Stress, Posture and Balance
Stress, Posture and Balance
Posture and balance are both critical components in human movement and independence. It is essential to strengthen postural muscles, but you need to make sure that your clients are in proper alignment first. If you strengthen muscles in poor alignment, muscle imbalances, stiffness, and pain will become an issue. This, in turn, will make it harder for your client to be able to perform the Activities of Daily Living (ADL’s) and Physical Activities of Daily Living (PADL’s) (Coined by the Stress Management Institute for Health and Fitness Professionals™) and chronic disease self – management skills, which leads to loss of independence. (Kade,2020)
What Causes Age-Related Balance Problems
According to Healthline, balance is an intricate process that involves many systems of the body, vestibular system, inner ear, eyes, the brain, muscles, sensory nerves, the labyrinth of the inner ear, heart, and blood vessels. If there is an issue with any of these areas of the body, an individual will be at risk for falls and even injury. As individuals age, they are more prone to balance problems and will begin to show symptoms of being off balance. The body can somewhat compensate for up to 50% loss of function of the vestibular system, but clients will likely have difficulty walking, unsteadiness, and overall issues with balance. The ear consists of two parts, which are the cochlea for hearing and the vestibular system for balance. The vestibular system consists of three semicircular canals that separate the vestibule, which contains vestibular ganglion cells that detect movement every time an individual moves their head. Most of these cells die off by the time an individual turns eighty years old. If someone has been moving a lot, it could take time for the vestibular system to calm down, which can initiate the feeling of dizziness or that the room is spinning. As we age, it takes longer to adjust to positional changes, which may cause older adults to feel dizzy or off-balance more often. (Jethani, 2017)
When individuals start to experience balance issues, they may also have dizziness, vertigo, lightheadedness, motion sickness, or double vision. There may be other symptoms as well if there is an underlying medical condition. A client can have temporary balance issues if they have experienced an injury, inflammation, or pain. Long term balance problems can be a concern if a client has joint pain, multiple sclerosis, Meniere’s disease, a brain tumor, Parkinson’s Disease, spinal cord compression or infarction, Guillain - Barre syndrome, myopathy, cerebral palsy, gout, muscular dystrophy, obesity, vitamin B-12 deficiency, migraine, and antihypertensive medications. (Jethani, 2020)
A doctor will test for balance disorders by ordering audiological testing, videonystagmography (VNG), and magnetic resonance imaging (MRI). Most tests are administered to stimulate the inner ear so the doctor can tell which position or movement is giving the patient a problem. The tests that are categorized under VNG testing are ocular mobility where the patient watches moving and stationary dots on the wall. The next test is the rotational chair, in which the chair moves slowly to see if there is any reaction from the inner ear. Positional Nystagmus is a test where the head and body are moved in different positions to try and see if there are any symptoms such as dizziness. Lastly, caloric testing may be done by filling the ear with water or air to see if one ear responds differently. If one ear shows a difference, this could indicate an inner ear condition. According to the National Institutes of Health, a decline in balance starts to occur between the ages of forty and fifty, and one in three individuals over the age of sixty-five will experience a fall each year. Below is a chart that shows the vestibular decline and symptoms as we age. (Hain, 2017)
% of Loss
Impairment or Symptoms
0
Nothing
50% to 70%
Somewhat unsteady
70% to 90%
Mild oscillopsia, scared to drive at night
90% to 100%
Oscillopsia, sensory ataxia, moderately unsteady
Treatment For Balance Problems
Treatment for these clients will depend on the cause of the balance disorder. Individuals may have to seek the help of a Physical Therapist or Occupational Therapist, and be prescribed medications by a Physician to help with conditions like vertigo. Rehabilitation professionals give patients exercises so they can obtain better balance and prevent falls, injury, and possibly dependence on others.
