Good balance is essential to running, jumping or participating in sports that involve changing position quickly. However, a 2009 study 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, presented at the October 2009 annual scientific meeting of the American College of Rheumatology in Philadelphia, was one of the first to examine balance in kids with lower extremity arthritis, 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. She was concerned that poor balance might place children with arthritis at increased risk of injury during play and physical activity.
Dr. Houghton and colleagues at the British Columbia Children’s Hospital in Vancouver 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, 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.
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. “In particular, almost half – 48 percent – had difficulty standing on one leg, single-leg balance. Children with ankle arthritis had more difficult balancing on an unstable platform.”
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.
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.