, and movement, called kinesthesia. Although this may sound very conscious, much of the conversation between proprioceptive receptors in our tissues (peripheral nervous system) and the brain (central nervous system) happens without our moment-to-moment awareness. It’s a conversation we are not typically tuned into.
Proprioception is affected by age-related changes in central and/or peripheral somatosensory function: decreased number of muscle spindles, decreased number of cutaneous receptors (cells in our tissues that read our relationship to the environment), decreased number of joint receptors (similar kind of cells), and structural changes coupled with decreased subcortical activity (1).
It’s a body and mind change – musculoskeletal, but also cortical (brain). We call it neuromuscular in the biz.
The body does not move unless the brain tells it to. The brain needs to get messages from the body in order to formulate the response. It’s really a quid pro quo situation.
Proprioception can also be affected by age-related issues, such as osteoarthritis (OA). Knee OA, for instance, is correlated with impaired proprioception and balance stability (2). The tissues at the knee complex can be dramatically affected by OA, decreasing quadricep muscle strength and creating tissue receptor changes in muscle, fascia, tendons, and ligaments. This will affect the proprioceptive ability of our peripheral nervous system (those cells I was talking about) to grock joint position sense and kinesthesia – where the knee is, how is it moving and relating to the rest of the body, and understanding its place in the mix. This continues creating changes at the joint surfaces and in our movement or motor control.
Another example of proprioceptive changes is that at the ankle, correlating to impaired balance and stability during gait (walking).
Slower walking speed, reduced stride length, and smaller range of motion from the hip and ankle joints is typical in older adults with impaired ankle proprioception and reduced postural stability (3). Precise locomotor control depends on ankle proprioception for joint position and motion (proprioception and kinesthesia).
In other words, your ankle is talking to your brain and the brain is responding in order to stay upright and balanced while walking/moving through space.
Ultimately, with proprioceptive changes, the brain has a harder time sending a message to the muscles to move the bones. And it can be a kind of spiral effect.
The How
Balance stability is coordinated through a neuromuscular reaction by the nervous system – again, that conversation between the body sensing where it is in space and in movement, sending that information to the brain, and the brain’s ability to formulate and get a message back to the muscles to move the bones.
Neuro + Muscular.
The brain and musculoskeletal system have a synergistic relationship.
Specific stability techniques/exercises (the “how”) can help reduce diminished balance issues and increase motor control, or that neuromuscular reaction mentioned above. For those of us who are aging this could, and I think likely does, mean bending the aging curve in our favor towards increased postural stability.
Building hip stability is part of the “how”.
I’m going back to the ankle, but it’s going relate to hip stability – I promise.
When we feel unstable, we tend to reduce our forward momentum during walking via shortened steps, etc.. This has a lot to do with decreased proprioception in the ankle – somehow the receptors and the brain aren’t having an in-depth conversation.
Remember the kinetic chain?
The foot bone connected to the ankle bone, the ankle bone connected to the knee bone, the knee bone connected to the hip bone…...
Another strategy the nervous system takes when we feel unstable while walking is to create smaller range of motion at the hip. In fact, lower concentric hip muscle contraction correlates to changes in our motor control patterns for gait, pointing to imparied balance (concentric is a type of muscle activation that induces tension on a muscle, generating enough force to move an object – think Popeye and his bicep contraction to get the spinach to his mouth).
Weakness in leg and hip muscles correlates to changes in our walking pattern (3).
Building stability in the hip region may help reduce proprioceptive deficits and allow us to continue moving with a greater hip range of motion and with concentric contractions that generate enough force at the hip to move objects.
Yep, that object is you, my friend.
Motor control strategies for hip stability help reduce proprioceptive deficits at the ankle (and other joints) because they assist in correcting postural sway in the medial-lateral direction (side to side). Decreased proprioception in the lower extremities (ankle, etc) has been shown to increase body sway. Hip fractures are more likely to occur when we lose our balance in the medial-lateral direction, meaning when we fall sideways (1).
We can build hip stability in several ways and by targeting several muscle groups above the lower extremity. One of the muscle groups shown to improve postural sway (feeling unbalanced, unstable, like we are going to fall) are the hip abductors. You’ve heard me talk about the gluteus medius, right?
The good ole glut med.
In anatomy education, we’re often taught that the function of the glut med is to abduct the hip.
Try this – stand in Tadasana and then lift your straight leg out to the side. That’s glut med doing its abduction job.
But how often do we actually lift our leg out to the side during daily activity? Well, ok, maybe if we are avid kickboxers.
More often the glut med functions to stabilize our pelvis while we are moving through space or balancing on one leg.
The above statement seems really important for those of us who may be looking at balance deficits. Um, anyone aging…..
The glut med stabilizes the pelvis by pulling it downward, or depressing it, towards the foot in what is called a closed chain action, especially when we are walking.
When you take a step forward there is a moment when the front leg is hanging in mid air, right? Something has to stabilize the leg you are standing on. While there are many things helping in this scenario, the glut med is right there as a stabilizing force, pulling the pelvis downward towards the ankle on the standing leg.
Ah, remember gait and the ankle and proprioception from what I wrote earlier? I swear to you, it’s all related. It’s all about interdependence when it comes to the mind and body, baby.
Try this – stand in tadasana, place your left hand on your upper outer left buttock region, pick up your right foot as though to step forward and let it hover for a moment, and notice if you feel a contraction or sense of muscle action under your left hand. That left glut med is concentrically contracting (shortening) to pull your pelvis towards the left foot for a stabilizing effect. You can also begin to see, I hope, how it plays into keeping you upright and balancing!
