When I am helping someone improve their balance after a stroke there is a process that I go through to look at several different aspects of a person. That is because to be balanced when you are upright and moving around, there are many requirements that have to be met; as well as many things going on at once. When I help someone improve their balance after a stroke, one of the things I assess is their strength. Strength isn’t just about muscle—it's also about how well your brain and nerves communicate with those muscles. And without enough strength, your body struggles to make the quick adjustments needed to keep you upright and balanced.
One requirement that is needed for a person to make all the necessary adjustments in the body to stay upright and balanced is strength. A person needs adequate strength throughout the body to make those adjustments. Many times people think that only strength in the legs is necessary. But, the movements we make in our trunk and the adjustments we make in our arms also help in maintaining our balance.
A simple way to look at strength is that there is a nerve component and a muscle component. The muscles are the things that we think of when we think of getting stronger. You might be imagining a muscle getting bigger (the medical term for that is hypertrophy). That is part of what happens when increasing strength.
Then there is the nerve part of strengthening. Many people think of strength as just a muscle issue, but after a stroke, it's just as much about retraining the brain. Your brain has to relearn how to send strong, coordinated signals to your muscles. That’s why strengthening after a stroke isn’t just about lifting weights—it’s about improving the way your brain, nerves, and muscles work together. A simple way to think about the nervous system in relation to strengthening is this: The brain makes a signal for a body part to move (Knee straighten), then it sends the signal along nerves to the muscles that straighten the knee (those front thigh muscles called the quads), when the signal gets to the end of the nerve it sends a message to the muscle fibers to contract and…your knee straightens. When you do this against a resistance that is a challenge for the muscle, the muscle grows larger and gets stronger.
Also, there is a timing and coordination of how much signal the brain should send to get a response and how fast to get the movement you intend to produce- straightening the knee against the resistance. I am going to refer to this as neuromuscular strengthening.
For a stroke survivor, it is not simple to work on increasing your strength. There are issues stroke survivors have that make it more difficult. One issue can be that The brain may not be able to make the signal to the muscle, because the part of the brain that does that was damaged by the stroke. Or maybe only a portion of that part of the brain was damaged, so the signal to the muscle is partial. Then there is only a partial contraction that can occur. Or, maybe you are experiencing spasticity and the signals from the brain to the muscles are a bit “haywire”. The coordination system of the brain is not working properly so the signals may be too much or too frequent, making it hard for the appropriate signal to get to the muscle.
So, what is a Stroke Survivor supposed to do? First, realize that strength is not just in the muscle, it is in the brain too. That is where that term muscle memory comes from (more on that in a later blog). As a Stroke Survivor, you have had an injury to your brain and nervous system, so that needs to be considered when assessing your strength and making a plan to increase it.
Also, that strength is also about coordination. Coordination of the signals coming from your brain to your muscles and coordination of body parts to create the movement. That also needs to be considered when working on increasing strength.
So, creating a plan to work on the different aspects that affect your balance is key in improving your balance. In my next blog I will share some of the key areas to focus on for your strengthening and how you can incorporate increasing neuromuscular strength.
If you are looking for guidance to improve your balance and walking join the Balance Boost, my online 5 step program that guides you on assessing where you need work, tells you what work to do and helps you challenge yourself to make the changes you are looking for. Click here to join
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