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Hello and welcome to episode 19 of the Enlightened Anatomy Podcast.
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And this week we're looking at balance.
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So balance poses, balance training.
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Does it help people?
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Does it prevent falls?
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All of these questions and more in today's episode.
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So it's a good one.
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Stay tuned and cue the intro music so we often say things in yoga like, you know, yoga is good for improving balance, and I've definitely said that.
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I've said that during our Physiology of Yoga eight-week course.
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I've said it when I've taught the anatomy on a yoga teacher training.
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But does it actually?
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I've actually never looked into the research until now.
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And the reason I started looking into this is because our online community for yoga teachers, the Enlightened Yoga Collective, has a monthly inspiration, and this month, August 2026, it's all about balance.
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So I actually looked at the research, and it was fascinating, and I learned a lot.
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Um, and contrary to what we might think or hope there was some really interesting research about Iyengar yoga and the people who did Iyengar yoga in this specific study and whether they had a decreased or increased fall rate.
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So we'll get into that a little bit later.
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But first, just wanted to explore what questions we're gonna be looking at today.
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So we're going to be exploring, first of all, what do we actually mean by balance?
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And it might be different to what you actually think.
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Does balance inevitably decline with age?
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Is balance actually important for younger people?
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Because we often talk about it in relation to older people, but what about young people too?
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And does improving balance reduce falls?
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Now, that is an important thing, and that is two different things, as we'll learn.
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So has yoga been shown to improve balance?
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H- has what I've said actually been justified?
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And what kinds of balance training actually work?
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Finally, we will think about how to apply this to our yoga practice and especially as yoga teachers, how to apply it into our classes.
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So let's begin.
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First of all, that Iyengar yoga study.
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So this large trial of seven hundred people, published in 2025, but actually they did the work of it during COVID, and so that was why they did o- online yoga.
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They had seven hundred volunteers divided into two groups randomly.
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So this is a randomized controlled trial, which is, you could say the highest level of evidence.
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And half of the people did an online Iyengar yoga program, and the other half did a seated meditation.
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So that would be the control group, and it's, it's an active control, which is better than just people doing nothing.
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So a seated meditation, at least they're doing something, and we can compare.
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And- As most of us would hope, I think, you would expect the Iyengar yoga group, and, you know, I don't think this is specific to Iyengar, but just in general yoga, you would think, you would hope people would have fewer falls as a result.
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It was actually the opposite in this specific study.
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So the Iyengar yoga group, and these people were followed for a whole year, which is actually a good amount of time for a study.
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The Iyengar yoga group actually had a 33% higher fall rate.
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Now, I know that sounds horrible, right?
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But don't be disconcerted because there are lots of factors that go into this, and what this definitely does not mean is that yoga causes falls or, you know, we should all stop our yoga practice.
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And in fact, I'm gonna get into evidence later about how useful exercise is for reducing falls.
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But in this specific study, and remember, this is why it's important to look at the whole body of evidence, not just one individual study.
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But in this specific study, they did find that those people had a higher incidence fall rates.
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Maybe it was a, an outlier.
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Maybe it was a one-off.
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This is why the same study should be repeated and see, do they get the same result?
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And, the participants did that one specific style of yoga.
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Would it be the same if they did a different style of yoga?
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Would it be different if they did different balance poses?
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So in this study they primarily did tree pose as their balance pose, and then there were other standing poses also.
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But nonetheless, already I think it's good to have this information.
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Let's not discard it'cause it's very easy to say,"I don't like that information'cause it goes against my beliefs that yoga is good for everything." So still, let's keep this information.
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Let's be good critical thinkers and say,"Okay, I'm gonna incorporate that knowledge and also look at the wider body of knowledge" which is what we're gonna do today.
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So let's start by looking at first, you know, what is balance, and I think most people would probably say balancing on one leg," right?
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But it's actually more than that.
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A classic textbook definition is keeping the body's center of mass over its base of support.
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It's a nice simple definition.
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Now, your base of support can change.
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It could be two feet, okay?
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Two feet parallel hip distance apart, which would be what?
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Tadasana pose, right?
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But then it could also be one foot.
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That's just a different base of support, and the fewer bases of support you have, the more difficult balance becomes.
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Similarly, the closer, the smaller the base of support, so if you bring your feet closer together, that will be harder.
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Or if you bring one foot in front of the other, that will be harder than having your feet wider apart.
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And in fact, people who tend to have bad balance tend to have their feet a little bit wider because they tend to feel more stable in that wider base of support.
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But your base of support could also be two hands, which is of course a handstand.
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Your base of support could be one hand and the outer edge of one foot, which would be side plank.
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Yeah?
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So balance is not just being on one foot, though of course y- you know, that's often what we think of.
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But it's basically being able to balance out all of the opposing forces on the body, gravity pulling you down to the center of the earth forward forces if you're leaning forward, backwards forces, side to side, balancing of all of those out so that you can remain over your center, over your base of support.
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And this is an I think this is an interesting little thing.
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There is a cone of balance.
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So if you think about your base of support, and let's, let's just think about tree pose to make it really simple.
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Your base of support is one foot, and then there's a cone of balance inside which your center of mass can be, and you can be in balance.
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So your center of mass can shift over to the side.
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So if you shift your hips over to the side, you'll still be in balance.
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Hopefully, as long as you're inside that cone, and then the other side.
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But there is some point outside that cone where no matter what, if your center of mass is outside that cone, you have to fall.
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You will fall.
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That's simple physics.
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But also what's interesting is that cone of balance can increase with training, and it tends to decrease as we get older or if we detrain, if we don't train, if we don't exercise, if we don't move.
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So that's a little aside.
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Another thing to bear in mind about balance is it's not just purely a mechanical thing like, like I described, but actually it is a constantly changing interaction of your nervous system, your body, the task that you're doing, and actually also your environment.
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'Cause if there's a strong gust of wind that will affect your balance.
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So there are two important elements to balance.
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There is the sensory information that we receive, and then there is the muscular output that your brain gives in order to maintain your balance.
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So vision is important in our balance.
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We are sensing where our horizon is, and we'll notice with our vision if our horizon goes off to the side because that means our head is tilting to the side.
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We have the vestibular system, which is located in the inner ear, and this is really fascinating, I think.
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There are these donut-shaped structures inside your inner ear, and they don't really have anything to do with hearing.
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So we think of inner ear as having to do with the ear and hearing, but they're kind of separate to that.
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That's just hap- where they happen to be located.
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But you have these donut-shaped structures filled with a small amount of fluid.
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And so if you imagine you tilt the donut structure to the side, then the fluid will drain to one part of the donut.
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And then we have sensors all throughout the inner ear which are sensing where that fluid is moving.
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And so that sensory information will be sent to the brain.
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And so for an issue like vertigo, where someone feels dizzy, there might be a problem with that information being sent to the brain or it being processed inside the brain We also receive sensory information from joints, so what you know of as, as proprioception.
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Like, you can tell if your head is leaning to one side.
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You can tell if your arm is lifted up, if your knee is bending.
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We also can sense our muscles, and I think this is really interesting, skin also plays an important role in balance.
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So you can feel if wind or air is brushing across your skin and you know, oh, I'm falling.
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Now, all of those things taken together, the brain will synthesize that information and say,"I am in balance," or,"I am out of balance." And then it will choose what it does next.
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And your brain is just an incredible thing, right?
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Um, another thing is that it will not rely equally on those three systems.
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So for example, standing on a firm floor in good lighting differs from standing on soft ground in darkness.
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And so your brain will choose to prioritize, uh, the visual information, visual feedback, in a well-lit room on a hard surface, versus it'll choose to increase the proprioceptive information that it receives if you're in a darker room.
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Again, balance is, I'm hoping you're, you're starting to realize, a, a very complex thing.
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It's more than just a mechanical thing and more than just one system involved Now that your brain has that information, it decides what to do with it.
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So your brain can send motor signals down to muscles to produce muscular force, to contract muscles, um, to increase joint stiffness, to move its center of mass, to change your posture, to take a recovery step if needed, to reach for support, all of these different things that we know that we tend to do when we feel like we're losing our balance.
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Now a little task I like to do when teaching anatomy on a teacher training is for everyone to stand up and to balance on one foot, and then to look down at that foot.
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And so as long as you're not driving, I encourage you to do this, or the next time you're at home with no socks and shorts on, lift one foot and look at all the muscles that are engaging and the tendons that you'll see moving underneath your skin to maintain your balance.
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As a matter of fact, your foot is a bit like a puppet, and the puppet masters which control your foot, they have these strings, so the tendons, which originate on the foot or even beneath the foot and go all the way up the sides and the front of the calf.
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And then the puppet masters are at the top of the calf.
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So your evertors and invertors like the tibialis anterior, your plantar flexors, dorsiflexors, they are moving, pulling up and down to keep your foot in balance.
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And so when you look at your foot while you're trying to balance on one foot, you will see that balance is not a passive thing.
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It is constant movement.
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It is a constant wobble.
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It's a constant shifting right and left.
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And what's incredible is we don't even have to think about that consciously at all.
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It's all just happening Now, factors can influence our balance.
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So these include our strength and power.
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So It's one thing to sense that you are out of balance.
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It, it's another thing to have that muscular strength to be able to pull yourself back into balance.