Here are two exercises that you can practice to build strength and motor control in the abudctor/glut med region.
Clamshells & Glide Backs
“Clamshells” are an open chain exercise targeting the gluteus medius. The role of this exercise is to build abductor strength.
Lying on your side – lift top leg up and lower it slowly down
Isolate the movement at the hip joint only – do not allow the pelvis to roll or rotate.
Add a resistance band for the next progression.
Take yourself into a side plank for a harder progression.
“Clamshells” are an open chain exercise, which target gluteus medius strength. Although a great exercise, especially if we are very aware of the posture above the pelvis (think core – ribs towards pelvis, no lower rib thrust, lifted under body waist), Clamshells might not be as “functional” or provide the same motor control as the next exercise.
Why?
Because the second exercise, “Glide Backs”, are a closed chain exercise with foot connected to the earth and is weight bearing. This glide back exercise is great for creating both concentric and eccentric contraction in the abductors of the standing leg, which should increase the motor “function” of the gluteus medius to depress, or pull the pelvis down towards the foot. This is the stabilizing bit that is so important for our balance, whether static and standing on one leg like tree pose or moving through space like walking.
I’m using a glider disc, but you can use a paper plate or yoga blanket.
I’m pointing to the right glut med/abductor region on the standing leg. That’s where you want to feel the work. My opposite foot is on the glider disc.
I work assiduously to keep my thoracopelvic cylinder engaged and aligned.
Slowly bend (flex) the standing leg hip, knee, and ankle, allowing the disc to glide backwards on the opposite leg. Like a small gliding lunge action. Then stand back up again by pressing the standing leg foot down into the earth and feeling the contraction at the left upper buttock region.
So, which exercise should you do?
Both exercises have merit. One exercise is open chain and one is closed. “Clamshells” can be done lying on your side and they isolate the hip joint. “Glide backs” ask you to transfer force through the entire lower kinetic chain, which means your foot, ankle, and knee have to open and close (flex and extend). Overall, the Glide Backs recruit more actions at the joints, require standing and moving, and thus, recruit more muscle action.
They are different applications of a similar region. Whether you do one or both, it is vitally important to think QUALITY rather than quantity or just plowing through the exercise.
Be mindful.
We’re often in a hurry to do the “exercise”, or the “posture” when we haven’t set the stage. Don’t skip the process of integrating the foundation of optimal movement patterning – practice diaphragmatic breathing first to create intra -abdominal pressure, understand and practice how the thorax sits above the pelvis, create proper alignment in the cervical spine, etc.
Then ask yourself these questions as you practice the two exercises presented:
Can you stabilize the thoracopelvic cylinder and move only the leg in the hip joint for Clamshells without any rotation of the pelvis? Can you isolate the movement to hip joint only?
Can you keep the pelvis neutral without rotation in the standing Glide Backs? Can you maintain the relationship of the thoracopelvic cylinder while moving the lower kinetic chain? Can you focus on the standing leg action rather than the moving leg in the glide backs?
WRAP UP
Motor control strategies at the hip help create stability for correcting postural sway in the medial-lateral direction (side to side). We can build hip stability in several ways.
One is to increase motor control and strength in the hip abductors, especially the gluteus medius. I’ve provided two exercises to target this region and tried to explain in layman’s terms the “why” and “how”.
The second is to be physically active on a regular basis. But, let’s define that a bit, shall we?
One study looking at age related hip proprioception deficits found no declines in their study participants (1). This might suggest that aging is not linked to proprioception declines, changing joint sense position, or postural sway leading to balance deficits.
However, we always have to look at the mechanism presented in the findings of a study and parse out all the details – who were the participants, what tests were used to quantify the findings, how were the participants tested, were their lifestyle habits taken into account?
In this study, the participants were not only aging, they were highly active, averaging 10 hours of physical activity per week. That’s more than an hour a day. That’s pretty darn good!
This bodes well for those of us moving our bodies 10 hours or more a week. Unfortunately, I do not have a spreadsheet providing exact details on what activities these older adults were participating in, but the fact that they were physically active this many hours is key, I think, to the fact that they were bending the aging curve.
So, in order to enhance our joint sense position, proprioceptive input, and neuromuscular output, we can add in specific exercises targeting hip stability and in general, up our ante on weekly physical activity.
It’s the old “use it or lose it”, “a body in motion stays in motion”, “motion is lotion”….. you get the picture.
Let’s bend the aging curve in our favor!
I’d like to hear from you. Tell me what you think and how this “muse” may have enlightened you, confused you, supported what you are already doing, given you new strategies, etc. Send me an email – yogaburr@gmail.com
References
- Wingert, J.R., Welder, C., & Foo, P., (2014). Age related hip proprioception declines: Effects of postural sway and dynamic balance. Archives of Physical Medicine and Rehabilitation, 95, 253 – 261. https://www.ncbi.nlm.nih.gov/pubmed/23994251
- Kim, D., Park, G., Kuo, L-T., & Park, W., (2018). The effects of pain on quadriceps strength, joint proprioception and dynamic balance among women aged 65 to 75 years with knee osteoarthritis. BMC Geriatrics, 18(245), 1 – 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192068/
- Ko, Seung-uk., Simonsick, E.M., Despande, N., Studenski, S., & Ferruci, L., (2016). Ankle proprioception associated gait patterns in older adults: Results from BLSA. Med Sci Sports Exerc., 48(11), 2190 – 2194. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069127/
