The Power of Tandem Balance and Tandem Walking

Ever felt wobbly just standing still? Imagine walking heel-to-toe on a tightrope, even just one foot above the ground—does that sound absolutely terrifying to you? You aren’t alone.

Balance issues can start creeping up as early as our 50s, long before most of us expect them. (1) But there’s good news—you can improve your balance with some simple yet powerful exercises. Let’s dive into two specific balance exercises, static tandem balance and tandem walking, and how these exercises can help you maintain your balance, improve athleticism, and prevent falls and injuries as you age.

What is Static Tandem Balance (Sharpened Romberg)?

Static tandem balance, also known as the Sharpened Romberg, is when you stand still in a heel-to-toe position. It is a valuable assessment and training tool for those seeking to improve their balance. This position challenges your balance by narrowing your base of support, and forces your body to rely more on internal balance mechanisms rather than using compensation strategies to find balance.

Studies have shown that static tandem balance tests can effectively identify balance impairments that might not be evident during other balance tests.​ (2, 3) For instance, the Sharpened Romberg Test, a common static tandem balance test, is sensitive enough to detect subtle balance issues even in individuals who appear to have normal balance during other activities. (4) Additionally, the inability to hold a tandem stance for at least 10 seconds can indicate that an assistive device (cane, walker, rollator) may be needed in the very near future to prevent falling. (5)

Regularly practicing static balance exercises, especially tandem balancing, can significantly improve your overall balance, coordination, and stability. These exercises train your brain and muscles to work together more effectively, enhancing your ability to maintain equilibrium in various situations. Not only that, but as you master static tandem balancing, you can build into performing the more difficult and functional exercise called a tandem walk.

What is Tandem Walking (Heel-to-toe Walking)?

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While static tandem balance provides a solid foundation, and can even potentially help avoid the need for assistive devices, tandem walking takes it a step further by incorporating dynamic movement. After all, we don’t spend our lives standing in one place, thus we should always aim to train with movement when possible. Tandem walking involves walking heel-to-toe in a straight line, much like walking on a tightrope, but on the ground. This exercise challenges your stability, coordination, and proprioception (our bodies ability to sense our joint position in space), making it a reliable indicator of your overall balance ability.

Uncovering Compensation Patterns with Tandem Walking

At its core, tandem walking is about showing stability in an extreme walking position. By narrowing our base of support, it forces us to recruit more physical and mental resources to balance. With each step, we must delicately shift our weight, engage our muscles, and adjust our posture to prevent toppling over. It’s a symphony of muscles with your brain as the conductor undergoing the ultimate “everyday” balance test in my opinion.

You might be wondering, “Why is this important?” After all, you don’t walk heel-to-toe in the grocery store. The simple answer is, tandem walking exposes underlying balance issues and compensations for poor balance that might not be apparent during normal walking.

When you walk normally, you probably don’t notice your balance too much. If you make it from point A to point B, your balance is good, right? Not necessarily. The body is a master of compensation and covering up balance deficits, even if you don’t consciously recognize any imbalance.

Common compensations I often see while working with clients include:

• Widening of feet - Wide base of support

• Shuffling of feet - Lack of foot clearing the floor

• Veering to one side - Often lack of balance on the opposite side of veering

• Fast walking - Avoiding the need to balance by subtly falling forward to the next foot in controlled manner

• Waddling - Usually demonstrating underlying hip issues in regards to stability

• Outstretched arms - May be subtle, and demonstrates need for counterbalancing (Think a child learning to walk)

• Feeling of your feet “sticking to the ground” - Inability to lift feet for clearance of floor, similar to shuffling

Once you attempt to tandem walk in a straight line with good form, those pesky balance deficits no longer have a place to hide. It’s the ultimate test to see if your balance is up to snuff for normal activities. Your performance will tell you the truth.

Testing the Bodily Balance Systems and Functional Movement with Tandem Walks

Balance isn't just about physical prowess; it's also about sensory integration (successfully using all information from your surroundings) in the brain. Our ability to maintain equilibrium relies on a complex interplay of proprioception, vision, and the vestibular system—the three bodily balance systems responsible for keeping us upright and steady. Tandem walking, with its advanced variations, puts these sensory systems to the test, requiring us to finely tune our body's position based on the feedback we receive internally and externally.

In addition to testing sensory integration, tandem walking also serves as a functional movement assessment. It challenges our balance not only while standing still but also while moving with purpose and poise. Whether we're navigating crowded sidewalks or hiking rugged trails, our ability to maintain equilibrium in dynamic environments is essential. Tandem walking offers a glimpse into our capacity to execute functional movements safely and effectively. By simulating an extreme version of a real-life scenario (walking), it provides valuable insights into how we fare when our balance system is pushed to the edge.