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Certain really important muscles in one-legged balance are all around the shin, like I was mentioning, those tibialis anterior muscles, the fibularis muscles.
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And then also muscles higher up into the hip, particularly as you bend forward.
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So muscles involved in balancing Warrior III are gonna be high up in the hip versus being vertically stacked like in tree pose are gonna be further down on the ankle and the calf And so if you have stronger muscles to begin with, they'll be able to engage.
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And also power refers to how quickly a muscle can engage, how quickly it can produce force.
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So if you can do those more quickly, then theoretically your balance will be better.
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But also what matters is your reaction time, your attention, and your cognitive load.
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So something I'm always talking about in balance in a yoga class is to focus.
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Focus on one point, but also to focus on the thing that we're doing.
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And I almost feel like I can see when people's thoughts shift and they start thinking about something else, and then their balance wobbles.
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Now it could be something else.
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It could be a muscle thing, but I often see there's like a shift of the eye or something, and then boom, they lose their balance.
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Um, also cognitive load, so if you're carrying a lot cognitively, in your mind, that will also affect your balance.
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Confidence and fear affect your balance.
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I was just in the States visiting family, and I was there with my mom, who's in her 70s now, towards her late 70s.
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We were walking on a little beach towards a lake, and she had her arm in mine.
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And as we were getting to a place with an uneven terrain and sand, I could feel her grip on my arm get really tight.
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And so she had a decreased confidence.
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Now, that could actually be a useful thing because it tells your body, your brain is saying,"Okay, I need to be more alert now.
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There, you know, this is a less safe terrain.
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I need to be more careful." That could be a positive thing.
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But also, as we know with fear, we can over-engage.
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We can tighten up.
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We can take smaller steps.
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We can do things that actually might not help our balance.
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So confidence and fear do play a role in balance, both in a good and potentially a, a, a less helpful way Also things like fatigue, pain, medication, previous injury, and also the environment, like I said before, like a gust of wind or the terrain that you're on will all affect your balance.
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So the take-home message for this little segment on the introduction is basically balance is not one single system, but it's lots of things involved, both sensory and motor.
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There are also different types of balance.
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There is static or steady state balance.
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So this is quite often what we focus on in yoga, put your foot on your thigh in tree pose, look forward, don't move.
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Right?
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That is one way of doing balance, and if you do that, you'll probably get better at doing that thing.
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But that's only one way.
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There's also dynamic balance, which is controlling the body while it's moving.
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So instead of just holding the pose, going into a pose and coming out of it.
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So for example, going into half moon and then coming back up to tree pose.
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That works a different type of balance There is proactive or anticipatory balance where you are preparing f- for a predictable movement that will disturb your balance.
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So if you think about throwing a baseball or throwing something and you know you're gonna be stepping onto one foot, so you can expect that.
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That is predictive balance And then there's also reactive balance, which is responding to an unexpected disturbance.
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If that's bumping into a pole, someone accidentally pushing you or purposefully pushing you, hopefully not.
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But anyway, y- th- y- your balance can be disturbed, and how good is your reaction to that balance?
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So all of these are different elements of balance.
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There's not just one thing of do this one thing and you'll get better at all of them.
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Each one will probably improve based on w- how you do it.
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And then there's also what's called functional balance, which is a, a, a bit of a vague term, but it's things that are more tied to specific things that you would do in your life.
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For example, if you need to step over a bathtub to get into a shower, that i- then that movement would be considered a functional movement So now onto the question of does balance decline with age?
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And, on average, the sad answer is yes.
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I know it can be a bit depressing talking about aging and hearing about things, and as someone who is now closer to 50 than 40, I, I'm starting to think about my later life.
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And, and the reality is we are all aging.
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We are all a day closer to, to our grave, And I know that can sound a bit depressing, but while we're on the topic, you know, there are some interesting yoga texts that talk about how coming to terms with death actually can help, uh, liberate us in life.
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So again, that's a bit of an aside, but nonetheless, we are on this, this steady path towards death.
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Nice and enlightening podcast episode for you here, isn't it?
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But the good news is you're still alive.
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You know?
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Let's celebrate the fact that we are still here, and I'm grateful that I'm close to, closer to 50 and I'm still here, I'm still kicking.
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I'm still doing yoga.
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And I hope to have all the problems that come with being a 100-year-old and that I'm still alive then.
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I know I've said that in a previous podcast episode.
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But anyway, yes, balance does decline with age is the point, I guess, that I was going to get to.
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But there's a lot that we can do to help slow it down and actually maybe even reverse it if you're someone who hasn't done balance training.
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You know, possible factors that affect- whether or why balance changes with age, uh, has to do with changes in vision'cause vision is an important part.
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Reduced vestibular function, so that inner ear donut thing I was talking about.
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Lower muscle strength and power, and that's something that we can control, as we know.
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Slower reactions.
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So there are some adaptations that happen with the nervous system when you start training and when you start training for quicker movement.
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So that can be trained also, so don't think,"Oh, it's just, uh, all downhill from here." No.
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Uh, reduced physical activity, again, a thing that we can change, can-- thing that we can influence.
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Medication and health conditions, now, you know, that, that's just part of life, innit?
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And greater difficulty dividing attention between movement and another task.
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Okay?
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That's another factor But let's not catastrophize here, okay?
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So age-related changes are normal and, and they are real, yeah?
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But it is not a cliff edge.
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It is not, as soon as you get to a, a certain age it's all boom, it's all going to pot.
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A- and actually physical activity and exercise and practice can meaningfully improve balance in older adults, and that's supported by the literature.
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And also, as you kn- probably know, people of the same age can vary enormously.
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Y- I'm sure you can think of an 85-year-old with great balance and then a 60-year-old who, uh, has, has poor balance.
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So y- th- there's...
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We've also seen examples of people in their 80s and 90s with great muscle mass, people in their 20s with very little muscle mass.
00:19:18.778 --> 00:19:22.189
So a lot of it comes down to what we do with our bodies.
00:19:22.489 --> 00:19:27.759
As I mentioned, balance is also important for younger people It's not just a senior's disease.
00:19:28.058 --> 00:19:53.509
So young people need balance to run and change direction, land from a jump, play sports, dance respond to physical contact, navigate uneven ter- everything that adults do and older adults do And interestingly, 2018 systematic review evidence has found that balance training produces moderate to large improvements in static and dynamic balance in younger people.
00:19:53.808 --> 00:20:05.739
So the effects are not just restricted to older adults And really good news another systematic review suggests balance and neuromuscular programs can reduce ankle sprains, particularly in sporting populations.
00:20:05.749 --> 00:20:10.338
So another reason that more than just older adults need to be doing balance training.
00:20:10.638 --> 00:20:13.409
Which brings us to the question of, does balance training work?
00:20:13.509 --> 00:20:16.058
And the research actually does say it does work.
00:20:16.358 --> 00:20:20.118
And as I'm gonna get to shortly, that might be a little bit different to falls, okay?
00:20:20.169 --> 00:20:36.919
But several reviews have found that in both healthy older adults and adults with health conditions, balance training improves static balance, dynamic balance, like I mentioned earlier, proactive and reactive balance And it seems the more you do it, the better, to some degree.
00:20:37.219 --> 00:20:41.308
So based on the research, 11 to 12 weeks of training.
00:20:41.608 --> 00:20:43.919
Is much better than just a couple of weeks.
00:20:44.219 --> 00:20:54.038
And doing it three times per week, so three sessions of balance training yields better results than just one per week, which does not tend to have meaningful results.
00:20:54.338 --> 00:21:04.338
Also, sessions should be, according to this research, around 30, 30 to 45 minutes, and if it's more than 60 minutes, you're not getting any more benefit out of it.
00:21:04.638 --> 00:21:12.338
You know, this doesn't mean you need to drop everything and, you know, we've always got this benefit-cost analysis.
00:21:12.638 --> 00:21:13.769
You can't do everything in the world.
00:21:13.769 --> 00:21:15.959
You can't do every single exercise.
00:21:16.108 --> 00:21:19.028
You can't do every single self-care treatment.
00:21:19.148 --> 00:21:22.989
You can't be taking a bath and relaxing while also going out for a run, you know?
00:21:23.219 --> 00:21:31.808
So we always have this cost-benefit analysis, and so we're, remember in research, we're just looking at one specific question, what is the dosage?
00:21:31.838 --> 00:21:33.288
How much has to be done?
00:21:33.588 --> 00:23:03.639
And these systematic reviews have found that information about the 11 to 12 weeks of training and doing it three times per week.
00:23:03.659 --> 00:23:06.109
That's gonna be more beneficial than doing it once per week.
00:23:06.409 --> 00:23:11.479
I think where this all keeps pointing to is the value of moving and of not just sitting down, right?
00:23:11.778 --> 00:23:20.129
Of going to yoga classes and going to your exercise classes and everything else But what the research also points to is specificity.
00:23:20.429 --> 00:23:24.479
So if you do static balance, you will get better at static balance.
00:23:24.479 --> 00:23:48.669
If you do dynamic balance, you'll get better at dynamic balance And so if you generally wanted to help someone with a very specific task, like I want you to be able to comfortably step over the bathtub to get into your shower, then doing things that involve that would be really useful, like stepping over yoga bricks, considering the sensory, mechanical, and cognitive demands of that task, and getting away from holding onto the wall.
