My experience with BALANCE STEP

Since a couple of years as a physician I have learned about SMS (sensomotor stimulation) that has been developed since 50th of our century. The basics of the subject-matter were at that time established by Mr. Kabat, who introduced the meaning of efferent centres and roots facilitating into the clinical practice on the basis of afferent systems stimulation (irritation). Then he was followed by Ms. Kenny and later by Mr. Freeman with his team, who systematically explored a number of aspects of articular and ligament traumatology, emphasized a significance of afference failure in the posttraumatic ankle pathogenesis, and also focused on way how to influence the coordination of selected traumatic lesions. Mr. Janda and Ms. Vavrova described those techniques in our country.

After a careful consideration of the hereafter mentioned methodology theoretical basics I can enunciate that I was really happy to get among those whom Dr. Mares, the BALANCE STEP deviser, provided as the first with an opportunity to exercise with the equipment and to recommend that unpretentious technique either to common patients, or to experienced athletes.

The equipment helps to all those people to prevent, to rehabilitate after various traumas, as well as to improve the whole body coordination and by this to increase one’s own performance and capacity.

What is SMS?

SMS is derived from a concept of two stages of the motoric theory.

1.stage is distinguished with the efforts aimed at managing of a new motion and at creating of a basic functional connection, which all is being controlled mostly by the cortex. The motion control at that level is a very tiresome process, which is requiring the cortex activation. It is the reason why the CNS (central nervous system) when reaching at least an elementary motion performance is trying to move the process management to inferior subcortical controlling centres, where that 2.stage of the motoric control is less tiresome and, what is really important, much quicker. On the other hand, a once established stereotype is hardly to be changed.

The primary goal of SMS is to achieve a reflex, quick and automatic activation of the desired muscles with the minimum stress of a motion and with a high level of muscles coordination. This requires a perfect cooperation of either the CNS, or the peripheral receptors – like those articular, muscle, cutaneous and, what is most important, those of the feet, hock, knee, pelvis, shoulders, neck and head.

The sensomotor exercise is supposed to be preceded by an intervention aimed at normalising the peripheral (peripheral structures functions) condition, which means that all peripheral tissues like skin, hypodermis, ligament, muscles and articulations should function “properly”. An example: uninfluenced scar after an injury that could cause a pressure, and by this a circulation failure, a tumour, restricted motility. Hence it could be an afferent pathology of the periphery, which would be fixed, and changes the whole stereotype of the motion with more sequels in the whole body to follow. That is why we are supposed first of all to improve the pathological conditions at the periphery. For example, it is necessary to improve a restricted articular clearance, to remove a blockage, to release and extend contracted muscles, and only after all that to begin the exercise. This rule is often forgotten in the practical care, and there appears a habit of a pathological protection of an affected zone.

The BALANCE STEP exercise primarily affords using such an opportunity in the everyday life and in the sports activities. As in the motion, as well as in the medical care it is important to break the existing improper stereotypes and to achieve an automatic muscles activation that is necessary for a proper body posture and for a better stability and gait. According to my personal experience, SMS and BALANCE STEP techniques are not widely used, that is a real pity.

Why?

It is difficult to answer why, but by my opinion, the lack of professional articles could be regarded among the most important reasons of such a bad situation, there exist also a deficit of skilled professionals in this field. We can mention also a very poor and not always adequate cooperation between surgical practitioners in rehabilitation care and physiotherapeutic specialists, which situation, I believe, will be improved in the future.

As a very positive is regarded the BALANCE STEP effect related to:

• unstable ankle, as a most frequent after an injury;
• knee-cap surgery outcomes (today it is a domain of ASK – ligament plastics, meniscectomy;
• spinal column pains, poor body posture, scoliosis;
• different DK injures with a motion coordination failure, etc.

There are many more options, and I have to admit that with a proper approach: pathological state periphery treatment, injury healing time-table (do not hurry, especially for athletes), a progressive step rehearsal under a professional supervision with a proper erect exercise (“small foot”, knee, pelvis, shoulders, and head hold). There were visible results achieved already in 14 days, according to patients’ evidence and to a detached investigation. During the first week there was registered a muscles strain, at the shank front, at the thigh inner side and at the gluteus maximus zone, but later there appeared a better confidence of the motion, better muscles coordination of the whole body, quicker legs reaction at land return and on unstable surface.

Despite the fact, that I do not have a long-term experience, the actual results of the SMS implementation and BALANCE STEP exercise permit me to recommend that techniques as a very effective therapy and prevention. As a professional physician I am working in the rehabilitation section of the Motol hospital, where I can monitor various patients, as “common” adults, children with hock and knee injures and after different kinds of surgery, where we apply the aforementioned exercise. I have an outstanding experience with many athletes who use the BALANCE STEP every day for prevention as well as for their performance improvement. That is why I would recommend that balance exercise as a necessary daily practice along other disciplines, for instance, for football (soccer), basketball, volleyball, tennis players, track-and-field athletes, etc., where hock and knee injures are very “common”.

But not only athletes – ALL of us need these techniques as a very effective prevention and care about the body posture, spinal column pains, stability failure, muscles weakness. It is very easy to find some time for oneself and to do something good in one’s own sake. But that depends on each of us. Here is the opportunity: just use it.

