CHAPTER NINE

Balance Training
Concepts
Objectives

After studying this chapter, you will be able to:

Describe balance and its purpose.
Rationalize the importance of balance training.
Design a balance-training program for clients in any level of training.
Perform, describe and instruct various balance-training exercises.

Key Terms

Dynamic joint stabilization

Multisensory condition
Controlled instability

MODULE 9-1:
Concepts in Balance Training
The Importance of Balance

hether on a basketball court, stability ball or walking down stairs,

maintaining balance is key to all functional movements. In functional
activities, balance does not work in isolation. Therefore, it should
not be thought of as an isolated component of function. Balance is a component
of all movements, regardless of whether strength, speed, flexibility or endurance
dominates the movement.1,2
Balance is often thought of as a static process. However, functional balance is
a dynamic process involving multiple neurological pathways. Maintenance of
postural equilibrium (or balance) is an integrated process requiring optimal
muscular balance (or length-tension relationships and force-couple relationships),
joint dynamics (or arthrokinematics) and neuromuscular efficiency.1,2
The integrated performance paradigm (Figure 9-1) shows that adequate force
reduction and stabilization are required for optimum force production.The ability
to reduce force at the right joint, at the right time and in the right plane of motion
requires optimum levels of functional dynamic balance and neuromuscular
efficiency.1,2

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Importance of Properly Training the Balance Mechanism

Balance training should constantly stress an individuals limits of stability
(or balance threshold). An individuals limit of stability is the distance outside
of the base of support that he/she can go without losing control of his/her
center of gravity. This threshold must be constantly stressed in a multiplanar,
proprioceptively enriched environment, utilizing functional movement patterns
to improve dynamic balance and neuromuscular efficiency.1,2
Training functional movements in a proprioceptively enriched environment
(unstable, yet controllable) with appropriate progressions (floor, balance beam,
half foam roll, Airex pad, Dyna Disc), correct technique and at varying speeds,
facilitates maximal sensory input to the central nervous system, resulting in the
selection of the proper movement pattern.1,2
Fitness professionals must implement progressive, systematic training
programs in order to develop consistent, long-term changes in each client.
Traditional program design often results in an incomplete training program,
which does not challenge the proprioceptive mechanisms of the kinetic chain.
Balance training fills the gap left by traditional training. It focuses on
functional movement patterns in a multisensory, unstable environment.3,4 The
design and implementation of balance into a program is critical for developing,
improving and restoring the synergy and synchronicity of muscle-firing patterns
required for dynamic joint stabilization and optimal neural muscular control.3-6

Figure 9-1: Integrated Performance Paradigm

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Concepts

MODULE 9-1: Summary

Balance is key to all functional movement. However, it does not work in
isolation and is not static. Maintenance of postural equilibrium is an integrated,
dynamic process requiring optimal muscular balance, joint dynamics and
neuromuscular efficiency. Balance training should challenge an individuals ability
to stabilize outside their normal base of support. By training in a multisensory
environment, there will be more of a demand on the nervous systems ability
to activate the right muscles at the right time in the right plane of motion.

MODULE 9-1: Quiz

1. The limit of stability is the distance a person can go outside of his base
of support, without losing control of his ___________________.
2. The integrated performance paradigm demonstrates that adequate force
reduction and stabilization are required for optimum force production.
True

False

3. What type of environment is created by training with any of the following

implements: floor, balance beam, half foam roll,Airex pad, Dyna Disc?

4. Balance is an isolated activity.

True

False

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MODULE 9-2:
Scientific Rationale for Balance Training
Benefits of Balance Training
DYNAMIC JOINT
STABILIZATION:
The ability of the
kinetic chain to
stabilize a joint
during movement.

MULTISENSORY
CONDITION:
Training
environment that
provides heightened
stimulation to
proprioceptors and
mechanoreceptors.

CONTROLLED
INSTABILITY:
Training
environment that is
as unstable as can
safely be controlled
by an individual.

