Standing on Textured Surfaces

Effects on Standing Balance in Healthy Older Adults

Anna Lucy Hatton; John Dixon; Keith Rome; Denis Martin


Age Ageing. 2011;40(3):363-368. 

In This Article

Abstract and Introduction


Background: standing on textured surfaces or wearing textured shoe insoles can alter balance performance. This evidence, although inconclusive, offers a potential intervention for improving balance in older adults. This study explored the effect of standing on textured surfaces on double-limb balance in older adults and changes in muscle activity as a possible mechanism of effect.
Methods: 50 healthy older adults (29 female, age mean [1SD] 75.1 [5.0]) stood quietly in six conditions—eyes open and closed on two different textured surfaces and a smooth surface control. Mediolateral sway, anterior-posterior sway and centre of pressure velocity were extracted from a force platform and lower limb muscle activity collected using surface electromyography (EMG) over 30 s.
Results: for mediolateral range with eyes closed, there was a statistically significant effect of texture (F [2, 47] = 3.840, P = 0.033). This was attributed to a 9.2% decrease with Texture 1 compared with Control. No such effects were seen in any other balance variable or lower limb EMG activity for either visual condition.
Conclusion: the results suggest an effect of standing on textured surfaces on mediolateral sway in older adults, supporting further work to develop the therapeutic benefits of textured surfaces as an intervention to improve balance.


Some people experience a deterioration in balance performance with increasing age, heightening their risk of falling.[1] Mediolateral (ML) balance may be particularly affected.[2–5] Evidence that textured floor surfaces[6] and textured shoe insoles[7,8] can improve static and dynamic balance in healthy young adults points to their potential to improve balance in older people. However, to date only one study has focused on older people, concluding that standing balance improved after wearing textured shoe insoles for 5 min.[7] A textured surface, whether used as a footwear intervention or floor covering, may have the capacity to ameliorate age-related declines in balance by adding sensory input at the feet.[7] Changes in touch sensation and proprioception at the foot are commonly associated with poor function and risk of falling in older adults.[9,10]

Putative mechanisms for the effects of texture on balance include changes in muscle activity.[11,12] Wearing textured shoe insoles has been shown to significantly reduce mean electromyography (EMG) activity in tibialis anterior and soleus in healthy young adults[11] and increase gastrocnemius activity in adults with multiple sclerosis[12] during walking. It is unknown whether texture affects lower limb muscle activity in older adults during standing balance.

An early investigation compared different textured surfaces and showed that an important factor in affecting balance was the density of the protrusions that comprised the texture.[6] However, subsequent studies have explored the effect of only one design of textured intervention compared with control[7,8,11,12] and the importance of texture type remains very much unexplored.

The aims of this study were to explore: (i) the effect of textured surfaces on standing double-limb balance in older people; (ii) the importance of texture type and (iii) the effect of texture on lower limb muscle activity during standing double-limb balance. In this study double-limb balance describes the dynamics of body posture, which occur in response to inertial forces acting on the body, in order to achieve equilibrium between the body and the surrounding environment and prevent falling, when standing on two feet.