Balance, Posture, and Stress
Many disorders coincide with stress, as you already know. It is vital to have an understanding of how balance and posture work together in the presence of stress. After weeding out if a balance issue is due to Psychogenic Gait Disorder or the aging process, you can create a more comprehensive mind/body program™. As stress makes muscles tighter, balance, gait, and posture tend to be thrown off, leaving the body unbalanced. According to Sylvain Guimond, with the San Diego University for Integrative Studies, Wael Massrieh with the Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada state that some individual's bodies conform to specific postures when they are stressed. They have found that individuals who are extroverted assume a kyphosis – lordosis posture and introverts assume a flatback – swayback posture when stressed. (Guimond, 2012)
If you notice these postures, work on flexibility and exercises to help correct them. If the person assumes this position for too long, it will become a habit and harder to correct in the long run. Clients may also have to see a Physical Therapist if posture becomes worse or is staying the same. It is essential to do a visual as well as a physical assessment of each client that you are currently working with. We go over what a physical and visual assessment consists of in the Mind/Body Zone™ Assessment section of the course. If you notice any mild to severe balance problems, we recommend that you refer your client to the primary physician to be tested. (Kade, 2020)
What Is Psychogenic Gait Disorder
One in three people ages 65 and over fall each year, while more than 2 million older adults go to the emergency room for an injury from a fall per year. According to Health and Human Services, 8% to 10% of individuals with balance issues are treated for Psychogenic Gait Disorder. This is a disorder that can be caused by a neurological condition such as epilepsy, a mental health condition, chronic stress, physical or emotional trauma, history of physical or sexual abuse, or childhood neglect. This condition is a psychogenic motor disorder that affects how an individual walks as well as speech but cannot be explained as a neurological disease. The Journal of Rehabilitation Medicine states that individuals who attended an outpatient physical therapy program for three weeks saw a significant improvement in their ability to walk, quality of life, and functional independence. A one year follow up showed that participants kept the results that they had seen after physical therapy had ended the previous year. According to Research Gate, Individuals who require six to twelve months of treatment will usually have long term disability. It is also important to note that individuals who have psychogenic gait disorder may also have anxiety and depression.
What To Look For
The signs and symptoms of psychogenic gait disorder are the dragging of one leg, sudden buckling or collapsing of the knee, small slow steps, excessive swaying, extra movements of arms and legs that disrupt balance, crouching, and anxiety about falling. A neurologist must examine the client to get a diagnosis for this disorder. Treatment is multidisciplinary and usually includes physical therapy, occupational therapy, and seeing a psychologist. Each program is specifically tailored to an individual since the cause and symptoms of the disorder are different for each person. If you suspect your client may have Psychogenic gait disorder refer them to their primary physician. These individuals will need the help of a psychologist, physical therapist, and an occupational therapist in order to get better. The healthcare team will decide if the client can continue an exercise program at this point. Sometimes the client may have to wait a few months before being able to train with you again. The physical therapist may have exercises that he/she would like you to continue during your training sessions. Keeping open communication with the healthcare team is extremely important if you have permission from your client to do so. You must also listen carefully to your client’s doctors and other healthcare providers. The information in this article can help you to create successful mind/body programs for your clients.
References
“Functional (Psychogenic) Movement Disorders.” Baylor College of Medicine, 2018, www.bcm.edu/healthcare/specialties/neurology/parkinsons-disease-and-movement-disorders/conditions/psychogenic-movement-disorders.
Guimond, Sylvain, and Wael Massrieh. “Intricate Correlation between Body Posture, Personality Trait and Incidence of Body Pain: A Cross-Referential Study Report.” PLoS ONE, vol. 7, no. 5, 18 May 2012, doi:10.1371/journal.pone.0037450.
Jethani, Zara. “5 Things About Hearing and Balance.” Pacific Neuroscience Institute, 29 July 2020, www.pacificneuroscienceinstitute.org/blog/eye-ear/5-things-about-hearing-and-balance/.
Kade, Robyn. Mind/Body Medicine Specialist Manual. 4th ed. / USA, Stress Management Institute for Health and Fitness Professionals, 2020.