Safety of Split Stance for Individuals with Pre-existing Balance or Mobility Issues
Split stance is generally not recommended for individuals with pre-existing balance or mobility issues due to increased risk of falls and potential for injury.
Understanding Split Stance and Balance Concerns
Split stance (where one foot is positioned in front of the other) presents significant challenges for those with compromised balance or mobility for several reasons:
Reduced Base of Support: Split stance narrows the base of support compared to parallel stance, making balance maintenance more difficult 1.
Increased Balance Demands: The position requires greater postural control and balance capabilities than standard standing positions 2.
Fall Risk Considerations: Individuals with pre-existing balance issues already demonstrate increased body sway and reduced ability to maintain narrowed stance positions 2, 3.
Evidence-Based Positioning Recommendations
The American Heart Association and American Red Cross guidelines provide clear direction on positioning for individuals with balance concerns:
For Individuals with Balance Issues: "If a person has been injured and the nature of the injury suggests a neck, back, hip, or pelvic injury, the person should not be rolled onto his or her side and instead should be left in the position in which they were found, to avoid potential further injury" 1.
Stability Principle: Any position should be "stable, near a true lateral position, with the head dependent and with no pressure on the chest to impair breathing" 1.
Alternative Positioning Options
For individuals with balance or mobility issues, safer alternatives include:
Supine Position: For those showing evidence of shock but who are responsive and breathing normally, the supine position is reasonable 1.
Modified Recovery Position: For unresponsive individuals who are breathing normally, a lateral side-lying recovery position may be appropriate, with adaptations as needed 1.
Supported Sitting: For those who need to be upright but have balance concerns, supported sitting with back support is preferable to standing positions 4.
Clinical Assessment Considerations
When evaluating whether a split stance might be appropriate, consider:
Balance Test Performance: Individuals who require initial support to stabilize in tandem stance (similar to split stance) show significantly worse performance on mobility measures and balance confidence tests 3.
Time Maintenance: The ability to maintain challenging stance positions for less than 23 seconds may indicate subtle balance deficits that would make split stance unsafe 2.
Staff-to-Patient Ratio: Higher support ratios (2:1) are typically needed when practicing challenging stance positions with individuals with balance issues 5.
Risk Mitigation Strategies
If a split stance must be attempted for therapeutic purposes:
Progressive Approach: Begin with wider, more stable stances before attempting split stance 6.
Physical Support: Ensure adequate physical support is available, as research shows those requiring initial support to achieve challenging stance positions have significantly worse balance outcomes 3.
Environmental Modifications: Remove obstacles, provide stable surfaces for hand support, and ensure adequate lighting 4.
Regular Position Changes: Avoid maintaining any single position for extended periods, as recommended in positioning guidelines 1.
Conclusion
The evidence strongly suggests that split stance poses unnecessary risks for individuals with pre-existing balance or mobility issues. Alternative positioning strategies that provide greater stability should be prioritized to reduce fall risk and prevent injury.