00:23:48.839 --> 00:24:02.549
As useful as touching a wall can be or having support from the wall or support from a chair, and as useful as chair yoga can be, nothing will be as good for balance as just letting go of that thing and trying to balance on your own.
00:24:02.849 --> 00:24:13.099
Which brings us to one of our last segments and, you know, ties back into that initial Iyengar study with the question, you know, does actually improving balance prevent falls?
00:24:13.399 --> 00:24:21.798
And incredibly, falls, as in slips, trips and falls, are the number one cause of accidental death of people over 65.
00:24:21.818 --> 00:24:30.044
And just last year I lost my own aunt as a result of a fall where she was alone in her house going to the kitchen in the middle of the night.
00:24:30.054 --> 00:24:34.148
So, if we can decrease fall rates, it's gonna be really beneficial...
00:24:34.448 --> 00:24:37.948
so let's look at what the research says So just to be clear, there is...
00:24:37.958 --> 00:24:38.788
two different things, right?
00:24:38.798 --> 00:24:41.858
There's improved balance test performance.
00:24:42.158 --> 00:24:45.948
Like, it's one thing to have someone do dancer pose, right?
00:24:46.248 --> 00:24:47.828
And then measure them.
00:24:47.878 --> 00:24:50.298
Let's do this little study where someone does dancer pose.
00:24:50.298 --> 00:24:58.718
We measure how long they can do it for, and then we have them do dancer pose three times a week, uh, you know, in, as part of a yoga program, and we measure it 12 weeks later.
00:24:58.928 --> 00:25:00.807
They will probably get better at dancer pose.
00:25:01.088 --> 00:25:03.628
Like, that's pretty much guaranteed, and that's what the research supports.
00:25:03.928 --> 00:25:05.698
So balance makes you better at balance, right?
00:25:05.968 --> 00:25:10.748
But do improved balance test scores actually translate to decreased falls?
00:25:10.898 --> 00:25:12.678
Let's finally get to the punchline.
00:25:12.688 --> 00:25:14.928
Let's get to the point of this podcast episode.
00:25:15.228 --> 00:25:18.978
And the question is, you know, can we actually reduce our fall risk?
00:25:19.038 --> 00:25:29.768
Because that's ultimately what can lead to problems both, you know, if you're an older adult, but also just, falls are what cause injury, wh- when you land on your elbow, when you land on your hand, right?
00:25:30.148 --> 00:25:35.168
So if you've listened to podcasts with me or done a course with me, you would know there are different levels of evidence.
00:25:35.418 --> 00:25:43.038
The systematic review is considered the highest level of evidence, and even within systematic reviews, there are still different levels of quality.
00:25:43.338 --> 00:25:46.948
There's one by the Cochrane Library, the Cochrane Reviews.
00:25:47.248 --> 00:25:56.057
Cochrane Reviews have a reputation of being the most rigorous, and they tend to come with the most conservative conclusions, right?
00:25:56.288 --> 00:26:09.688
So they tend to be more cautious in saying,"This treatment," whether it's a drug or, you know, a, a, a movement modality like yoga,"this thing will do that effect, will have that effect." They tend to be more conservative.
00:26:09.988 --> 00:26:16.018
And here is what their 2019 review, Sherrington et al., concluded.
00:26:16.318 --> 00:26:35.268
They looked at, first of all, exercise in general for older adults, and they found that exercise reduced the rate of falls in older community-dwelling adults, as in people who are still living in private homes, living with their families, living on their own, not in nursing homes.
00:26:35.568 --> 00:26:39.178
Exercise reduced the rate of falls by approximately 23%, right?
00:26:39.208 --> 00:26:48.368
So we can pretty confidently say that if you exercise and if you move in lots of different ways, you probably will reduce your risk of falls.
00:26:48.668 --> 00:26:49.888
That's a relative risk.
00:26:50.188 --> 00:27:06.228
And they also looked at more specific balance training and, quote-unquote,"functional exercise," finding that balance and functional exercises reduced the rate of falls by approximately 24%, so really not much more.
00:27:06.528 --> 00:27:08.278
So- What does this all mean?
00:27:08.288 --> 00:27:16.208
Maybe we don't need to be looking specifically at balance, and when we look at balance, maybe we should look at it in a slightly different way.
00:27:16.508 --> 00:27:32.868
And that review also found some characteristics of promising programs, which included that, number one, balance is sufficiently challenged, that exercise is progressive, as in it, it's not just the same thing every single day, but it becomes harder.
00:27:32.898 --> 00:27:34.598
You do more challenging things.
00:27:34.618 --> 00:27:36.628
You work to build more strength.
00:27:36.928 --> 00:27:49.468
Functional movements are included, so things that are-- you find in your everyday life, again, like stepping over the tub or reaching across while balancing on one foot, if that's something you do, which most of us tend to at some point.
00:27:49.768 --> 00:27:51.128
You know, reaching into your car.
00:27:51.428 --> 00:27:59.138
Also promising aspects are when strength is included where appropriate, practice is repeated consistently.
00:27:59.438 --> 00:28:04.528
So, you know, it's not like you can do all your exercise in one week and then rest the rest of the year.
00:28:04.568 --> 00:28:07.218
No, we need to keep at it week in, week out.
00:28:07.518 --> 00:28:12.268
And the overall amount or dose is sufficient, right?
00:28:12.318 --> 00:28:14.268
So it's not just a little bit here and there.
00:28:14.568 --> 00:28:19.008
Balancing on one foot while brushing your teeth two minutes a day might not be enough.
00:28:19.307 --> 00:28:33.557
And also another authority for guidance is the World Health Organization, which looks at all of the evidence and comes up with guidelines as they have, for example, for physical activity, 150 minutes plus two days of strength training every week.
00:28:33.568 --> 00:28:38.758
That is the standard guidelines that a lot of countries have then adopted from the World Health Organization.
00:28:38.788 --> 00:28:47.458
And what they say specifically is adults aged 65 plus should undertake varied multi-component physical activity.
00:28:47.758 --> 00:28:57.826
So multi-component refers to components like balance, strength, aerobic activity, and also functional movement such as stepping, turning, and getting up from a chair.
00:28:57.836 --> 00:29:00.167
I think those are quite good guidelines.
00:29:00.467 --> 00:29:07.137
And the World Health Organization also recommends doing this on three or more days per week.
00:29:07.437 --> 00:29:11.957
And so this is broader than simply practicing static balance poses.
00:29:12.257 --> 00:29:16.097
And into our, our last two segments, you know, does yoga actually improve balance?
00:29:16.137 --> 00:29:20.687
And then what should we be doing differently in our yoga practice, if anything?
00:29:21.864 --> 00:29:32.334
In answer to the question, yeah, yoga probably does improve balance to some degree But the certainty and the practical application of the evidence varies.
00:29:32.634 --> 00:29:40.403
A 2016 systematic review looked at six trials that involved yoga, and so there were 307 participants.
00:29:40.403 --> 00:29:42.394
So remember, this is before the Iyengar study.
00:29:42.694 --> 00:29:47.034
And they concluded that yoga produced a small improvement in balance.
00:29:47.114 --> 00:29:47.534
Okay?
00:29:47.754 --> 00:30:11.624
And they also f- determined that yoga produced a medium improvement, so better than just a small improvement, in physical mobility, which is also important as we get older, the ability to bend down, pick something up, or to squat down and get something from the lower cupboard But the researchers explicitly stated that it was unclear whether these improvements translated into fewer falls And as you all know, there's so many different styles of yoga.
00:30:11.924 --> 00:30:14.153
People do yoga at different frequencies.
00:30:14.454 --> 00:30:15.794
Class lengths can vary.
00:30:15.944 --> 00:30:19.274
And then even within the research, there are different balance tests.
00:30:19.294 --> 00:30:27.544
And quite often yoga studies can be quite small, and it can even be difficult to identify which element of yoga is responsible.
00:30:27.594 --> 00:30:39.153
Is it the one-legged balance, which seems the most obvious, or is it actually the combination of the one-legged with the two-legged balances, w- with the arm balances you know, like with a side plank or a crow?
00:30:39.454 --> 00:30:42.694
There are plausible reasons that yoga could help balance, you know?
00:30:42.694 --> 00:30:55.494
Like repeated one-legged standing, narrow base of support, shifting the center of mass and all that stuff But I think we need to be a little bit cautious to say that yoga will definitely prevent falls at this point.
00:30:55.794 --> 00:31:06.124
And as for what we might do differently, first of all, I don't think it's for me to tell you how to change your yoga practice or to how to teach differently.
00:31:06.424 --> 00:31:07.484
That that's up to you.
00:31:07.634 --> 00:31:10.214
And you might love your practice just as it is.
00:31:10.514 --> 00:31:26.634
However, if you would like to try some different things, and based on everything that we've explored today, here are a few things that you could add in to your yoga practice/yoga teaching So of course, we're already holding poses statically in yoga, you know, balance poses.
00:31:26.934 --> 00:31:32.153
We already have that nailed, but what about trying something like reaching during a balance pose?
00:31:32.163 --> 00:31:34.214
Reaching over to the right side, reaching to the left side.
00:31:34.514 --> 00:31:41.014
Transitioning between poses rather than just holding that pose, going in and out of it, especially between balance poses.