This is even more true when performing advanced variations of tandem walking. These advanced variations can include: rotating the head side to side, nodding the head up and down, carrying objects in both hands, carrying objects in one hand, stepping over objects, holding a conversation at various levels, performing high level mental tasks. All of these variations add elements of real-world tasks to an otherwise controlled exercise. Often, balance can be challenged significantly when attempting to dual-task (perform two actions at once, otherwise known as multi-tasking), and thus must be trained as such if possible for greatest benefits. (6, 7, 8)

Using Tandem Walking to Assess Fall Risk

For many, the fear of falling looms large, particularly as we age. Falls can have devastating consequences, both physically and emotionally, making fall prevention a top priority. Tandem walking serves as a valuable tool in assessing fall risk, as research has shown a clear correlation between impaired balance and an increased likelihood of falls. (9, 10)

Due to the difficult nature of tandem walking it is a useful test to assess parts of a person’s balance ability. (11) Despite this, no standardized scores have been published in the research as of yet. I personally, have my patients and clients attempt to walk 10-20 feet in a controlled manner to establish baseline ability. While performing the test, it is best to look out for any compensations and any deviation from good posture and controlled steps.

Why Static and Dynamic Balance Practice Matter

1. Preventing Falls and Overall Injury Prevention: Regular balance training reduces the risk of falls by improving your ability to recover from trips and stumbles​. Older adults who regularly practice static balance exercises, as well as a well rounded exercise routine, showed significant improvements in balance and a reduced risk of falls. (12, 13)

2. Enhancing Athletic Performance: Better balance can lead to improved performance in sports and physical activities by allowing you to move more efficiently and with greater control​ while reducing some aspects of injury risk. (14)

3. Promoting Healthy Aging: Maintaining good balance can help you stay active and independent as you age, reducing the risk of injury and improving your overall quality of life​​. One study found that older adults who engaged in regular balance training were more likely to maintain their stability and even help cognitive functions. (15)

Real-Life Examples From the Clinic

Meet Linda

For HIPPA reasons, this picture is not actually Linda.

Linda is a former patient of mine. She was a 60-year-old grandmother when we first met, and she noticed she was becoming more unsteady on her feet during typical activities around the house. After a minor fall while gardening, she decided to take action and come work with me. Linda showed ok balance, but struggled to stand for more than 5 seconds in a tandem balance position. After explaining to Linda that this may mean a cane or walker in her near future, she refused to accept that fate.

Linda started practicing static tandem balance exercises every day for at least 10 minutes. Within a few weeks, she noticed a significant improvement in her stability and was able to hold the tandem position for 45 seconds! She felt like a new woman and reported, "I feel more confident and steady, even when playing with my grandkids,".

Meet David

For HIPPA reasons, this picture is not actually David.

Consider David, another former patient of mine. He was a 70-year-old avid hiker who found his balance deteriorating on the mountains, making his favorite trails more challenging. After a few near falls and slips on his favorite trail, he knew something was off. After coming to see me, we discovered he would hold standing balance exercises well, but fell apart with movement.

After incorporating tandem walking exercises into his daily workout routine for a month, he experienced significant improvements. At his one month follow-up appointment he said, "I feel more stable and confident on uneven terrain, and my hiking ability is back to normal.".

Practical Tips for Incorporating Tandem Balance Exercises into Your Routine:

1. Start Slow: Begin with static tandem balance exercises. Stand heel-to-toe for a few seconds at a time, gradually increasing the duration as you become more comfortable. Aim for at least 30 seconds of controlled standing on both sides before progressing to harder exercises.

2. Add Variations: Once you’ve mastered static tandem balance, try tandem walking. Walk heel-to-toe in a straight line, focusing on maintaining a steady gait.

3. Use Props: Use a narrow beam (advanced) or a line on the floor (beginner) as a guide for your tandem walking. This helps keep you on track and provides a visual cue for alignment. Beams and other implements may also increase the challenge.

4. Incorporate Balance into Daily Activities: Practice standing in a tandem position while brushing your teeth or waiting in line. These small efforts add up over time.

5. Challenge Yourself: As your balance improves, try closing your eyes or turning your head while maintaining your tandem stance or walk. This engages your sensory systems even more and may imitate real life scenarios in busy environments.

6. Stay Consistent: Like any exercise, consistency is key. Aim to practice your balance exercises several times a week for the best results.

7. Seek Professional Guidance: If you’re unsure where to start or have specific balance concerns, consider consulting a physical therapist or coach who specializes in balance and stability training. Here at Science of Falling we provide coaching that is tailored to you in order to help you age well and live life to the fullest.