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Balance exercises using the BALANCE STEP

Balance exercises on a segment are derived from the Freeman technique, which are used and described in detail by Janda and Vávrová. It is a method, which works not only by activating the proprioreceptors (the nerve endings in the muscles taking into account the position and motion), but also even more significantly by activating the subcortical mechanisms, which are concerned in managing motion. The above-mentioned authors called this methodology sensomotion stimulation.

The aim of sensomotion stimulation is to achieve the reflexive automatic activation of the required muscles at the level where the motion does not need significant corticular or volitional control. This method is about the influence of motion and stimulating reflexive muscular contraction, within the framework of a certain stereotyped motion, which is influenced by the proprioreceptors, which participate significantly in standing, the vertical bearing of the body and carrying out precisely adjusted coordinated motion.

Afferent plays an important role in the regulation of the vertical stance of the proprioreceptors of the sole of the foot. These receptors are influenced during the sensomotion stimulation while carrying out exercises with the segment. This involves mainly the activation of the musculus quadratus plantae, and the long and short flectors of the foot when the instep is significantly influenced. This change of the foot- instep configuration, which in the clinical terms is known as “small“ or less succinctly “short“ foot, leads to changes in the position of all joints in the foot and also changes the pressure in the joints which greatly influences the proprioceptive signalization. “Small feet“ are achieved when the metacarpal bones approach the strongly fixed base when the toes must be totally free, so-called ‘non-inflected’.

The equipment which make sensomotion stimulation easier is orbicular and bole segments, twister, fitter (swinger), minitrampoline, balance air balls, and also BALANCE STEP based on the principles already used in the balance sandal.

How to use BALANCE STEP?

BALANCE STEP must firstly be attached by the bands with the dry zips onto the shoe with the solid sole in the middle where the centre of gravity of the foot should be. Then follow the instructions given below, and maintain them throughout the exercise:

• 1. form a “small foot“
• bend the knees slightly
• consciously confirm the position of pelvis by tensing the abdominal and gluteal muscles
• keep the head straight, shoulders down
• control the pelvis in the lateral direction, keep the hip joints horizontal
• move the feet in parallel (we recommend training in front of a mirror)

We recommend that when first training with the machine you should take steps on the spot with a stable support. After this you can walk with short, fast steps, frequently transferring the weight from one foot to the other. The exercise should be repeated several times during the day, briefly but intensively. Never over do the exercise!!! Tiredness will not help the muscles, which you want to activate.

If you carry out all these basic steps successfully than you can continue with more complicated exercises, e.g. standing on one foot, raising the leg forward and to the side, jumping etc.

The most frequent mistakes during exercising!!!

• Defective correction of foot (mainly the bending of the toes)
• the feet are turned out
• the knees are rigid
• the pelvis ascends on the side of the moving leg
• The stomach and posterior muscles are slack
• the head is in a forward position
• the shoulders are raised

Who is the BALANCE STEP suitable for?

A. during treatment, convalescing, rehabilitation

• non-stable shin (distorted, during a fracture, when the proprioception is not good, weakened muscles)
• non-stable knee (problems with the side muscles and anterior crossed attachment), during rehabilitation after an operation on the knee to build up the damaged part of the knee)
• chronic back pains , especially in the lower back
• wrong body posture
• any condition after an accident to the hands, where there is a breakdown in co-ordination, muscle-weakness, a disruption of balance, bad walking posture, a breakdown in the consistency of various ethiology.

B. Prevention

For healthy individuals, for people with sedentary work and especially for sportsmen for building up not only the postural (static) muscles, but also the dynamic muscles. It is recommended to train in balancing and muscle-coordination, to improve performance in sports or just to improve the body structure.

This exercise has no basic adverse effects, it is not suitable during treatment for acute pain and for the complete loss of feeling.

Mudr. Martin Ošťádal
Ortopedická klinika
Fakultní nemocnice na Bulovce
Budínova 2,180 01 Praha 8

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GYNAECOLOGIST’S ABOUT BALANCE STEP

The balance step is an excellent aid for ladies who at least once gave birth to a child. After the childbirth the perineum is usually low and loose, the tonus of the vaginal introitus is decreased as compared to the pre-natal period. That feeling is much stronger by women who delivered without an incision, or when incision was wider in order to make the birth of a big foetus easier. Within six weeks the BBalancestep helps to improve backbone setting, reflexively increases the tonicity of the perineum musculature and of the pelvic bottom that also sustained when the head was proceeding by a vaginal birth.

The toughness of the pelvic bottom and the perineum is a very important factor in the sexual life. The vagina is always larger after the birth than before the birth, and very often the perception of the anatomical conditions is less positive than before birth. During the sexual intercourse the vagina becomes wider and longer and a feeling can appear that it is too large. The partners have a feeling of an insufficient contact, and the musculature laxity of the pelvic bottom as well as of the perineum and the introitus can increase that feeling. Very often partners feel a great disappointment in result, and their sexual enjoyment aggravates. Women also can have such a feeling but often they do not try to improve this situation.

Balancestep is a very useful aid in such cases, because within six weeks it can prevent fixing the changes appeared caused by the childbirth and secure the restitution of the original functions ad integrum.

The Balancestep could be effectively used also by middle-aged ladies, if the gynaecological investigation disclosed a womb descend that can in different forms affect up to 40% of women. Usually recommended Kegel exercise could be extended with the use of the Balancestep at home in order to achieve a better pelvic bottom consolidation. It has also a positive impact in case of the stress incontinence for younger women, in particular, at the initial phase.

Zdeněk Stránský, D.Med.

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