316

Balance training has been shown to be particularly beneficial to improve

dynamic joint stabilization.7-14 Dynamic joint stabilization refers to the
ability of the kinetic chain to stabilize a joint during movement. Some examples
of this include:
The rotator cuff stabilizing the head of the humerus on the glenoid
fossa while performing a push-up
The gluteus medius and adductor complex stabilizing the hip when
performing a squat
The posterior tibialis and peroneus longus stabilizing the foot and
ankle complex when performing a calf raise.
Balance and neuromuscular efficiency are improved through repetitive
exposure to a variety of multisensory conditions.5,6 An example of this
would be having a client balance on one foot on a half foam roll, while squatting
down and reaching across the body, toward the floor. This helps facilitate the
nervous system to achieve maximal sensorimotor integration, resulting in the
selection of the proper movement pattern.
The main goal of balance training is to continually increase the clients
awareness of his/her limit of stability (or kinesthetic awareness) by creating
controlled instability.1 An example of this could range from having a 65-yearold client balance on one foot, to having a 25-year-old client balance on one
foot on a half foam roll or Dyna Disc.

Balance and Joint Dysfunctions

Research has demonstrated that specific kinetic chain imbalances (such as
altered length-tension relationships, force-couple relationships and
arthrokinematics) in individuals leads to altered balance and neuromuscular
efficiency.15-24
Alterations in the kinetic chain before, during or after exercises further
affect the quality of movement and perpetuate faulty movement patterns.The
faulty movement patterns alter the firing order of the muscles involved,
disturbing specific functional movement patterns and decreasing
neuromuscular efficiency.15,25,26 Prime movers may be slow to activate, while
synergists, stabilizers and neutralizers substitute and become overactive
(synergistic dominance). This leads to abnormal joint stress, which affects the
structural integrity of the kinetic chain.This may lead to pain, joint dysfunction

CHAPTER NINE
Balance Training
Concepts

and further decrease neuromuscular efficiency.17

Research has demonstrated that joint dysfunction creates muscle
inhibition.17,27,28 Joint injury results in joint swelling, which results in the
interruption of sensory input from articular, ligamentous and muscular
mechanoreceptors to the central nervous system (Figure 9-2).29 This results in
a clinically evident disturbance in proprioception. It has been demonstrated
that sensory feedback to the central nervous system is altered, following ankle
sprains, ligamentous injuries to the knee and low back pain.17,19,20,30-34 This is
critical for the fitness professional to understand because 85 percent of the
adult U.S. population experiences low back pain and an estimated 80,000 to
100,000 anterior cruciate ligament (ACL) injuries and two million ankle sprains
occur annually.

Joint Dysfunction
Muscle Inhibition
Joint Injury
Swelling

Altered Proprioception
Figure 9-2: Effects of Joint Dysfunction

Thus, muscle imbalances, joint dysfunctions, pain and swelling can lead to
altered balance.Therefore, the majority of the clients that fitness professionals
work with may have decreased neuromuscular efficiency. It is imperative to
understand balance and how to design a balance routine that caters to the
needs of todays client.

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MODULE 9-2 Summary

Balance training benefits dynamic joint stabilization. Its main goal is to
continually increase awareness of limits of stability. Repetitive exposure to
varied multisensory conditions can improve balance and neuromuscular
efficiency. Training should occur in an unstable environment in which an
individual can still safely control movements.
Individuals with altered neuromuscular control likely have specific kinetic
chain imbalances.These affect the quality of movement, create faulty movement
patterns and lead to lowered neuromuscular efficiency.This may contribute to
synergistic dominance, which can cause joint dysfunction and pain elsewhere.
Joint dysfunction creates muscle inhibition, which alters balance and leads to
tissue overload and injury.
The majority of fitness clients have decreased neuromuscular efficiency
and problems with balance.

MODULE 9-2 Quiz

1. Joint dysfunctions, pain and swelling can lead to altered balance.
True

False

2. When the body stabilizes a joint during movement, it is known as what?

3. Joint dysfunction may lead to:

Synergistic dominance
Muscle inhibition
Decreased neuromuscular control
All of the above
4. A training environment should be as unstable as possible.
True

318

False

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Balance Training
Concepts

MODULE 9-3:
Designing a Balance Training Program
Balance Training Design Parameters
A balance-training program is a vital component of any integrated training
program. It ensures optimum neuromuscular efficiency of the entire kinetic
chain.The program must be systematic and progressive.1,2 Fitness professionals
must follow specific program guidelines, proper exercise selection criteria and
detailed program variables (Figure 9-3).1,2
Exercise Selection
Safe
Progressive
Easy to hard
Simple to complex
Known to unknown
Stable to unstable
Static to dynamic
Slow to fast
Two-arm/leg to
single-arm/leg
Eyes open to eyes closed
Systematic
Stabilization
Strength
Power
Proprioceptively
challenging
Floor
Balance beam
Half foam roll
Airex pad
Dyna Disc