00:31:41.014 --> 00:31:42.284
That could be really challenging.
00:31:42.584 --> 00:31:43.854
Maybe adding a step.
00:31:44.153 --> 00:31:49.194
So stepping forward, sideways, or even diagonally into a pose and then out of it.
00:31:49.494 --> 00:31:51.464
Another element may be turning.
00:31:51.614 --> 00:31:54.574
So you could first look in different directions.
00:31:54.584 --> 00:31:59.934
You can change that sensory information, but you could also turn your entire body while in a balanced pose.
00:31:59.934 --> 00:32:08.624
This could be something that could make it a little bit more similar to what, how balance happens in real life And maybe playing a game of following a verbal directional cue.
00:32:08.624 --> 00:32:12.744
So with that reach, for example, maybe people could reach forward or reach sideways.
00:32:13.044 --> 00:32:13.354
I don't know.
00:32:13.374 --> 00:32:15.504
You might think,"No, that doesn't sound like yoga to me.
00:32:15.534 --> 00:32:27.334
I don't wanna do this at all." Or you might think,"Okay, maybe I'll try one or two of those." And I created an asana class and excerpts with three of those inside the Enlightened Yoga Collective.
00:32:27.344 --> 00:32:31.014
So if you're interested and want to see how I would do it, you can check out that.
00:32:31.314 --> 00:32:35.413
Also, we don't talk about progressive changes in yoga very often.
00:32:35.413 --> 00:32:38.034
We just do one thing and then keep doing that same thing, I think.
00:32:38.334 --> 00:32:49.403
But y- For someone with very poor balance, just having feet closer together would be the starting point, or maybe one foot in front of the other, what's called tandem standing could be a starting point.
00:32:49.704 --> 00:32:52.274
Uh, starting with a fingertip on the wall, but moving away from that.
00:32:52.574 --> 00:32:58.824
But at the same time, maybe someone needs to go from holding dancer pose to touching the floor and coming back up, right?
00:32:58.834 --> 00:33:05.074
So let's think about how we could also progress our balance poses and just our asana as in, as well.
00:33:05.374 --> 00:33:11.674
And I know that might rub some people the wrong way, the idea of progressing and regressing, and I totally get you.
00:33:11.974 --> 00:33:20.824
But I'm thinking about it purely not like this is better, that is worse, but really purely from a physical capability point of view.
00:33:21.124 --> 00:33:33.324
And knowing that physical capability can lead to those better quality of life markers that we're talking about, like reducing your risk of falls And something I always like to say is notice the wobble.
00:33:33.384 --> 00:33:35.574
And like the wobble is the balance.
00:33:35.874 --> 00:33:38.894
If you're wobbling, that doesn't mean you're doing it badly.
00:33:38.903 --> 00:33:41.554
Y- your body is doing what it's supposed to be doing.
00:33:41.854 --> 00:33:44.284
And don't worry, you're not the only one feeling wobbly.
00:33:44.324 --> 00:33:45.074
We all are.
00:33:45.374 --> 00:33:53.224
So in summary of today's episode, a few things that we've touched on is first of all, that balance is not one thing.
00:33:53.334 --> 00:34:02.734
It's a dynamic process and it emerges from sensory information, motor responses, cognition, the task, and the environment.
00:34:03.034 --> 00:34:46.014
Balance does on average decline with age, but there's a lot that we can do to change that, and a lot of balance actually remains trainable Though it's difficult to say yet whether yoga and particularly just holding tree pose will reduce falls, though we probably can't say that based on the evidence, we do know that exercise programs in general containing challenging balance and functional exercise can reduce falls And if nothing else, I hope you've maybe l- you're leaving today's episode thinking, Maybe I'll, I'll explore some different ways of looking at balance and actually moving well in balance." And if you want to explore it more, you can check out the Enlightened Yoga Collective.
00:34:46.063 --> 00:34:58.983
Members receive facts to share with clients, a practical teacher cheat sheet on all this stuff that we've been talking about, class themes and progressions, balance sequences, and a full asana class.
00:34:59.284 --> 00:35:02.083
So just check out the links in the show notes.
00:35:02.204 --> 00:35:07.733
And with that, we will conclude, and I hope you have found this interesting.
00:35:07.744 --> 00:35:14.163
Like I said from the beginning, I learned a lot while doing the research on this and it was different to what I expected to learn.
00:35:14.463 --> 00:35:23.844
And I'll probably stop saying a couple things, and I'm gonna add a few things into my own teaching So keep questioning, keep learning, and I'll see you next time.
00:35:27.344 --> 00:35:30.793
Thank you for listening to the Enlightened Anatomy Podcast.
00:35:31.384 --> 00:35:35.203
We would be grateful if you would leave a review and a five-star rating.
00:35:35.963 --> 00:35:42.353
Be sure to tune in next time for more science-based knowledge to get enlightened and help others
00:00:00.299 --> 00:00:04.389
Hello and welcome to episode 19 of the Enlightened Anatomy Podcast.
00:00:04.690 --> 00:00:08.300
And this week we're looking at balance.
00:00:08.470 --> 00:00:11.539
So balance poses, balance training.
00:00:11.839 --> 00:00:13.060
Does it help people?
00:00:13.070 --> 00:00:14.429
Does it prevent falls?
00:00:14.730 --> 00:00:18.250
All of these questions and more in today's episode.
00:00:18.250 --> 00:00:19.250
So it's a good one.
00:00:19.350 --> 00:00:52.881
Stay tuned and cue the intro music so we often say things in yoga like, you know, yoga is good for improving balance, and I've definitely said that.
00:00:53.182 --> 00:00:58.432
I've said that during our Physiology of Yoga eight-week course.
00:00:58.462 --> 00:01:02.021
I've said it when I've taught the anatomy on a yoga teacher training.
00:01:02.322 --> 00:01:03.171
But does it actually?
00:01:03.421 --> 00:01:06.691
I've actually never looked into the research until now.
00:01:06.992 --> 00:01:18.561
And the reason I started looking into this is because our online community for yoga teachers, the Enlightened Yoga Collective, has a monthly inspiration, and this month, August 2026, it's all about balance.
00:01:18.861 --> 00:01:23.742
So I actually looked at the research, and it was fascinating, and I learned a lot.
00:01:23.762 --> 00:01:40.802
Um, and contrary to what we might think or hope there was some really interesting research about Iyengar yoga and the people who did Iyengar yoga in this specific study and whether they had a decreased or increased fall rate.
00:01:40.802 --> 00:01:43.031
So we'll get into that a little bit later.
00:01:43.072 --> 00:01:47.441
But first, just wanted to explore what questions we're gonna be looking at today.
00:01:47.561 --> 00:01:51.772
So we're going to be exploring, first of all, what do we actually mean by balance?
00:01:52.072 --> 00:01:54.272
And it might be different to what you actually think.
00:01:54.572 --> 00:01:57.682
Does balance inevitably decline with age?
00:01:57.932 --> 00:02:00.331
Is balance actually important for younger people?
00:02:00.331 --> 00:02:04.501
Because we often talk about it in relation to older people, but what about young people too?
00:02:04.802 --> 00:02:08.512
And does improving balance reduce falls?
00:02:08.641 --> 00:02:12.562
Now, that is an important thing, and that is two different things, as we'll learn.
00:02:12.861 --> 00:02:15.342
So has yoga been shown to improve balance?
00:02:15.372 --> 00:02:18.042
H- has what I've said actually been justified?
00:02:18.342 --> 00:02:20.981
And what kinds of balance training actually work?
00:02:21.282 --> 00:02:30.262
Finally, we will think about how to apply this to our yoga practice and especially as yoga teachers, how to apply it into our classes.
00:02:30.562 --> 00:02:31.731
So let's begin.
00:02:32.032 --> 00:02:34.912
First of all, that Iyengar yoga study.
00:02:35.211 --> 00:02:48.002
So this large trial of seven hundred people, published in 2025, but actually they did the work of it during COVID, and so that was why they did o- online yoga.
00:02:48.301 --> 00:02:53.342
They had seven hundred volunteers divided into two groups randomly.
00:02:53.352 --> 00:02:58.282
So this is a randomized controlled trial, which is, you could say the highest level of evidence.
00:02:58.581 --> 00:03:06.322
And half of the people did an online Iyengar yoga program, and the other half did a seated meditation.
00:03:06.622 --> 00:03:12.972
So that would be the control group, and it's, it's an active control, which is better than just people doing nothing.
00:03:13.271 --> 00:03:16.032
So a seated meditation, at least they're doing something, and we can compare.
00:03:16.331 --> 00:03:28.711
And- As most of us would hope, I think, you would expect the Iyengar yoga group, and, you know, I don't think this is specific to Iyengar, but just in general yoga, you would think, you would hope people would have fewer falls as a result.
00:03:29.012 --> 00:03:31.912
It was actually the opposite in this specific study.
00:03:32.211 --> 00:03:38.361
So the Iyengar yoga group, and these people were followed for a whole year, which is actually a good amount of time for a study.
00:03:38.662 --> 00:03:42.641
The Iyengar yoga group actually had a 33% higher fall rate.
00:03:42.651 --> 00:03:43.901
Now, I know that sounds horrible, right?
00:03:43.901 --> 00:03:54.262
But don't be disconcerted because there are lots of factors that go into this, and what this definitely does not mean is that yoga causes falls or, you know, we should all stop our yoga practice.
