Balance and Stability Exercises during Menopause
Menopause is a natural phase in every woman's life, often marked by a variety of physical and emotional changes. While most people are aware of common symptoms like hot flashes and weight gain, fewer women realize that menopause can also impact balance and stability which can be an unexpected and challenging aspect of aging. It is well-known that both muscle mass and strength decline with age which can contribute to balance impairments.
Balance issues can affect your normal daily routine, from walking around your home to exercising and playing sports. Understanding the connection between menopause and balance is important for managing these changes and maintaining a high quality of life as we age. I went into a deep dive looking at the current research on menopause and balance. Most of it was focused on falls and osteoporosis, but I did my best on weeding through it all to summarize what we should be focusing on when it comes to balance as we get older.
In this blog, I will discuss how hormonal shifts during menopause can influence balance and stability, how to test your balance, and share recommendations and exercises to improve your balance. And, the great news is that no matter how old you are, you can improve your balance with exercises.
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What is Balance?
Let’s first define what balance is. Balance is the ability to control your body in space, distributing your weight evenly in a way that allows you to remain upright. There are 2 types of balance: static and dynamic balance. Both are important.
Static balance is the ability to maintain the body’s center of mass within its base of support.
Dynamic balance is the ability to move outside the body’s base of support while maintaining posture control. Both types are essential, and you can improve both with specific exercises.
The Connection Between Menopause and Balance
During menopause and aging, the significant decrease in estrogen leads to physiological changes that affect balance and increase the risk of falls and injuries. Here's how these changes contribute to balance:
Bone Density and Muscle Strength: Estrogen maintains bone density and muscle strength, crucial for balance. Its decline during menopause results in weaker bones (osteoporosis) and muscles, increasing fracture and fall risk.
Joint Health: Estrogen plays a role in joint health. Reduced levels can lead to joint stiffness and pain, further impairing mobility and stability.
Vestibular System:The vestibular system in the inner ear helps regulate balance. These vestibular nerve endings tend to degenerate over time, leading to dizziness and a sense of unsteadiness.
Proprioception: This is the body's ability to sense its position in space. Estrogen deficiency can impair proprioception, making it harder to stay balanced and coordinated.
Understanding the Impact of Menopause on Balance and Fall Risk
Postural control and balance rely on the cooperation of the neural and musculoskeletal systems. The proprioceptive, visual, and vestibular systems send information to the brain, which then triggers the right muscle responses in the trunk and lower body. However, these systems tend to weaken over time.
Declining estrogen during perimenopause and menopause leads to muscle loss and impaired balance, increasing fall risk. This systematic review and meta-analysis evaluated different exercise interventions impact on balance. It also demonstrated that static and dynamic balance are important indicators of fall risk and fracture susceptibility in postmenopausal women, even more so than bone density.
Research shows that balance exercises, whole-body vibration, and resistance training all improved balance, although the most effective approach still remains unclear. Aerobic exercise alone did not improve balance. However, core stability does play a key role in dynamic balance. This study found that as core stability decreases, dynamic balance gets worse. This suggests that strengthening the core is also important for maintaining balance.
Importance of Single Leg Balance
Balance problems are associated with risk of falls and fall related injuries in older adults. Therefore, the ability to balance on 1 leg with no assistance is crucial. Many activities in our daily life require standing on 1 leg, including walking. For example, you spend about 40% of the time with one foot in the air when walking, while the other 60% is spent with both feet on the ground. You are most vulnerable to lose your balance during that single leg stance part of the gait pattern. Other examples of when you use single leg balance are running, going up and down stairs, putting on pants while getting dressed, getting in and out of a car, and playing sports.
How to Test Your Balance
The most common and easiest balance test to do is called the Single Leg Stance (SLS) Test and is used to assess static postural and balance control. I use this test in my physical therapy practice everyday. This test will quantify balance status for those who are at increased risks for fall.
How to Perform The Single Leg Stance Balance Test:
This test is performed barefoot, so take off your shoes and socks. Stand near a sturdy surface like a kitchen counter.
With eyes open and hands on your hips in order to prevent using your arms for balance.
Stand on one leg unassisted. Start the timer when the opposite foot leaves the ground. Time stops when the opposite foot touches the ground or when hands leave the hips.
Record the length of time you can maintain balance on 1 leg. Perform 3 times with the eyes open. Take the average of 3 times, or the best time.
Repeat on the opposite leg.
If you can balance for >30 seconds successfully, try it with your eyes closed.
You can compare your time to the following generally accepted normal values for various ages listed below. If unable to SLS with eyes open for at least 5 seconds, there is a greater risk of injury from a fall.
40-49 years-old (eyes open): 40 seconds
40-49 years-old (eyes closed): 7 seconds
50-59 years-old (eyes open): 37 seconds
50-59 years-old (eyes closed): 4.8 seconds
60-69 years-old (eyes open): 26.9 seconds
60-69 years-old (eyes closed): 2.8 seconds
70-79 years-old (eyes open): 18.3 seconds
70-79 years-old (eyes closed): 2 seconds
JUST FOR FUN:
If you already know you have good balance, here is a fun and challenging test to try called The Old (Wo)man’s Balance Test.
11 Exercises to Improve Your Balance During Menopause:
Everyone can benefit from balance training, no matter their age. Balance training creates muscular balance, improves neuromuscular coordination by getting the brain to talk to the muscles, and teaches your body to use your core muscles for stabilization. Give these exercises a try in the order they are listed, as they progress from easier to more advanced.