Variables
Plane of motion
Sagittal
Frontal
Transverse
Range of motion
Full
Partial
End-range
Multisensory
Half foam roll
Reebok Core Board
Airex pad
Dyna Disc
BOSU

Type of resistance
Body position
Two-leg
Staggered-stance
Single-leg
Multiposition
Upright
30
45
75
90
Speed of motion
Duration
Frequency
Amount of feedback

Figure 9-3: Program Design Parameters for Balance Training

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Levels of Balance Training

There are three levels of training within the OPT model: stabilization,
strength and power (Figure 9-5).A proper balance-training program follows the
same systematic progression.
Phase 7
Phase 6

POWER

Phase 5

STRENGTH

Phase 4
Phase 3
Phase 2
Phase 1

STABILIZATION

Figure 9-4: The OPTTM Model

Stabilization Level
In balance-stabilization training, exercises involve little joint motion. They
are designed to improve reflexive joint stabilization contractions to increase
joint stability.1,2 This means that when the body is placed in unstable
environments, it must react by contracting the right muscles at the right time
to maintain balance. Exercises in this level include:
Single-leg Balance
Single-leg Hip Internal and External Rotation
Single-leg Hip Flexion and Extension
Single-leg Balance Reach
Single-leg Rotation
Single-leg Lift and Chop

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Concepts

Single-leg Balance
Preparation
1. Stand with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly and tuck chin.

Movement

Start

3. Draw abs in and activate glutes.

4. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
5. Hold for five to 20 seconds.
6. Slowly return to original position.
7. Switch legs and repeat as instructed.

Finish

Single-leg Hip Flexion and Extension

Preparation
1. Stand with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly and tuck chin.

Movement

Start

3. Draw abs in and activate glutes.

4. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
5. Slowly flex and extend hip of lifted leg, holding each
end position for two seconds.
6. Slowly return to original position.
7. Switch legs and repeat as instructed.

Finish

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Single-leg Balance Reach (Sagittal, Frontal and Transverse)

Preparation
1. Stand with feet shoulder-width apart and pointed straight ahead. Hips should be in a
neutral position.
2. Lift chest, retract shoulders slightly and tuck chin.

Movement
3. Draw abs in and activate glutes.
4. Lift one leg directly beside balance leg. Dorsiflex toe, flex hip at a 90-degree angle and
slightly flex knee. Maintain optimal alignment, including level hips and shoulders.
5. Move lifted leg to the front of the body (sagittal). Hold for two seconds.
6. Slowly return to original position.
7. Move lifted leg to the side of the body (frontal). Hold for two seconds.
8. Slowly return to original position.
9. Externally rotate balance hip and move lifted leg to the rear of the body (transverse).
Hold for two seconds.
10.Slowly return to original position.
11.Switch legs and repeat as instructed.

322

Sagittal Start

Sagittal Finish

Frontal Start

Frontal Finish

Transverse Start

Transverse Finish

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Balance Training
Concepts

Single-leg Lift and Chop

Preparation
1. Stand with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Hold medicine ball (between five and 10 percent of
body weight) in extended hands.
3. Lift chest, retract shoulders slightly and tuck chin.

Movement
Start

Movement

4. Draw abs in and activate glutes.

5. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
6. Extend arms so that hands are at the outside of the
balance leg.
7. Lift medicine ball in a diagonal pattern, rotating the
body using hips, abs and glutes until medicine ball is
overhead. Hold for two seconds.
8. Slowly return to original position.
9. Switch legs and repeat as instructed.

Finish

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Strength Level
In balance-strength training, exercises involve more dynamic eccentric and
concentric movement of the balance leg,through a full range of motion.Movements
require dynamic control in mid-range of motion, with isometric stabilization at the
end-range of motion.The specificity, speed and neural demand are progressed in
this level.These exercises are designed to improve the neuromuscular efficiency of
the entire kinetic chain.1,2 Exercises in this level include:

Single-leg Squat
Single-leg Squat Touchdown
Single-leg Romanian Deadlift
Lunge to Balance
Step-up to Balance

Single-leg Squat
Preparation
1. Stand with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly, tuck chin and
place hands on hips.

Movement

Start

Movement

Finish

324

3. Draw abs in and activate glutes.

4. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
5. Slowly squat as if sitting in a chair. Lower to first
point of compensation. Hold for two seconds.
6. Slowly stand upright but pushing through heel, using
abs and glutes.
7. Switch legs and repeat as instructed.

