"Balance Exercises": Skill or Specific Tissue Challenge?

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I was talking with my dad this past weekend about what is commonly referred to as "balance exercises" and in particular its implementation post-injury early on in the rehab process.  For context, if you don't know, my dad practices sports medicine so he's not your average dude off the street when it comes to discussing the human body and rehabbing injuries, etc.  Point being, we are often able to discuss things in fairly great detail and challenge each others thoughts in that regard.

Much, if not all, of my argument was more or less a collection of ideas that have been brought up during RTS™ classes and/or through discussions with various RTS™ students and other exercise professionals.  That being said, this was the first time in recent memory that I had discussed this topic with someone who has not been through RTS™.

**Pseudo-disclaimer:  There are a ton of points that could be made on this topic.  While I will try to touch on the ones that I feel are most applicable to the point I am trying to make in this post (and that are in my head right now), I will undoubtedly omit some, either intentionally or not.  If you think I missed something major that needs to be discussed either as an addendum to this post or covered in a completely separate post, feel free to drop a comment below and I will do my best to accommodate.

Additionally, as stated above, this conversation first took place under the context of the injury rehabilitation process, but in reality it is applicable to many other contexts.

I understand I am opening up a monstrous can of worms by touching on this subject.  Admittedly, this post may be better-served to be published after some more basic information is discussed, but my brain doesn't always come up with ideas like that.  So, over the course of the next few weeks I hope to discuss as many relevant topics to this as possible, and hopefully by the end a clearer picture than what is presented today will be formed.**

When looking at balance, you are more or less looking at an outcome.  This outcome is the skill of being able to maintain your center of mass (COM) over your base of support (BOS).  Much like other skills--for example, shooting a basketball--seeing the outcome alone cannot tell you HOW the outcome was attained.  What I mean is, only being able to see that the ball goes through the hoop does not tell you anything about how the person shot it.  You can spend a few minutes watching any basketball game and see that to be the case.  You can also check out trick shot videos on YouTube and see the vast array of ways people have come up with to put the ball through the hoop.

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Going back to balance, if all you see is somebody who is able to stand upright, you don't exactly know what muscles are contributing to allowing them to do that and/or the relative contribution of each of the muscles.  Because one of the brain's main goals when you are standing is to keep you standing, you end up in this situation where you will utilize whatever it takes to get the job done.

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Applying this to an exercise or rehab setting with someone who is coming off of an injury, if the goal of providing "balance exercises" is to positively stimulate the tissue(s) that is/are trying to be rehabbed, it is nearly impossible to say with any type of certainty that that is being done due to their body's desire to keep their COM over their BOS under all circumstances.  While there may be a point in the progression where these exercises are an appropriate challenge, failing to ensure that this stimulus is within the tension generating capability of the tissue in question may end up nullifying the response of the tissue that was hoping to be gleaned from the exercise.

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If the requirements of the prescribed "balance" exercise exceed the tension generation capability of the tissue you are trying to stimulate, the brain will default to using other tissues in order to accomplish the goal of COM over BOS.

While you cannot isolate muscles during exercise, you can bias your force application in an attempt to emphasize specific muscle fibers.  One of the challenges of this is in creating exercises in which other tissues have a relatively small ability to oppose the applied force.  However, by understanding some basic principles of force application, creating this opportunity becomes much easier.

When performing "balance exercises", is your goal to challenge specific tissue or the skill of balancing?

Your body.  Your training.

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