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Postural control and stand up paddle boarding!
23 Feb, 2020 - 07:47 pm 0 comments

As an avid convert to Stand Up Paddleboarding (SUP) in the last few years I have found myself using it as an excellent way to teach the principles of postural control on Bobath Courses.  

 

The understanding of postural control within the neuroscience and movement control fields of research is both fascinating and continually developing, so keeping up with the theory and it’s relevance to clinical reality and rehab interventions is a continuous process. 

 

Understanding and improving the integration of postural and movement control within our patients, to improve their sensorimotor performance and function within the ‘real world’, has always been a key focus of both the teaching of, and the clinical application of the Bobath Concept. It is easy to see within clinical contexts how many impairments impact on postural control, and the common movement control consequences, but we all need good postural control to move and function efficiently…

 

Cue ‘Stand up paddleboarding’; often quoted as the ‘worlds fastest growing sport’, great all around exercise, and, in my experience, an excellent way to improve your own postural control… as well as a rich source of examples to illustrate key principles of postural control in teaching.

 

Let me give you some examples (complete with SUP tips if you want to have a go!) 

 

Base of support: standing on a board which is itself on water….Boards vary in design for stability versus speed etc, but you are still basically standing on a board on water, so its inevitably going to be an ‘unstable’ base!  Your foot position, and where you are on the board are key to maintaining stability (TIP: aim to have your feet either side of the central handle – it’s the stability point of the board, and about hip width apart). 

 

We often talk about the need for an ‘Interactive base of support’ ie proprioceptive awareness and adaptability, particularly relevant in feet in any challenging situations regarding balance (TIP: try not to ‘grip’ the board with your feet – your intrinsic foot muscles will complain very quickly).

 

Alignment/kinetic chain: your overall alignment and stability of one body segment to another is key for anatomical/biomechanical efficiency and movement performance, and as with many challenging activities people will often use flexion at the hips and knees as a ‘strategy’ to lower their centre of gravity. They will improve their postural alignment against gravity as their postural control improves (TIP: use your core/pelvic stability and try to look ahead, not at the board, but don’t use visual ‘fixation’ (visually over-reliant). Your postural responses need to be adaptable, not fixed and stereotypical …

 

APA’s and CPA’s: The range of postural adaptations described which occur before, during and in response to movement or perturbation is ever expanding in the literature, and can be confusing, particularly when ‘terminology’ changes eg feedforward/predictive/anticipatory postural adjustments (APA’s) all mean the same thing – the system gets you posturally prepared for predictable, self generated movement such as your paddling stroke.  You still need feedback/reactive/compensatory postural adjustments (CPA’s) to unexpected perturbations eg a wave moving the board under you unpredictably. If you really want to challenge them put the dog on the board with you! 


Interestingly the range of postural preparatory phases being identified is expanding with EPA’s (Early postural adjustments: described as more global postural preparations), ASA’s (Anticipatory Synergic Adjustments) identified as inter-limb, multi-muscle synergic adjustments, and APA’s which we are more familiar with being described.  Research continues regarding time scales and sequence / roles of these varying preparatory phases, and remember we are talking maybe 100’s to 1000 milliseconds. It seems clear that the nervous system has very sophisticated ways of preparing you for self generated, predictable movement based on prior movement experience. These enable the system to minimise displacement and can improve very quickly based on sensorimotor feedback, as described in Cavallari 2016 the APA performance can improve within 3 or 4 movement repetitions…. Pretty clever. 

 

CPA’s are dependent on sensory feedback and deal with the result of movement or displacement, hopefully preventing you falling in. Remaining actively stable and adaptable is key: if you ‘freeze’ or ‘fix’ yourself you are less adaptable and more likely to end up getting wet! Or in our clinical work if the patient cannot remain adaptable to the challenge they are more likely to fall (TIP: many people stiffen their legs too much in order to try to ‘control the board’ – you can’t – the water controls the board, the best you can do is stay adaptable!) 

 

In SUP, as in life, APA’s and CPA’s are both occurring all the time, paddling is rhythmic and predictable, the waters effect on the board is not, so it’s a great way to improve integration of balance systems with movement control. As you get mere posturally stable and confident, your posture can adapt, narrower base, get fancy and be in step standing for improved speed, generate more force in your paddle stroke or change speed, start chatting to your pals, take a photo while standing (dual task) all ‘progressions’ we may be very familiar with using in our clinical work 

 

As well as the well recognised effects of activity and exercise on mood and well-being generally, many people are talking about the additional effect of the ‘blue mind’ ie being in, on, around or beside water is very calming for many, and water based activities are being used to great effect in depression, and PTSD. 

 

An interesting observation is described in the book ‘The body keeps the score’; that the emotional centres in the brain ie limbic system are influenced both from a ‘top down’ direction ie cortex: motivation, planning, voluntary movement, and a ‘bottom up’ proprioceptive information from the body, particularly with rhythmical movement.  SUP combines both of these streams of influence very effectively: constant proprioceptive information and postural adjustments in response to sensory information from the body and environment, with planned voluntary movement eg paddling. 

 

So SUP may be an ideal activity to improve not just your ‘physical’ balance but your emotional balance as well!

 

Pretty cool eh?? 

 

If you fancy having a go at SUP look for an instructor who is a WSA (Water Skills Academy) trained instructor.  I have done most of my training with Psyched Paddleboarding in Snowdonia, and can highly recommend them for fun, safety and skill! (and great hot chocolate….) 

www.psychedpaddleboarding.com

Although this is intended to be a fun informative blog rather than an ‘academic’ piece of work, you may be interested in reading more!  If so, here are some resources….

 

 

·      Cavallari 2016 The Organization and Control of Intra-Limb Anticipatory Postural Adjustments and Their Role in Movement PerformanceFrontiers in Human Neuroscience doi: 10.3389/fnhum.2016.00525 

 

·      Sciascia 2012 Kinetic Chain Rehabilitation: A Theoretical Framework. Rehabilitation Research and Practice Hindawi Publishing Article ID 853037, 9 pages doi:10.1155/2012/853037 

Books:

·      Blue Mind.  Author: Wallace J Nicholls.  2014. Pub: Little, Brown Book Group 

·      The Body Keeps The Score. Author: Bessel van der Kolk. Pub: Penguin


IF YOU WOULD LIKE TO LEARN MORE ABOUT POSTURAL CONTROL AND ITS CLINICAL APPLICATION, SIGN UP TO OUR COURSES AND DEVELOP YOUR KNOWLEDGE AND SKILLS.  www.bbta.org.uk


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