CHAPTER NINE
Balance Training
Concepts

Single-leg Squat Touchdown

Preparation
1. Stand with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly, tuck chin and
place hands on hips.

Movement

Start

Finish

3. Draw abs in and activate glutes.

4. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
5. Slowly squat as if sitting in a chair, reaching hand
opposite of balance leg toward lower foot and
keeping chest lifted.
6. Lower to first point of compensation. Hold for two
seconds.
7. Slowly stand upright but pushing through heel, using
abs and glutes.
8. Switch legs and repeat as instructed.

Single-leg Romanian Deadlift

Preparation
1. Stand with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly, tuck chin and
place hands on hips.

Movement

Start

3. Draw abs in and activate glutes.

4. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
5. Slowly reach hand toward stabilizing foot.
6. Lower to first point of compensation. Hold for two
seconds.
7. Slowly stand upright, using abs and glutes.
8. Switch legs and repeat as instructed.

Finish

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Lunge to Balance
Preparation
1. Stand with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly, tuck chin and
place hands on hips.

Movement

Start

Movement

Finish

326

3. Draw abs in and activate glutes.

4. Lunge forward, landing on the heel of lunge foot with
toes pointed straight ahead and knee directly over
the toes. Both knees should be bent at 90-degree
angles. The front foot should be flat and the back
heel should be lifted.
5. Stabilize.
6. Push off of front foot through heel onto back leg,
straightening balance leg and lifting opposite leg so
that hip and knee are flexed at 90-degree angles with
foot dorsiflexed.
7. Switch sides and repeat as instructed.

CHAPTER NINE
Balance Training
Concepts

Step-up to Balance
Preparation
1. Stand in front of a box or platform (between six and
18 inches) with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly and tuck chin.

Movement

Start

Finish

3. Draw abs in and activate glutes.

4. Step onto box with one leg, keeping toes pointed
straight ahead and knee directly over the toes.
5. Push through front heel and stand upright, balancing
on one leg, lifting opposite leg so that hip and knee
are flexed at 90-degree angles with foot dorsiflexed.
6. Stabilize.
7. Return lifted leg to the ground, keeping toes and
knees aligned.
8. Switch sides and repeat as instructed.

Power Level

In balance-power training, exercises are designed to develop high levels of

eccentric strength, dynamic neuromuscular efficiency and reactive joint
stabilization.1,2 Exercises in this level include:

Multiplanar Hop with Stabilization

Sagittal Plane Hop with Stabilization
Frontal Plane Hop with Stabilization
Transverse Plane Hop with Stabilization

Single-leg Box Hop-up with Stabilization

Single-leg Box Hop-down with Stabilization

Single-leg Hop with Stabilization

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Multiplanar Hop with Stabilization

(Sagittal, Frontal and Transverse)
Preparation
1. Stand with feet shoulder-width apart and pointed straight ahead. Hips should be in a
neutral position.
2. Lift chest, retract shoulders slightly and tuck chin.

Movement
3. Draw abs in and activate glutes.
4. Lift one leg directly beside balance leg. Dorsiflex toe, flex hip at a 90-degree angle and
slightly flex knee. Maintain optimal alignment, including level hips and shoulders.
5. Hop forward (sagittal), landing on opposite foot. Stabilize and hold for two to four seconds.
6. Hop backward (sagittal), landing on opposite foot in starting position. Stabilize and hold
for two to four seconds.
7. Switch legs and repeat as instructed.
8. Use the same format to move in frontal and transverse planes, hopping in a side-to-side
or turning manner.

328

Sagittal Start

Sagittal Finish

Frontal Start

Frontal Finish

Transverse Start

Transverse Finish

CHAPTER NINE
Balance Training
Concepts

Single-leg Box Hop-up with Stabilization

Preparation
1. Stand in front of a box or platform (between six and
18 inches) with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly and tuck chin.

Movement

Start

3. Draw abs in and activate glutes.

4. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
5. Using arms, jump up and land on top of box, keeping
toes pointed straight ahead and knee directly over
the toes. Stablize. Hold for two to four seconds.
6. Step off box, keeping toes and knees aligned.
7. Switch sides and repeat as instructed.
8. Use the same format to hop in the frontal and
transverse planes.

Finish

Single-leg Box Hop-down with Stabilization

Preparation
1. Stand on a box or platform (between six and 18
inches) with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly and tuck chin.

