Balance Training for Injury Recovery and Performance

Tips and Guidance for Dance Students

Balance training is about more than maintaining and improving your balance and proprioception. It can also be used as a tool to help recover from injury or improve performance.

We have worked with the medical team at The Royal Ballet School on this guide which brings you tips and guidance on balance training and how it can be used as one element in a regime for rehabilitation or performance optimisation.

The guide will cover:

Balance and Your Body
Foot Intrinsic Preparation
Positions of The Foot and Ankle - Dorsiflexion and Plantar Flexion
Somatosensory Input and Plantar Stimulation
Pro Tip: Fatigue and Cognitive Additions - Dual Tasking
Practical Demonstration – Video Guide

While this guide is aimed at and has obvious applications for dance students, it is also applicable to a wide range of other sports and physical activities so is well worth a look.

You should note that the below is for guidance, if you have an injury or niggle, you should always see a medical professional to address it or for advice on injury prevention.

Balance and Your Body:

It’s important to understand how your body controls balance, which is the ability to maintain the body’s equilibrium. This becomes important when recovering from an injury or looking at optimising performance.

There are three major inputs to balance, these are:

Vision
The vestibular system (found in the inner ear, it controls head position and our ability to perceive what is vertical)
Proprioception (the position of the body with respect to a support surface)

Changing any one of these inputs can help us train the balance system efficiently.

While improving your balance can help stabilise your body and make it more steady when moving, below we will be looking at tips for balance training to aid in recovering after injury and improving your artistic or athletic performance.

1. Foot Intrinsic Preparation:

Intrinsic foot muscles help stabilise the foot during postural tasks. Their principal physical function is to provide foot stability and flexibility for shock absorption, improve dynamic balance, alignment, stiffen the foot arches and stimulate proprioceptors on the sole of the feet.

There is emerging evidence that good intrinsic foot muscle function improves the postural stability, balance control of the lower limbs. Indeed a study by Zhen Wei et al found that training the intrinsic foot muscles can, among other things, improve postural balance as part of sports training sessions for people who enjoy activity through sports. This has obvious implications for dance students.

Exercise Tip:

The Royal Ballet School way encourages preparation before commencing balance tasks, starting with non-weight bearing exercises first to help activate these muscles. Foot intrinsics is seen as an essential part of activating these muscles ahead of starting balance training.

Resistance Bands and Soft Over Balls can be used as tools when doing non-weight bearing foot intrinsic muscle exercises to enhance them as demonstrated in the below video guide.

2. Positions of Foot and Ankle - Dorsiflexion and Plantar Flexion:

It’s important to train the foot and ankle for balance in different positions and angles. Most balance exercises can start in a neutral position (foot flat on the floor).

However changing the range from neutral to having the ankle at deep angles (near to full foot pointe and full knee over toe) is essential to aiding balance and proprioception because we become less aware of where our joint is in space at these angles.

Exercise Tip:

When recovering from injury, transitioning foot intrinsic exercises from non-weight bearing to weight bearing exercises is important to avoid further injury. It can also help move your performance training up a level.

As shown in the below video guide, The Royal Ballet School will begin to train the ankle at different angles. Starting intrinsic standing exercises with feet on the floor, doming or arching the toes on what will be the standing leg and then lifting and holding the other leg in the air before lowering again. They gradually increase the challenge of this exercise by raising the heel off the floor using a Foam Wedge.

3. Somatosensory Input and Plantar Stimulation:

Research shows that somatosensory input (increasing sensory information into the foot/ankle) contributes to a large proportion of the sensory system in controlling posture and balance. The foot directly interfaces with the ground, and somatosensory information from plantar surface benefits postural control.

Evidence is growing of the importance of this in patients that have recurrent ankle sprains. An article by Xiaomei Hu et al found that information from the plantar surface can change the ankle’s proprioception, enhance joint position allowing for faster and more accurate responses. This in turn can be important in avoiding injuries from sports or activities.

For the purpose of optimising performance, adding this extra challenge can help increase ankle stability and control of your balance.

Exercise Tip:

Exercises that challenge when standing as well as changing direction, like those demonstrated in the below video guide, make use of tools such as Balance Pads and Balance Pod Domes to provide an alternative stimulus and unstable surface for the foot to work on, therefore providing more information into the balance systems and challenging proprioception and helping towards improving balance.

Pro Tip: Fatigue and Cognitive Additions - Dual Tasking:

In the final stages of returning from injury, or when considering higher level performance tasks, thinking about training your balance either under fatigue or adding a cognitive (thinking) stimulus is essential. When adding a cognitive stimulus, we would call this dual tasking.

This involves completing a balance task, such as standing on one leg, possibly on a different foam surface, but then adding tasks like counting back from 100 in 7’s or reciting a list (items you would find in a post office for example) to stimulate the cognitive element of rehab or performance enhancement.

You could also use a ball like a Reaction Ball by bouncing it on the floor and trying to catch it in whatever direction it decides to go to increase the difficulty level if trying to increase performance levels.

Practical Demonstration – Video Guide:

In the below video guide Physiotherapist, Wayne Kitchner and Pilates Instructor, Leire Ortueta from The Royal Ballet School are joined by student, Jules Chastre in showing some balance training techniques he used when coming back from an ankle injury.

This video guide gives a practical demonstration of the various exercises mentioned in tips 1-3 above. We would advise that you don’t attempt these exercises without a medical professional present to guide and assist you.

Sources and References:

Zhen Wei, Ziwei Zeng, Min Liu, Lin Wang (2022). Effect of intrinsic foot muscles training on foot function and dynamic postural balance: A systematic review and meta-analysis. National Library of Medicine. Available at [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020712/]

Xiaomei Hu, Jingjing Liao, Xiaoyue Hu, Ziwei Zeng, Lin Wang (2023). Effects of plantar-sensory treatments on postural control in chronic ankle instability: A systematic review and meta-analysis. National Library of Medicine. Available at [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10298754/]