Good balance is essential to running, jumping or participating in sports that involve changing position quickly. However, a study by researchers at Columbia Children’s Hospital in Vancouver, Canada, shows kids with juvenile arthritis in the lower extremities often have impaired balance, which could potentially hamper sports performance and put them at greater risk of sports injury.
The study, which was published in the Summer 2013 issue of the journal Pediatric Physical Therapy, was first and only, to date, comprehensive assessment of balance in children with JIA and healthy controls, says study leader Kristin Houghton, MD. In her pediatric rheumatology practice, Dr. Houghton observed that children with arthritis affecting their legs often have difficulty with single-leg standing and hopping. Because increased rates of injury, including ankle sprains and anterior cruciate ligament knee injuries, are reported in young athletes with poor single-leg balance, Dr. Houghton was concerned that poor balance might place children with arthritis at increased risk of injury during play and physical activity.
Dr. Houghton and colleagues decided to put those observations to the test. Although their study did not look at sports performance, it did help confirm that children with arthritis have difficulty with balance.
The study evaluated 25 children with JIA between the ages of 8 and 18 and 36 healthy age-matched controls, using the Biodex Balance System (BBS) platform. The movable platform provides up to 20 degrees of surface tilt within a 360-degree range of motion, with a visual feedback that allows assessment of single-and double-leg postural balance. Allowing for varying levels of difficulty of stability testing from static to very unstable, it has been used to study balance in adults with rheumatoid arthritis and ankylosing spondylitis.
The researchers measured the children’s ability to balance on one leg as well as their ability to stand on both legs and balance the BBS platform at three settings: stable, moderately unstable and very unstable. They also measured arthritis severity and muscle strength, and the children completed forms to rate function and pain.
“The key finding was that children with lower extremity arthritis appear to have impaired balance,” says Dr. Houghton. Single-leg balance was significantly impaired, the study showed, with 40 percent of the children with JIA unable to stand on one leg on a stable surface for 20 seconds with their eyes open, while all of the controls were able to.
Exercises Can Help
As strength and balance are shown to be positively related, proprioceptive exercises – that is, exercises that enhance balance – are likely to emerge as an important therapy in the treatment of children with JIA and lower extremity arthritis, says Dr. Houghton.
If you think your child might have problems with balance, have him stand on one foot with his eyes closed. Most adolescents can stand this way for at least 25 seconds, studies show. If your child becomes unsteady or has to put the other foot down to remain standing, exercises to promote balance are a good idea.
Two exercises Dr. Houghton recommends are:
• Standing on one leg for increasing lengths of time. Hop from front to back and side to side.
• Standing on both legs on a slightly unstable surface (wobble board).
These exercises – often prescribed after a sports injury – may be helpful for children with arthritis and impaired balance, she says. For the optimal benefit these exercises should be performed three times a week.
For promoting balance, the Centers for Disease Control and Prevention also recommends:
- tai chi ( a traditional Chinese practice that combines gentle flowing movement, deep breathing and meditation)
- walking backwards
- standing on one foot;
- heel-and-toe-walking (in which the heel of one foot touches ground before the toe of the other foot is lifted);
- side stepping, (walking sideways, leading with the outer thigh and closing the step with the opposite leg).
For children with JIA who are interested in playing sports, Dr. Houghton recommends an injury prevention program such as FIFA11+, a 20-minute program designed for soccer players age 14 and older. In studies, teams that performed 11+ at least twice a week had 30 percent less injuries and 50 percent less serious injuries over the course of a season.
“Most children with JIA can participate in sports, but they may need to modify their activities depending on their symptoms and disease activity,” says Dr. Houghton. “Weight-bearing activity should be minimized during disease flares, as there may be increased stress to the joint and neuromuscular control may be impaired, posing increased risk of injury.”