Movement

Start

3. Draw abs in and activate glutes.

4. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
5. Using arms, jump off box and land on ground, keeping
toes pointed straight ahead and knee directly over
the toes. Stablize. Hold for two to four seconds.
6. Step onto box, keeping toes and knees aligned.
7. Switch sides and repeat as instructed.
8. Use the same format to hop in the frontal and
transverse planes.

Finish

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Single-leg Hop with Stabilization

Preparation
1. Stand with feet shoulder-width apart and pointed
straight ahead. Hips should be in a neutral position.
2. Lift chest, retract shoulders slightly and tuck chin.

Movement

Start

Finish

330

3. Draw abs in and activate glutes.

4. Lift one leg directly beside balance leg. Dorsiflex toe,
flex hip at a 90-degree angle and slightly flex knee.
Maintain optimal alignment, including level hips and
shoulders.
5. Squat slightly as if sitting in a chair.
6. Jump up, extending arms overhead.
7. Land softly, maintaining optimal alignment and
returning arms to sides. Stabilize and hold for two
to four seconds.
8. Switch legs and repeat as instructed.

CHAPTER NINE
Balance Training
Concepts

MODULE 9-3 Summary

A balance-training program is designed to ensure optimum neuromuscular
efficiency of the entire kinetic chain. Balance training programs must be
systematic and progressive, following specific program guidelines, proper
exercise selection criteria and detailed program variables.
A proper balance-training program follows the same systematic
progression as the OPT model: stabilization, strength and power levels of
training. Exercises in the stabilization level of balance training do not involve
much joint motion and improve joint stability. In the strength level of balance
training, the balancing leg moves dynamically through a full range of motion,
with exercises that require greater specificity, speed and neural demand.These
movements require isometric stabilization at the end-range of motion. They
improve neuromuscular efficiency of the entire kinetic chain. Exercises in the
power level of balance training improve high levels of eccentric strength,
dynamic neuromuscular efficiency and reactive joint stabilization.

MODULE 9-3 Quiz

1. Which guidelines must be taken into consideration when designing
a balance training program?
Proprioceptively challenging
Isolated
Systematic
Unrelated to activities
Creative
Progressive
2. In the stabilization level of balance training, exercises involve little joint
motion to _____________ joint stability.
Increase
Decrease
3. Match the exercises to either stabilization, strength or power levels
of training:
Single-leg Balance:_____________________
Single-leg Hop with Stabilization:_____________________
Single-leg Squat:_____________________
Lunge to Balance:_____________________

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MODULE 9-4:
Implementing a Balance Training Program
Balance Training Design Parameters
Implementing a balance-training program requires that fitness
professionals follow the progression of the OPT model. For example, if a
client is in the stabilization level of training (Phase 1 or 2), select balancestabilization exercises. For a client in the strength level of training (Phase 3, 4
or 5), the fitness professional should select balance-strength exercises. For an
Table 9-2: Balance Training Program Design
OPT
Level

Phase(s)

Exercise

Number of
Exercises

Sets

Reps

Tempo

Rest

Stabilization

1
2

Balance
1-4
Stabilization

1-3

10-20
3-10 sec
(or single-leg hold
6-10 each)

0-90
sec.

Strength

3
4
5

Balance
Strength

0-4

2-4

8-12

3/2/1 1/1/1

0-60
sec.

Power

Balance
Power

0-3

2-4

8-12

Controlled. 0-90
Hold
sec.
stabilization
position for
3-5 seconds.

Included in resistance-training portion of workout.

advanced client in the power level of training (Phase 6 or 7), select balancepower exercises (Table 9-2).

Filling in the Template

To fill in the program template, go to the section labeled Core and Balance.
You will then refer to Table 9-2 for the appropriate type of balance exercise
(stabilization, strength or power), the appropriate number of balance exercises

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Concepts

Figure 9-5: OPTTM Template

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Optimum Performance Training for the Health and Fitness Professional

and the appropriate acute variables specific to the phase of training your client
will be working in (1-7).

MODULE 9-4 Summary

To choose the right exercises when designing a program, follow the
progression of the OPT model. In the stabilization level, choose one to four
balance-stabilization exercises. In the strength level, select zero to four balancestrength exercises (optional in Phases 4 and 5). In the power level, pick from
zero to three balance-power exercises.

MODULE 9-4 Quiz

1. What kind of exercises would you choose for a client in Phase 3 of the
OPTTM model?

2. What is the optimal tempo for a single-leg balance reach?

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Concepts

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18. Janda V, Vavrova M. Sensory motor stimulation video. Brisbane, Australia: Body
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