00:03:54.562 --> 00:04:00.352
And in fact, I'm gonna get into evidence later about how useful exercise is for reducing falls.
00:04:00.352 --> 00:04:07.872
But in this specific study, and remember, this is why it's important to look at the whole body of evidence, not just one individual study.
00:04:08.171 --> 00:04:12.931
But in this specific study, they did find that those people had a higher incidence fall rates.
00:04:12.951 --> 00:04:14.542
Maybe it was a, an outlier.
00:04:14.592 --> 00:04:15.442
Maybe it was a one-off.
00:04:15.472 --> 00:04:20.062
This is why the same study should be repeated and see, do they get the same result?
00:04:20.362 --> 00:04:23.422
And, the participants did that one specific style of yoga.
00:04:23.422 --> 00:04:25.752
Would it be the same if they did a different style of yoga?
00:04:26.052 --> 00:04:29.072
Would it be different if they did different balance poses?
00:04:29.072 --> 00:04:35.831
So in this study they primarily did tree pose as their balance pose, and then there were other standing poses also.
00:04:35.862 --> 00:04:39.942
But nonetheless, already I think it's good to have this information.
00:04:39.961 --> 00:04:48.382
Let's not discard it'cause it's very easy to say,"I don't like that information'cause it goes against my beliefs that yoga is good for everything." So still, let's keep this information.
00:04:48.411 --> 00:04:56.141
Let's be good critical thinkers and say,"Okay, I'm gonna incorporate that knowledge and also look at the wider body of knowledge" which is what we're gonna do today.
00:04:56.442 --> 00:05:03.411
So let's start by looking at first, you know, what is balance, and I think most people would probably say balancing on one leg," right?
00:05:03.711 --> 00:05:05.122
But it's actually more than that.
00:05:05.422 --> 00:05:14.362
A classic textbook definition is keeping the body's center of mass over its base of support.
00:05:14.661 --> 00:05:16.041
It's a nice simple definition.
00:05:16.062 --> 00:05:18.531
Now, your base of support can change.
00:05:18.831 --> 00:05:21.622
It could be two feet, okay?
00:05:21.922 --> 00:05:24.771
Two feet parallel hip distance apart, which would be what?
00:05:24.882 --> 00:05:26.091
Tadasana pose, right?
00:05:26.391 --> 00:05:27.882
But then it could also be one foot.
00:05:27.911 --> 00:05:35.401
That's just a different base of support, and the fewer bases of support you have, the more difficult balance becomes.
00:05:35.701 --> 00:05:41.471
Similarly, the closer, the smaller the base of support, so if you bring your feet closer together, that will be harder.
00:05:41.771 --> 00:05:47.201
Or if you bring one foot in front of the other, that will be harder than having your feet wider apart.
00:05:47.232 --> 00:05:55.812
And in fact, people who tend to have bad balance tend to have their feet a little bit wider because they tend to feel more stable in that wider base of support.
00:05:55.872 --> 00:06:00.401
But your base of support could also be two hands, which is of course a handstand.
00:06:00.701 --> 00:06:06.132
Your base of support could be one hand and the outer edge of one foot, which would be side plank.
00:06:06.411 --> 00:06:06.732
Yeah?
00:06:06.831 --> 00:06:11.721
So balance is not just being on one foot, though of course y- you know, that's often what we think of.
00:06:12.021 --> 00:06:30.322
But it's basically being able to balance out all of the opposing forces on the body, gravity pulling you down to the center of the earth forward forces if you're leaning forward, backwards forces, side to side, balancing of all of those out so that you can remain over your center, over your base of support.
00:06:30.622 --> 00:06:33.711
And this is an I think this is an interesting little thing.
00:06:34.012 --> 00:06:35.521
There is a cone of balance.
00:06:35.531 --> 00:06:39.711
So if you think about your base of support, and let's, let's just think about tree pose to make it really simple.
00:06:40.012 --> 00:06:48.502
Your base of support is one foot, and then there's a cone of balance inside which your center of mass can be, and you can be in balance.
00:06:48.802 --> 00:06:51.322
So your center of mass can shift over to the side.
00:06:51.322 --> 00:06:53.851
So if you shift your hips over to the side, you'll still be in balance.
00:06:54.081 --> 00:06:57.021
Hopefully, as long as you're inside that cone, and then the other side.
00:06:57.291 --> 00:07:04.982
But there is some point outside that cone where no matter what, if your center of mass is outside that cone, you have to fall.
00:07:04.982 --> 00:07:05.411
You will fall.
00:07:05.411 --> 00:07:06.541
That's simple physics.
00:07:06.641 --> 00:07:20.851
But also what's interesting is that cone of balance can increase with training, and it tends to decrease as we get older or if we detrain, if we don't train, if we don't exercise, if we don't move.
00:07:21.151 --> 00:07:23.122
So that's a little aside.
00:07:23.322 --> 00:07:39.651
Another thing to bear in mind about balance is it's not just purely a mechanical thing like, like I described, but actually it is a constantly changing interaction of your nervous system, your body, the task that you're doing, and actually also your environment.
00:07:39.672 --> 00:07:42.851
'Cause if there's a strong gust of wind that will affect your balance.
00:07:43.151 --> 00:07:45.812
So there are two important elements to balance.
00:07:45.841 --> 00:07:55.291
There is the sensory information that we receive, and then there is the muscular output that your brain gives in order to maintain your balance.
00:07:55.591 --> 00:07:58.411
So vision is important in our balance.
00:07:58.502 --> 00:08:07.031
We are sensing where our horizon is, and we'll notice with our vision if our horizon goes off to the side because that means our head is tilting to the side.
00:08:07.331 --> 00:08:14.221
We have the vestibular system, which is located in the inner ear, and this is really fascinating, I think.
00:08:14.521 --> 00:08:21.291
There are these donut-shaped structures inside your inner ear, and they don't really have anything to do with hearing.
00:08:21.291 --> 00:08:26.541
So we think of inner ear as having to do with the ear and hearing, but they're kind of separate to that.
00:08:26.581 --> 00:08:28.581
That's just hap- where they happen to be located.
00:08:28.882 --> 00:08:32.902
But you have these donut-shaped structures filled with a small amount of fluid.
00:08:33.201 --> 00:08:42.022
And so if you imagine you tilt the donut structure to the side, then the fluid will drain to one part of the donut.
00:08:42.322 --> 00:08:48.062
And then we have sensors all throughout the inner ear which are sensing where that fluid is moving.
00:08:48.361 --> 00:08:51.621
And so that sensory information will be sent to the brain.
00:08:51.922 --> 00:09:10.192
And so for an issue like vertigo, where someone feels dizzy, there might be a problem with that information being sent to the brain or it being processed inside the brain We also receive sensory information from joints, so what you know of as, as proprioception.
00:09:10.201 --> 00:09:12.672
Like, you can tell if your head is leaning to one side.
00:09:12.971 --> 00:09:15.981
You can tell if your arm is lifted up, if your knee is bending.
00:09:16.282 --> 00:09:23.731
We also can sense our muscles, and I think this is really interesting, skin also plays an important role in balance.
00:09:23.741 --> 00:09:29.111
So you can feel if wind or air is brushing across your skin and you know, oh, I'm falling.
00:09:29.412 --> 00:09:41.412
Now, all of those things taken together, the brain will synthesize that information and say,"I am in balance," or,"I am out of balance." And then it will choose what it does next.
00:09:41.711 --> 00:09:44.032
And your brain is just an incredible thing, right?
00:09:44.081 --> 00:09:50.241
Um, another thing is that it will not rely equally on those three systems.
00:09:50.542 --> 00:09:57.451
So for example, standing on a firm floor in good lighting differs from standing on soft ground in darkness.
00:09:57.501 --> 00:10:13.851
And so your brain will choose to prioritize, uh, the visual information, visual feedback, in a well-lit room on a hard surface, versus it'll choose to increase the proprioceptive information that it receives if you're in a darker room.
00:10:14.042 --> 00:10:18.261
Again, balance is, I'm hoping you're, you're starting to realize, a, a very complex thing.
00:10:18.392 --> 00:10:27.251
It's more than just a mechanical thing and more than just one system involved Now that your brain has that information, it decides what to do with it.
00:10:27.552 --> 00:10:49.581
So your brain can send motor signals down to muscles to produce muscular force, to contract muscles, um, to increase joint stiffness, to move its center of mass, to change your posture, to take a recovery step if needed, to reach for support, all of these different things that we know that we tend to do when we feel like we're losing our balance.
00:10:49.881 --> 00:10:59.692
Now a little task I like to do when teaching anatomy on a teacher training is for everyone to stand up and to balance on one foot, and then to look down at that foot.
00:10:59.741 --> 00:11:15.091
And so as long as you're not driving, I encourage you to do this, or the next time you're at home with no socks and shorts on, lift one foot and look at all the muscles that are engaging and the tendons that you'll see moving underneath your skin to maintain your balance.
00:11:15.392 --> 00:11:30.802
As a matter of fact, your foot is a bit like a puppet, and the puppet masters which control your foot, they have these strings, so the tendons, which originate on the foot or even beneath the foot and go all the way up the sides and the front of the calf.
