The STAB:LE Program

Physios… teach your clients to get off the floor. Even if they’re 90. No, ESPECIALLY if they’re 90. This is Bill. Bill is 97. Be like Bill.

Exercises like this are great if you want to rehab and ankle injury or improve your static balance on a dynamic surface... ...but does little to develop an integrated ankle-hip-step response Great for surfing/skating. Terrible for reducing the risk of falls

There's 2 ways to help an older adult improve balance: 1) Prioritise functional deficits, then systematically improve performance in select task(s) before moving onto the next one 2) Simultaneous address all skill deficits & achieve gradual improvements across the board

Physios: Whenever prescribing balance rehabilitation exercises it's important to consider that context is a form of progression... ...and that anxiety affects not just performance, but motor learning

Static exercises that isolate ankle strategy only train ankle strategy... ...while balance exercises that include stepping simultaneously train ankle, hip and step strategies One of these is effective at replicating real world balance needs, one of these is a vanity exercise

You can judge the effectiveness of a balance & mobility rehab program by not just what's included, but also what's included: 🛑 Ineffective & overused: 👎 Standing hip abduction 👎 SLS behind a chair ✅ Necessary but neglected: 👍 Stepping in all directions 👍 Cross-and-step

There’s no perfect balance exercise. Rehab needs to be individualised. But not over-complicated. It’s simple: Practice scaled versions of each movement skill that needs to be improved & then progressively increase the challenge until the client reaches their movement goal

The problem with generic "balance" training is that you get diluted generic "balance" results When "balance" is the priority there are no priorities Balance is task specific. Good PTs provide movement skill training to address deficits & improve performance in specific tasks

The optimal repetition range for a balance exercise might be 5, 15, or 50 reps Dosage of balance exercises must depend on both the client's current capacity AND the specific movement skill that's being practised

To improve balance & prevent falls the focus must be developing an integrated ankle-hip-step response And, practice scaled versions of each movement skill that needs to be improved, progressively increasing the challenge until the client reaches their movement goals

Exercises that are useless when it comes to improving balance & preventing falls: 🚩Standing on foam mat 🚩Hip abduction 🚩Hip extension 🚩Single leg stand 🚩Heel-toe between chairs 🚩Marching on spot 🚩Standing feet together 🚩Calf raises 🚩Partial squats 🚩Anything seated

Perhaps the single most important concept when it comes to improving balance: 👉 Select variations of the movement skill you're trying to improve BUT the level of difficulty is such such that you DO NOT need use of your hands Exercises like this 👇👇👇 do not improve balance.

There is no science behind prescribing 3x10 for balance skills... ...and there's even less science behind daily 3x10 for strength training It's lazy programming. Come on physios,we know better than this.

The world would be a better place once rehab physios recognise that partial depth squats do not improve an older adult's ability to get out of a low chair

Physios: If for some reason you still persist with exercises like tandem-stand "for balance"... ...at the very least get your clients to step into & out of position without upper limb support (this is the part of the exercise that actually has some value for falls prevention)

Effective balance & mobility rehab: 🟢 Systematically developing a few priority movement skills over several sessions THEN moving onto other skills 🟠 Addressing multiple skills simultaneously 🔴 Prescribing exercises with no clear relationship to the clients movement goals

EVERY older needs a progressive ankle-hip-step response: ✅ Forwards ✅ Backwards ✅ Sideways, & ✅ Ability to cross-&-step Assessment & development of these essential movement skills should be prioritised (they're needed everyday AND are foundations for functional tasks)

It can take months to improve balance sufficiently enough to prevent falls… ... yet it can take only a session or two to help someone regain the ability to get up off the floor Physios, think about this next time you are prioritising goals and planning treatments

The quote "exercise is medicine" is often thrown around... but imagine if a pharmacist didn't have even a basic understanding of frequency, dose & types of medication? Luckily there's A LOT of readily available data on the relationship between rep ranges, 1RM%, & training load

If a client doesn't have the capacity do 8+ reps of a given task, they're operating in the strength training intensity range just to complete their ADLs This guides my conversations and clinical practice with the older adult for joint goal setting and treatment planning