A measure of balance

Balance is something you take for granted until it fails you. If stumbles have become more frequent, even if you’ve escaped with only a jolt of adrenaline or a minor knee scrape, they could be a wake-up call that your balancing skills need attention.

“As you age, balance becomes even more essential, and you should approach it like any other part of your fitness,” says Kaitlyn Buckwell, a strength and conditioning specialist with the Center for Sports Performance and Research at Harvard-affiliated Mass General Brigham. “Strong balancing skills not only can protect you from falling, but they can also reduce the likelihood of a severe injury if you do.”

Four-stage balance test

How can you tell if your balance is unbalanced? Take the four-stage balance test, a simple baseline assessment used by physical and occupational therapists to evaluate balance and an individual’s risk of falling.

The test measures how long you can stand in a series of positions. Each stance is harder than the one before.

“The goal is to maintain balance for at least 10 seconds without needing support before advancing to the next stance,” says Buckwell.

Perform the tests barefoot, keeping your arms at your sides or extended out, and your gaze straight ahead. “Do them near a wall, chair, or another person in case you do lose your balance,” says Buckwell.

Side-by-side. Stand on a flat surface with your feet positioned next to each other so they touch. Hold the position without moving your feet.

Semi-tandem. Place the instep of the arch of one foot so it’s next to and touching the big toe of the other foot. Hold the position without moving your feet. Switch foot positions and repeat.

Tandem. Place one foot in front of the other, so the heel and toes touch. Hold the position without moving your feet. Switch foot positions and repeat.

Single-leg. Stand with your feet hip-width apart, hands on your hips. Lift one foot off the floor to about mid-calf height. Hold this position for 10 seconds, or until the raised foot touches the ground or you lose your balance. Switch foot positions and repeat.

What do the results mean? If you can’t hold the tandem or single-leg for 10 seconds (or if you can’t progress to the tandem stance at all), you are at high risk of falling, and you should see a physical therapist for further evaluation, according to Buckwell. “They can help you improve your balance through exercises that increase joint stability, mobility, and strength.”

Advanced balance tests

Even if you easily pass the four-stage balance test, your balancing skills still may need attention. “More advanced tests can gauge your balance and coordination during everyday movements, when you are most likely to stumble or fall,” says Buckwell.

Here are three tests she recommends. “All these tests also act as balancing exercises. Practicing them regularly not only helps monitor your balance skills, but also improves them.”

Single-leg variations. Variations of the single-leg test are a good measure of overall balance and can assess how well you maintain stability on a single support. “One-leg standing — that is, shifting most of your weight to one leg — is something we do every day, although we may not notice it, such as when we’re walking, stepping off a curb, or climbing stairs,” says Buckwell.

Retake the single-leg test on each leg, only this time hold the pose for as long as possible. In general, adults ages 65 and older should aim for 10 to 30 seconds. “Being able to stand on one foot for close to 30 seconds is a sign of good balance,” says Buckwell.

Be aware that the balancing times may vary slightly between the right and left legs. “We often have a dominant leg just like a dominant hand, so you may find that one leg is weaker than the other and can’t hold the balance as long,” says Buckwell. “This can help identify if you have a muscle imbalance that needs attention.”

If you can hold the pose for longer than 30 seconds, make it more challenging. For instance, close your eyes while holding the pose, stand on a foam pad instead of the floor, or reach for an object on a nearby table or on the floor.

Heel-to-toe walking. This test gauges your balance, coordination, and body awareness as you walk. Assume the tandem standing position: one foot in front of the other, the heel and toes touching, arms to the sides or extended out. Gazing straight ahead, walk heel-to-toe as if you’re on a tightrope for 10 steps, then turn around and walk back to the starting point. The goal is to complete the test in 20 seconds or less. “Slower times may indicate a lack of balance and increased risk of falls,” says Buckwell.

Timed up and go (TUG). TUG assesses functional mobility and fall risk. From a seated position, stand and walk in a straight line at a normal pace for 10 feet, turn around, walk back, and sit down. “Generally, you want to complete the test in 12 seconds or less,” says Buckwell. “Times over 12 seconds may indicate a higher risk for falls.”

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