00:11:31.101 --> 00:11:34.302
And then the puppet masters are at the top of the calf.
00:11:34.601 --> 00:11:43.731
So your evertors and invertors like the tibialis anterior, your plantar flexors, dorsiflexors, they are moving, pulling up and down to keep your foot in balance.
00:11:44.032 --> 00:11:51.621
And so when you look at your foot while you're trying to balance on one foot, you will see that balance is not a passive thing.
00:11:51.841 --> 00:11:53.381
It is constant movement.
00:11:53.682 --> 00:11:55.111
It is a constant wobble.
00:11:55.142 --> 00:11:57.412
It's a constant shifting right and left.
00:11:57.711 --> 00:12:01.792
And what's incredible is we don't even have to think about that consciously at all.
00:12:01.792 --> 00:12:06.011
It's all just happening Now, factors can influence our balance.
00:12:06.022 --> 00:12:08.392
So these include our strength and power.
00:12:08.692 --> 00:12:12.511
So It's one thing to sense that you are out of balance.
00:12:12.511 --> 00:12:17.621
It, it's another thing to have that muscular strength to be able to pull yourself back into balance.
00:12:17.922 --> 00:12:27.902
Certain really important muscles in one-legged balance are all around the shin, like I was mentioning, those tibialis anterior muscles, the fibularis muscles.
00:12:28.201 --> 00:12:33.032
And then also muscles higher up into the hip, particularly as you bend forward.
00:12:33.182 --> 00:12:46.591
So muscles involved in balancing Warrior III are gonna be high up in the hip versus being vertically stacked like in tree pose are gonna be further down on the ankle and the calf And so if you have stronger muscles to begin with, they'll be able to engage.
00:12:46.601 --> 00:12:51.751
And also power refers to how quickly a muscle can engage, how quickly it can produce force.
00:12:51.822 --> 00:12:55.631
So if you can do those more quickly, then theoretically your balance will be better.
00:12:55.932 --> 00:13:01.282
But also what matters is your reaction time, your attention, and your cognitive load.
00:13:01.292 --> 00:13:06.111
So something I'm always talking about in balance in a yoga class is to focus.
00:13:06.412 --> 00:13:09.721
Focus on one point, but also to focus on the thing that we're doing.
00:13:10.022 --> 00:13:16.981
And I almost feel like I can see when people's thoughts shift and they start thinking about something else, and then their balance wobbles.
00:13:17.042 --> 00:13:17.902
Now it could be something else.
00:13:17.902 --> 00:13:23.851
It could be a muscle thing, but I often see there's like a shift of the eye or something, and then boom, they lose their balance.
00:13:24.152 --> 00:13:29.272
Um, also cognitive load, so if you're carrying a lot cognitively, in your mind, that will also affect your balance.
00:13:29.572 --> 00:13:31.792
Confidence and fear affect your balance.
00:13:32.091 --> 00:13:38.991
I was just in the States visiting family, and I was there with my mom, who's in her 70s now, towards her late 70s.
00:13:39.292 --> 00:13:45.241
We were walking on a little beach towards a lake, and she had her arm in mine.
00:13:45.542 --> 00:13:54.782
And as we were getting to a place with an uneven terrain and sand, I could feel her grip on my arm get really tight.
00:13:55.081 --> 00:13:57.692
And so she had a decreased confidence.
00:13:57.701 --> 00:14:05.412
Now, that could actually be a useful thing because it tells your body, your brain is saying,"Okay, I need to be more alert now.
00:14:05.701 --> 00:14:08.042
There, you know, this is a less safe terrain.
00:14:08.042 --> 00:14:09.841
I need to be more careful." That could be a positive thing.
00:14:10.142 --> 00:14:13.542
But also, as we know with fear, we can over-engage.
00:14:13.542 --> 00:14:14.341
We can tighten up.
00:14:14.371 --> 00:14:16.142
We can take smaller steps.
00:14:16.142 --> 00:14:19.471
We can do things that actually might not help our balance.
00:14:19.772 --> 00:14:38.261
So confidence and fear do play a role in balance, both in a good and potentially a, a, a less helpful way Also things like fatigue, pain, medication, previous injury, and also the environment, like I said before, like a gust of wind or the terrain that you're on will all affect your balance.
00:14:38.562 --> 00:14:49.211
So the take-home message for this little segment on the introduction is basically balance is not one single system, but it's lots of things involved, both sensory and motor.
00:14:49.511 --> 00:14:51.322
There are also different types of balance.
00:14:51.471 --> 00:14:54.511
There is static or steady state balance.
00:14:54.812 --> 00:15:02.111
So this is quite often what we focus on in yoga, put your foot on your thigh in tree pose, look forward, don't move.
00:15:03.032 --> 00:15:03.282
Right?
00:15:03.328 --> 00:15:07.769
That is one way of doing balance, and if you do that, you'll probably get better at doing that thing.
00:15:07.769 --> 00:15:08.548
But that's only one way.
00:15:08.849 --> 00:15:12.859
There's also dynamic balance, which is controlling the body while it's moving.
00:15:13.158 --> 00:15:16.979
So instead of just holding the pose, going into a pose and coming out of it.
00:15:16.989 --> 00:15:21.798
So for example, going into half moon and then coming back up to tree pose.
00:15:22.099 --> 00:15:32.349
That works a different type of balance There is proactive or anticipatory balance where you are preparing f- for a predictable movement that will disturb your balance.
00:15:32.649 --> 00:15:40.308
So if you think about throwing a baseball or throwing something and you know you're gonna be stepping onto one foot, so you can expect that.
00:15:40.318 --> 00:15:46.849
That is predictive balance And then there's also reactive balance, which is responding to an unexpected disturbance.
00:15:46.849 --> 00:15:52.359
If that's bumping into a pole, someone accidentally pushing you or purposefully pushing you, hopefully not.
00:15:52.658 --> 00:15:57.788
But anyway, y- th- y- your balance can be disturbed, and how good is your reaction to that balance?
00:15:57.798 --> 00:15:59.899
So all of these are different elements of balance.
00:16:00.068 --> 00:16:03.568
There's not just one thing of do this one thing and you'll get better at all of them.
00:16:03.869 --> 00:16:07.058
Each one will probably improve based on w- how you do it.
00:16:07.359 --> 00:16:15.369
And then there's also what's called functional balance, which is a, a, a bit of a vague term, but it's things that are more tied to specific things that you would do in your life.
00:16:15.609 --> 00:16:27.109
For example, if you need to step over a bathtub to get into a shower, that i- then that movement would be considered a functional movement So now onto the question of does balance decline with age?
00:16:27.408 --> 00:16:30.178
And, on average, the sad answer is yes.
00:16:30.479 --> 00:16:39.938
I know it can be a bit depressing talking about aging and hearing about things, and as someone who is now closer to 50 than 40, I, I'm starting to think about my later life.
00:16:40.239 --> 00:16:42.489
And, and the reality is we are all aging.
00:16:42.769 --> 00:16:58.668
We are all a day closer to, to our grave, And I know that can sound a bit depressing, but while we're on the topic, you know, there are some interesting yoga texts that talk about how coming to terms with death actually can help, uh, liberate us in life.
00:16:58.969 --> 00:17:05.138
So again, that's a bit of an aside, but nonetheless, we are on this, this steady path towards death.
00:17:05.439 --> 00:17:07.689
Nice and enlightening podcast episode for you here, isn't it?
00:17:07.989 --> 00:17:09.778
But the good news is you're still alive.
00:17:10.865 --> 00:17:11.005
You know?
00:17:11.169 --> 00:17:19.169
Let's celebrate the fact that we are still here, and I'm grateful that I'm close to, closer to 50 and I'm still here, I'm still kicking.
00:17:19.179 --> 00:17:20.449
I'm still doing yoga.
00:17:20.749 --> 00:17:26.679
And I hope to have all the problems that come with being a 100-year-old and that I'm still alive then.
00:17:26.699 --> 00:17:28.509
I know I've said that in a previous podcast episode.
00:17:28.509 --> 00:17:34.429
But anyway, yes, balance does decline with age is the point, I guess, that I was going to get to.
00:17:34.699 --> 00:17:43.128
But there's a lot that we can do to help slow it down and actually maybe even reverse it if you're someone who hasn't done balance training.
00:17:43.429 --> 00:17:52.778
You know, possible factors that affect- whether or why balance changes with age, uh, has to do with changes in vision'cause vision is an important part.
00:17:53.078 --> 00:17:57.669
Reduced vestibular function, so that inner ear donut thing I was talking about.
00:17:57.969 --> 00:18:02.219
Lower muscle strength and power, and that's something that we can control, as we know.
00:18:02.519 --> 00:18:03.989
Slower reactions.
00:18:04.288 --> 00:18:10.588
So there are some adaptations that happen with the nervous system when you start training and when you start training for quicker movement.
00:18:10.598 --> 00:18:15.848
So that can be trained also, so don't think,"Oh, it's just, uh, all downhill from here." No.
00:18:16.148 --> 00:18:20.739
Uh, reduced physical activity, again, a thing that we can change, can-- thing that we can influence.
00:18:21.038 --> 00:18:25.219
Medication and health conditions, now, you know, that, that's just part of life, innit?
00:18:25.519 --> 00:18:30.548
And greater difficulty dividing attention between movement and another task.
