As a trainer, I am a firm believer in starting with the basics, and the feet are the absolute most basic part when it comes to balance. The feet are the most under-worked and important part of any body that wants to remain upright, and the neck is a close second which is crucial for equilibrium.

I freely admit that quad and core exercises help a healthy, active, in-shape person improve balance. But how many people who are really and truly concerned about balance are healthy, active, and in-shape?

I have spent a good portion of my 30-plus years in the fitness industry working with older adults and sedentary individuals whose main concern is being able to maintain independence to live alone. I have also taken multiple trainer/fitness courses that treat older adult fitness as a lighter version of standard fitness. This is only helpful for someone who has been active throughout adulthood. For anyone else, this approach often leads to frustration and an even more sedentary lifestyle. Individuals who are starting from an extreme sedentary lifestyle are not even mentioned in most training courses. Why is this?

Some of the problem is liability. Personal/fitness trainers should not attempt to cross the line into physical therapy. I have held many different certifications over the years, and I completely agree that physical therapy is beyond the scope of a personal trainer. But I have also worked with many people who have been discharged from physical therapy and were not ready to pick up former activities. They had no road map to move forward and no bridge to get them from therapy to exercise. Bridging the gap between physical therapy and standard gym workouts is definitely a job for a personal trainer.

People who have experienced injury or who have led sedentary lives can be easily intimidated and discouraged by exercises not designed for their particular circumstances and condition. Mainstream articles that assume a certain level of fitness to start do a real disservice to this population. So, let me get back to the issue of balance for a non-fit population.

When you build a house, you have to start with a solid foundation. Feet are the foundation for all balance exercises. Approximately 25% of all body muscles are located in the feet. Feet should not be overlooked. We all – if we are lucky – have 5 little grippers on each foot, and the foot itself can flex, curl and tilt. Unfortunately, walking in straight lines on even ground in restrictive shoes discourages development of the muscles in the feet. If we are not active in multiple directions and on uneven surfaces on a regular basis – which includes most injured or sedentary people – the small muscles in the feet start to atrophy from lack of use. Those muscles need to be brought back to speed slowly, with targeted exercises.

There are many exercises that target the feet, but they do not require weights or machines; they do require concentration, specific positioning, and, perhaps, more effort than you would think.

Building balance means working the whole body, from the feet to the neck. Most of us, even those who don’t work out, can handle standard directional movement. Non-standard stresses – the cat weaving between your legs, stepping on a child’s toy, a dog jumping on you from the side, stepping in a hole – happen without warning and are the reasons for many falls and injuries. To successfully navigate the unexpected, the body has to be worked in non-standard directions on a regular basis. Weight machines do not ever work in non-standard directions because the movements plus added weight would be unsafe. Weight machines only work in standard directions due to safety concerns; this is as it should be. Non-standard movements have to be started with little or no body weight, with body weight added gradually, over time, and should never be done with added weights. This is not physical therapy, but it is also not the normal training regimen.

Knees, hips, and core all contribute to balance and all should be worked multi-directionally. Knees, hips and core are the focus of standard balance exercises and the literature is voluminous.

The neck also needs exercises, but in a different way. If balance is a problem, inner ear problems should be ruled out first by a medical professional. Once medical problems have been eliminated as a cause, the fluids in the ear still need to be re-trained. The tedious nature of the process means that people often skip it.

As we age, we do less play and more “adulting.” That means fewer playgrounds, fewer sports, less climbing fences and trees, less chasing children around, and fewer roller coasters. The less we change direction and tilt, the longer it takes our inner fluids to adjust to each movement. They are simply not used to it any more. The result is often a feeling of unsteadiness that registers as poor balance. This is not an inner ear “problem;” it’s a lack of inner ear conditioning.

Just like every other part of the body, the inner ear fluids need to experience consistent use in multiple directions for optimal performance. If you never tilt your head or bend over, getting out of bed in the morning will be a little tricky. The horizontal to vertical movement is not your normal movement. Your fluids need time to adjust. The only thing that will allow them to adjust more quickly is regular movement practice. For individuals who have balance problems, sitting in a stable position and practicing head tilts in small, controlled doses, then taking a deep breath before standing is an actual exercise. Many trainers and individuals skip this step because it seems too basic. It’s more fun and impressive to work the quads and core, but those steps are doomed if this one remains a problem.

My experience is that the more unconditioned a person is, the more basic the steps should be to create a safe progression to an active lifestyle. When the steps are too big or difficult, it’s easy to get frustrated and quit.

As a trainer, the goal should always be to celebrate each step along the way so that a client looks forward to the next step with anticipation and enthusiasm. Who cares if the steps are small? That just gives you more to celebrate on the journey.

Teresa S. Landry is an author, fitness trainer, and entrepreneur. Her background includes extensive classical dance training and instructing, competitive figure skating and coaching, ice dancing gold medal status in both the USFSA and CFSA, martial arts training, and 30 + years in the fitness industry as a personal trainer, group instructor, and manager. Teresa is the author of Cage Theory: Healthy Joints for Active Lives, The Aging Balance System, 4 Weeks to Stronger Knees, and others. For more information, visit LifeWithTeresa.com