Single leg stance balancing: Stand on one leg when you brush your teeth. Balance for 30 seconds to 1 minute on each leg. Try to keep your hips level and not to side bend too much. If this is easy, try it with your eyes closed.
Tandem Stance: Place one foot directly in front of the other in a straight line like you are on a balance beam. You can hover your hands over the sturdy surface for balance support if needed.
Tandem Stance with Head Movements: Repeat the exercise above, but now slowly turn your head left to right. And, then up and down. Repeat 5-10 times.
Heel Toe Walking: Imagine you’re walking on a tightrope placing your feet in a perfectly straight line, heel to toe. Try taking 10 steps forward then backwards without looking down.
Leg Swings: Stand on one leg and slowly swing the other leg forward and back with control up to 10 reps. If you find this easy, try turning your head gently from side to side.
Hip Abduction in Standing: One factor that can contribute to decreased single leg balance is weakness in the hip abductor muscles. This exercise is designed to help strengthen them. Stand on one leg near a stable surface and bring the opposite leg to your side without holding on. Repeat on opposite side for 10 reps.
Banded 3-Way Toe Taps: Put a resistance band around your ankles, keep your knees slightly bent, engage your core and hips muscles. then tap your leg forward, to the side, and straight behind you. Do 10-20 reps per side.
Single Leg Pallof Press: This exercise is more advanced and focuses on core muscle activation. Research has shown that weak core muscles can contribute to balance issues. Have a band anchored to something stable and then stand far enough away from it where you feel tension on the band making you try to resist rotating your body. Move your arms in and out. 10 times.
Single-Leg Deadlift: Start with feet hip-width apart. Balance on one leg with the knee slightly bent. Maintain a straight back and hinge from the hips while reaching forward with both arms extending toward the floor. Return to standing position. Repeat 10 times on each leg.
Toe Yoga: Yup, I am talking about your toes and feet here. Feet are a very important element to stability and balance. Try these toe yoga exercises. And, while standing, I want you to think of your feet as having 4 corners - the base of your big toe and pinky toe and the inside and outside of your heel. Each corner needs to be firmly rooted into the ground and then separate your toes. Practice doing this barefoot while standing on one leg.
Foam Roller: Spinal alignment is key when it comes to balance and stability. This exercise will help improve thoracic extension, especially since most of us are constantly looking down at our phones or laptops. Use a 36-inch foam roller (or a rolled-up beach towel) on the floor. Lie on it lengthwise so your head, spine, and tailbone touch the roller, but not your neck or low back. Bend your knees with your arms outstretched to your sides. Lie there for 2 minutes, allowing gravity to pull your shoulder blades down on either side.You can then roll back and forth between your shoulder blades for another 1-2 minutes.
*If you suffer from dizziness or have any health concerns, please consult a medical professional before trying any new exercise.
8 Preventive Strategies to Maintain and Improve Balance and Stability During Menopause and Midlife
Understanding Hormonal Changes: Recognize how the decrease in estrogen and other hormones affects bone density, muscle strength, and the vestibular system, contributing to balance issues.
Exercise and Physical Activity: Make sure you are engaging in regular exercises that enhance balance, such as balance training (see examples above), stretching, pilates, yoga, tai chi, and strength training. These activities help maintain muscle strength, improve coordination, and reduce the risk of falls.
Posture & Core Exercises: Good posture and a strong core are vital for balance. Posture exercises help align your body and maintain your balance. Core exercises strengthen your abdomen and lower back, enhancing stability. Together, they improve coordination and help prevent falls, ensuring better balance in daily activities. Pilates is a great exercise option that focuses on this.
Diet and Nutrition: A balanced diet rich in calcium and vitamin D supports bone health, while staying hydrated can help prevent dizziness.
Lifestyle Adjustments: Make necessary adjustments to your lifestyle, such as wearing proper footwear, ensuring a safe home environment- free of clutter on the floor, managing stress, and prioritizing good sleep.
Footwear and Assistive Devices: Wearing proper shoes with good support and using assistive devices (if needed) like canes or walkers can help prevent falls.
Seek Professional Help: Consult a healthcare professional if you have significant balance issues.Treatments like physical therapy and hormone replacement therapy (HRT) can be very beneficial.
Menopause brings about numerous physical and emotional changes, and one of the often-overlooked aspects is its impact on balance and stability. Developing good balance helps to improve your overall health and fitness, as well as reducing your risk of falls and injuries - ensuring that you stay active, independent and doing the things you love. If you wish to work with a physical therapist, please reach out to me.
I offer physical therapy solutions and coaching for women in midlife and can help you with balance, strength training, building a healthy lifestyle, and addressing any aches and pains. Contact me to work together.
Next on your reading list:
Solutions for Joint and Muscle Pains During Midlife and Menopause
HIIT Workouts for Menopause: High Intensity Interval Training During Menopause and Beyond
Meal Planning for Menopausal Women: Integrating Nutrition and Exercise for Lasting Results
Additional Resources
If you are looking for more information, here are some reputable resources to help you navigate menopause and manage balance and stability issues effectively:
North American Menopause Society (NAMS): Provides comprehensive information on menopause, including symptoms, treatment options, and health resources.
National Osteoporosis Foundation (NOF): Offers resources on maintaining bone health, preventing fractures, and managing osteoporosis.
Research Articles