00:18:30.548 --> 00:18:30.929
Okay?
00:18:31.229 --> 00:18:35.009
That's another factor But let's not catastrophize here, okay?
00:18:35.308 --> 00:18:39.499
So age-related changes are normal and, and they are real, yeah?
00:18:39.798 --> 00:18:41.588
But it is not a cliff edge.
00:18:41.628 --> 00:18:46.368
It is not, as soon as you get to a, a certain age it's all boom, it's all going to pot.
00:18:46.669 --> 00:18:56.598
A- and actually physical activity and exercise and practice can meaningfully improve balance in older adults, and that's supported by the literature.
00:18:56.898 --> 00:19:01.669
And also, as you kn- probably know, people of the same age can vary enormously.
00:19:01.969 --> 00:19:08.499
Y- I'm sure you can think of an 85-year-old with great balance and then a 60-year-old who, uh, has, has poor balance.
00:19:08.798 --> 00:19:10.368
So y- th- there's...
00:19:10.419 --> 00:19:18.479
We've also seen examples of people in their 80s and 90s with great muscle mass, people in their 20s with very little muscle mass.
00:19:18.778 --> 00:19:22.189
So a lot of it comes down to what we do with our bodies.
00:19:22.489 --> 00:19:27.759
As I mentioned, balance is also important for younger people It's not just a senior's disease.
00:19:28.058 --> 00:19:53.509
So young people need balance to run and change direction, land from a jump, play sports, dance respond to physical contact, navigate uneven ter- everything that adults do and older adults do And interestingly, 2018 systematic review evidence has found that balance training produces moderate to large improvements in static and dynamic balance in younger people.
00:19:53.808 --> 00:20:05.739
So the effects are not just restricted to older adults And really good news another systematic review suggests balance and neuromuscular programs can reduce ankle sprains, particularly in sporting populations.
00:20:05.749 --> 00:20:10.338
So another reason that more than just older adults need to be doing balance training.
00:20:10.638 --> 00:20:13.409
Which brings us to the question of, does balance training work?
00:20:13.509 --> 00:20:16.058
And the research actually does say it does work.
00:20:16.358 --> 00:20:20.118
And as I'm gonna get to shortly, that might be a little bit different to falls, okay?
00:20:20.169 --> 00:20:36.919
But several reviews have found that in both healthy older adults and adults with health conditions, balance training improves static balance, dynamic balance, like I mentioned earlier, proactive and reactive balance And it seems the more you do it, the better, to some degree.
00:20:37.219 --> 00:20:41.308
So based on the research, 11 to 12 weeks of training.
00:20:41.608 --> 00:20:43.919
Is much better than just a couple of weeks.
00:20:44.219 --> 00:20:54.038
And doing it three times per week, so three sessions of balance training yields better results than just one per week, which does not tend to have meaningful results.
00:20:54.338 --> 00:21:04.338
Also, sessions should be, according to this research, around 30, 30 to 45 minutes, and if it's more than 60 minutes, you're not getting any more benefit out of it.
00:21:04.638 --> 00:21:12.338
You know, this doesn't mean you need to drop everything and, you know, we've always got this benefit-cost analysis.
00:21:12.638 --> 00:21:13.769
You can't do everything in the world.
00:21:13.769 --> 00:21:15.959
You can't do every single exercise.
00:21:16.108 --> 00:21:19.028
You can't do every single self-care treatment.
00:21:19.148 --> 00:21:22.989
You can't be taking a bath and relaxing while also going out for a run, you know?
00:21:23.219 --> 00:21:31.808
So we always have this cost-benefit analysis, and so we're, remember in research, we're just looking at one specific question, what is the dosage?
00:21:31.838 --> 00:21:33.288
How much has to be done?
00:21:33.588 --> 00:23:03.639
And these systematic reviews have found that information about the 11 to 12 weeks of training and doing it three times per week.
00:23:03.659 --> 00:23:06.109
That's gonna be more beneficial than doing it once per week.
00:23:06.409 --> 00:23:11.479
I think where this all keeps pointing to is the value of moving and of not just sitting down, right?
00:23:11.778 --> 00:23:20.129
Of going to yoga classes and going to your exercise classes and everything else But what the research also points to is specificity.
00:23:20.429 --> 00:23:24.479
So if you do static balance, you will get better at static balance.
00:23:24.479 --> 00:23:48.669
If you do dynamic balance, you'll get better at dynamic balance And so if you generally wanted to help someone with a very specific task, like I want you to be able to comfortably step over the bathtub to get into your shower, then doing things that involve that would be really useful, like stepping over yoga bricks, considering the sensory, mechanical, and cognitive demands of that task, and getting away from holding onto the wall.
00:23:48.839 --> 00:24:02.549
As useful as touching a wall can be or having support from the wall or support from a chair, and as useful as chair yoga can be, nothing will be as good for balance as just letting go of that thing and trying to balance on your own.
00:24:02.849 --> 00:24:13.099
Which brings us to one of our last segments and, you know, ties back into that initial Iyengar study with the question, you know, does actually improving balance prevent falls?
00:24:13.399 --> 00:24:21.798
And incredibly, falls, as in slips, trips and falls, are the number one cause of accidental death of people over 65.
00:24:21.818 --> 00:24:30.044
And just last year I lost my own aunt as a result of a fall where she was alone in her house going to the kitchen in the middle of the night.
00:24:30.054 --> 00:24:34.148
So, if we can decrease fall rates, it's gonna be really beneficial...
00:24:34.448 --> 00:24:37.948
so let's look at what the research says So just to be clear, there is...
00:24:37.958 --> 00:24:38.788
two different things, right?
00:24:38.798 --> 00:24:41.858
There's improved balance test performance.
00:24:42.158 --> 00:24:45.948
Like, it's one thing to have someone do dancer pose, right?
00:24:46.248 --> 00:24:47.828
And then measure them.
00:24:47.878 --> 00:24:50.298
Let's do this little study where someone does dancer pose.
00:24:50.298 --> 00:24:58.718
We measure how long they can do it for, and then we have them do dancer pose three times a week, uh, you know, in, as part of a yoga program, and we measure it 12 weeks later.
00:24:58.928 --> 00:25:00.807
They will probably get better at dancer pose.
00:25:01.088 --> 00:25:03.628
Like, that's pretty much guaranteed, and that's what the research supports.
00:25:03.928 --> 00:25:05.698
So balance makes you better at balance, right?
00:25:05.968 --> 00:25:10.748
But do improved balance test scores actually translate to decreased falls?
00:25:10.898 --> 00:25:12.678
Let's finally get to the punchline.
00:25:12.688 --> 00:25:14.928
Let's get to the point of this podcast episode.
00:25:15.228 --> 00:25:18.978
And the question is, you know, can we actually reduce our fall risk?
00:25:19.038 --> 00:25:29.768
Because that's ultimately what can lead to problems both, you know, if you're an older adult, but also just, falls are what cause injury, wh- when you land on your elbow, when you land on your hand, right?
00:25:30.148 --> 00:25:35.168
So if you've listened to podcasts with me or done a course with me, you would know there are different levels of evidence.
00:25:35.418 --> 00:25:43.038
The systematic review is considered the highest level of evidence, and even within systematic reviews, there are still different levels of quality.
00:25:43.338 --> 00:25:46.948
There's one by the Cochrane Library, the Cochrane Reviews.
00:25:47.248 --> 00:25:56.057
Cochrane Reviews have a reputation of being the most rigorous, and they tend to come with the most conservative conclusions, right?
00:25:56.288 --> 00:26:09.688
So they tend to be more cautious in saying,"This treatment," whether it's a drug or, you know, a, a, a movement modality like yoga,"this thing will do that effect, will have that effect." They tend to be more conservative.
00:26:09.988 --> 00:26:16.018
And here is what their 2019 review, Sherrington et al., concluded.
00:26:16.318 --> 00:26:35.268
They looked at, first of all, exercise in general for older adults, and they found that exercise reduced the rate of falls in older community-dwelling adults, as in people who are still living in private homes, living with their families, living on their own, not in nursing homes.
00:26:35.568 --> 00:26:39.178
Exercise reduced the rate of falls by approximately 23%, right?
00:26:39.208 --> 00:26:48.368
So we can pretty confidently say that if you exercise and if you move in lots of different ways, you probably will reduce your risk of falls.
00:26:48.668 --> 00:26:49.888
That's a relative risk.
00:26:50.188 --> 00:27:06.228
And they also looked at more specific balance training and, quote-unquote,"functional exercise," finding that balance and functional exercises reduced the rate of falls by approximately 24%, so really not much more.
00:27:06.528 --> 00:27:08.278
So- What does this all mean?
00:27:08.288 --> 00:27:16.208
Maybe we don't need to be looking specifically at balance, and when we look at balance, maybe we should look at it in a slightly different way.
00:27:16.508 --> 00:27:32.868
And that review also found some characteristics of promising programs, which included that, number one, balance is sufficiently challenged, that exercise is progressive, as in it, it's not just the same thing every single day, but it becomes harder.
00:27:32.898 --> 00:27:34.598
You do more challenging things.
00:27:34.618 --> 00:27:36.628
You work to build more strength.
00:27:36.928 --> 00:27:49.468
Functional movements are included, so things that are-- you find in your everyday life, again, like stepping over the tub or reaching across while balancing on one foot, if that's something you do, which most of us tend to at some point.