Wrap-Up

Maintaining good balance is a lifelong journey, and it's never too early or too late to start. By making tandem walking and static tandem balance exercises a regular part of your routine, you can enjoy improved stability, reduced fall risk, and enhanced overall well-being. These exercises, while deceptively simple, play a crucial role in assessing and improving balance. They enhance stability, sensory integration, and core strength, offering a holistic approach to maintaining and improving balance as we age. So, stand tall, walk that line, and take confident strides toward a more balanced future. To get more guidance, check out the SoF Beginner to Intermediate Balance Program and take the first step towards better balance today.

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References

1. Hall KS, Cohen HJ, Pieper CF, et al. Physical performance across the adult life span: correlates with age and physical activity. the Journals of Gerontology Series a, Biological Sciences and Medical Sciences. June 2016:glw120. doi:10.1093/gerona/glw120

2. Briggs RC, Gossman MR, Birch R, Drews JE, Shaddeau SA. Balance performance among noninstitutionalized elderly women. Physical Therapy. 1989;69(9):748-756. doi:10.1093/ptj/69.9.748

3. Sharpened Romberg. Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/sharpened-romberg. Published May 25, 2013.

4. Gras LZ, Pohl PS, Epidy J, Godin B, Hoessle N. Use of the sharpened romberg as a screening for fall risk. Topics in Geriatric Rehabilitation. 2017;33(2):113-117. doi:10.1097/tgr.0000000000000145

5. Joo B, Marquez JL, Osmotherly PG. Ten-Second Tandem Stance Test: a potential tool to assist walking aid prescription and falls risk in balance impaired individuals. Archives of Rehabilitation Research and Clinical Translation. 2022;4(1):100173. doi:10.1016/j.arrct.2021.100173

6. Hiyamizu M, Morioka S, Shomoto K, Shimada T. Effects of dual task balance training on dual task performance in elderly people: a randomized controlled trial. Clinical Rehabilitation. 2011;26(1):58-67. doi:10.1177/0269215510394222

7. Wollesen B, Schulz S, Seydell L, Delbaere K. Does dual task training improve walking performance of older adults with concern of falling? BMC Geriatrics. 2017;17(1). doi:10.1186/s12877-017-0610-5

8. Khan MJ, Kannan P, Wong TWL, Fong KNK, Winser SJ. A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults. International Journal of Environmental  Research and Public Health/International Journal of Environmental Research and Public Health. 2022;19(24):16890. doi:10.3390/ijerph192416890

9. Cho BL, Scarpace D, Alexander NB. Tests of stepping as indicators of mobility, balance, and fall risk in Balance‐Impaired older adults. Journal of the American Geriatrics Society. 2004;52(7):1168-1173. doi:10.1111/j.1532-5415.2004.52317.x

10. Muir SW, Berg K, Chesworth B, Klar N, Speechley M. Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. Journal of Clinical Epidemiology. 2010;63(4):389-406. doi:10.1016/j.jclinepi.2009.06.010

11. Widiastuti HP, Pamungkas L, Arsyawina A, Hilda H. Tandem walking exercise for the risk of falling and the Daily and Activities’ Independency toward Elderly Preopleat UPT PSTW Nirwana Puri Samarinda. Journal of Nursing Practice. 2021;5(1):155-161. doi:10.30994/jnp.v5i1.166

12. Sherrington C, Fairhall N, Wallbank G, et al. Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. British Journal of Sports Medicine. 2019;54(15):885-891. doi:10.1136/bjsports-2019-101512

13. Sadaqa M, Németh Z, Makai A, Prémusz V, Hock M. Effectiveness of exercise interventions on fall prevention in ambulatory community-dwelling older adults: a systematic review with narrative synthesis. Frontiers in Public Health. 2023;11. doi:10.3389/fpubh.2023.1209319

14. Brachman A, Kamieniarz A, Michalska J, Pawłowski M, Słomka KJ, Juras G. Balance Training Programs in Athletes – A Systematic review. Journal of Human Kinetics. 2017;58(1):45-64. doi:10.1515/hukin-2017-0088

15. Dunsky A. The Effect of Balance and Coordination Exercises on Quality of Life in Older Adults: A Mini-Review. Frontiers in Aging Neuroscience. 2019;11. doi:10.3389/fnagi.2019.00318

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A no equipment balance program that will take you from ground zero to single leg balance hero.

This program has been designed for in-home balance training with no equipment needed. Those who may benefit from this program include anyone who is currently unable to maintain double-legged standing, currently using assistive devices, has occasional trips and stumbles, and able to balance fairly well but wants to refine and master single leg balance positions.

By the end of this program you will have improved balance, stability, body awareness, more confidence in your body, and less fear of falling.