00:27:49.768 --> 00:27:51.128
You know, reaching into your car.
00:27:51.428 --> 00:27:59.138
Also promising aspects are when strength is included where appropriate, practice is repeated consistently.
00:27:59.438 --> 00:28:04.528
So, you know, it's not like you can do all your exercise in one week and then rest the rest of the year.
00:28:04.568 --> 00:28:07.218
No, we need to keep at it week in, week out.
00:28:07.518 --> 00:28:12.268
And the overall amount or dose is sufficient, right?
00:28:12.318 --> 00:28:14.268
So it's not just a little bit here and there.
00:28:14.568 --> 00:28:19.008
Balancing on one foot while brushing your teeth two minutes a day might not be enough.
00:28:19.307 --> 00:28:33.557
And also another authority for guidance is the World Health Organization, which looks at all of the evidence and comes up with guidelines as they have, for example, for physical activity, 150 minutes plus two days of strength training every week.
00:28:33.568 --> 00:28:38.758
That is the standard guidelines that a lot of countries have then adopted from the World Health Organization.
00:28:38.788 --> 00:28:47.458
And what they say specifically is adults aged 65 plus should undertake varied multi-component physical activity.
00:28:47.758 --> 00:28:57.826
So multi-component refers to components like balance, strength, aerobic activity, and also functional movement such as stepping, turning, and getting up from a chair.
00:28:57.836 --> 00:29:00.167
I think those are quite good guidelines.
00:29:00.467 --> 00:29:07.137
And the World Health Organization also recommends doing this on three or more days per week.
00:29:07.437 --> 00:29:11.957
And so this is broader than simply practicing static balance poses.
00:29:12.257 --> 00:29:16.097
And into our, our last two segments, you know, does yoga actually improve balance?
00:29:16.137 --> 00:29:20.687
And then what should we be doing differently in our yoga practice, if anything?
00:29:21.864 --> 00:29:32.334
In answer to the question, yeah, yoga probably does improve balance to some degree But the certainty and the practical application of the evidence varies.
00:29:32.634 --> 00:29:40.403
A 2016 systematic review looked at six trials that involved yoga, and so there were 307 participants.
00:29:40.403 --> 00:29:42.394
So remember, this is before the Iyengar study.
00:29:42.694 --> 00:29:47.034
And they concluded that yoga produced a small improvement in balance.
00:29:47.114 --> 00:29:47.534
Okay?
00:29:47.754 --> 00:30:11.624
And they also f- determined that yoga produced a medium improvement, so better than just a small improvement, in physical mobility, which is also important as we get older, the ability to bend down, pick something up, or to squat down and get something from the lower cupboard But the researchers explicitly stated that it was unclear whether these improvements translated into fewer falls And as you all know, there's so many different styles of yoga.
00:30:11.924 --> 00:30:14.153
People do yoga at different frequencies.
00:30:14.454 --> 00:30:15.794
Class lengths can vary.
00:30:15.944 --> 00:30:19.274
And then even within the research, there are different balance tests.
00:30:19.294 --> 00:30:27.544
And quite often yoga studies can be quite small, and it can even be difficult to identify which element of yoga is responsible.
00:30:27.594 --> 00:30:39.153
Is it the one-legged balance, which seems the most obvious, or is it actually the combination of the one-legged with the two-legged balances, w- with the arm balances you know, like with a side plank or a crow?
00:30:39.454 --> 00:30:42.694
There are plausible reasons that yoga could help balance, you know?
00:30:42.694 --> 00:30:55.494
Like repeated one-legged standing, narrow base of support, shifting the center of mass and all that stuff But I think we need to be a little bit cautious to say that yoga will definitely prevent falls at this point.
00:30:55.794 --> 00:31:06.124
And as for what we might do differently, first of all, I don't think it's for me to tell you how to change your yoga practice or to how to teach differently.
00:31:06.424 --> 00:31:07.484
That that's up to you.
00:31:07.634 --> 00:31:10.214
And you might love your practice just as it is.
00:31:10.514 --> 00:31:26.634
However, if you would like to try some different things, and based on everything that we've explored today, here are a few things that you could add in to your yoga practice/yoga teaching So of course, we're already holding poses statically in yoga, you know, balance poses.
00:31:26.934 --> 00:31:32.153
We already have that nailed, but what about trying something like reaching during a balance pose?
00:31:32.163 --> 00:31:34.214
Reaching over to the right side, reaching to the left side.
00:31:34.514 --> 00:31:41.014
Transitioning between poses rather than just holding that pose, going in and out of it, especially between balance poses.
00:31:41.014 --> 00:31:42.284
That could be really challenging.
00:31:42.584 --> 00:31:43.854
Maybe adding a step.
00:31:44.153 --> 00:31:49.194
So stepping forward, sideways, or even diagonally into a pose and then out of it.
00:31:49.494 --> 00:31:51.464
Another element may be turning.
00:31:51.614 --> 00:31:54.574
So you could first look in different directions.
00:31:54.584 --> 00:31:59.934
You can change that sensory information, but you could also turn your entire body while in a balanced pose.
00:31:59.934 --> 00:32:08.624
This could be something that could make it a little bit more similar to what, how balance happens in real life And maybe playing a game of following a verbal directional cue.
00:32:08.624 --> 00:32:12.744
So with that reach, for example, maybe people could reach forward or reach sideways.
00:32:13.044 --> 00:32:13.354
I don't know.
00:32:13.374 --> 00:32:15.504
You might think,"No, that doesn't sound like yoga to me.
00:32:15.534 --> 00:32:27.334
I don't wanna do this at all." Or you might think,"Okay, maybe I'll try one or two of those." And I created an asana class and excerpts with three of those inside the Enlightened Yoga Collective.
00:32:27.344 --> 00:32:31.014
So if you're interested and want to see how I would do it, you can check out that.
00:32:31.314 --> 00:32:35.413
Also, we don't talk about progressive changes in yoga very often.
00:32:35.413 --> 00:32:38.034
We just do one thing and then keep doing that same thing, I think.
00:32:38.334 --> 00:32:49.403
But y- For someone with very poor balance, just having feet closer together would be the starting point, or maybe one foot in front of the other, what's called tandem standing could be a starting point.
00:32:49.704 --> 00:32:52.274
Uh, starting with a fingertip on the wall, but moving away from that.
00:32:52.574 --> 00:32:58.824
But at the same time, maybe someone needs to go from holding dancer pose to touching the floor and coming back up, right?
00:32:58.834 --> 00:33:05.074
So let's think about how we could also progress our balance poses and just our asana as in, as well.
00:33:05.374 --> 00:33:11.674
And I know that might rub some people the wrong way, the idea of progressing and regressing, and I totally get you.
00:33:11.974 --> 00:33:20.824
But I'm thinking about it purely not like this is better, that is worse, but really purely from a physical capability point of view.
00:33:21.124 --> 00:33:33.324
And knowing that physical capability can lead to those better quality of life markers that we're talking about, like reducing your risk of falls And something I always like to say is notice the wobble.
00:33:33.384 --> 00:33:35.574
And like the wobble is the balance.
00:33:35.874 --> 00:33:38.894
If you're wobbling, that doesn't mean you're doing it badly.
00:33:38.903 --> 00:33:41.554
Y- your body is doing what it's supposed to be doing.
00:33:41.854 --> 00:33:44.284
And don't worry, you're not the only one feeling wobbly.
00:33:44.324 --> 00:33:45.074
We all are.
00:33:45.374 --> 00:33:53.224
So in summary of today's episode, a few things that we've touched on is first of all, that balance is not one thing.
00:33:53.334 --> 00:34:02.734
It's a dynamic process and it emerges from sensory information, motor responses, cognition, the task, and the environment.
00:34:03.034 --> 00:34:46.014
Balance does on average decline with age, but there's a lot that we can do to change that, and a lot of balance actually remains trainable Though it's difficult to say yet whether yoga and particularly just holding tree pose will reduce falls, though we probably can't say that based on the evidence, we do know that exercise programs in general containing challenging balance and functional exercise can reduce falls And if nothing else, I hope you've maybe l- you're leaving today's episode thinking, Maybe I'll, I'll explore some different ways of looking at balance and actually moving well in balance." And if you want to explore it more, you can check out the Enlightened Yoga Collective.
00:34:46.063 --> 00:34:58.983
Members receive facts to share with clients, a practical teacher cheat sheet on all this stuff that we've been talking about, class themes and progressions, balance sequences, and a full asana class.
00:34:59.284 --> 00:35:02.083
So just check out the links in the show notes.
00:35:02.204 --> 00:35:07.733
And with that, we will conclude, and I hope you have found this interesting.
00:35:07.744 --> 00:35:14.163
Like I said from the beginning, I learned a lot while doing the research on this and it was different to what I expected to learn.
00:35:14.463 --> 00:35:23.844
And I'll probably stop saying a couple things, and I'm gonna add a few things into my own teaching So keep questioning, keep learning, and I'll see you next time.
00:35:27.344 --> 00:35:30.793
Thank you for listening to the Enlightened Anatomy Podcast.
00:35:31.384 --> 00:35:35.203
We would be grateful if you would leave a review and a five-star rating.
00:35:35.963 --> 00:35:42.353
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