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  • Baxter Bell, MD

Where to Gaze When Trying to Balance?

I recently received this question from a yoga teacher who has done our Yoga for Healthy Aging course in the past:


“When I am teaching my seniors, I notice that they tend to look down a lot when trying to balance. I have subscribed to the adage that if you look down, you go down! I try to get them to focus their drishti (gaze) on a fixed point on eye level. A neuroscientist friend pointed out that looking down is like having another limb on the ground and that it makes sense to look down as it feels more stabilizing. Since I consider you an expert on yoga for an aging population, I was curious to hear your thoughts.”

Where should you keep your eyes fixed (drishti) while doing yoga poses?

Well, this was an interesting question: where should older adults, or really any person, place their visual attention to help support balance and postural stability, and is it different in static poses like Tree versus when actively walking around in an environment?


I had not heard the idea presented by the neuroscientist before, so I immediately did an online literature search to see what I could uncover. And uncover some intriguing truths I did!


One study I found looked at gaze placement in healthy adults in different environments when walking and found, likely not to anyone’s surprise, that when walking on flat surfaces with no obstacles, gaze tends to be on the horizon with only occasional glances at terrain ahead for obstacles and balance and posture are easily maintained. However, with more uneven surfaces, in the study this included a moderately rocky trail and a very rocky dry creek bed, the gaze is more frequently downward. I have noticed this tendency for quite some time on hikes in places such as the Oakland hills or Yosemite Valley. I’d love to be looking out at the lovely vistas all the time, but find I have to frequently be gazing down at the path to avoid roots and rocks and such that might lead to a trip and a fall.


Another study looked specifically at older adults and stroke survivors compared to younger adults to determine if downward gaze improved postural steadiness. They found that when the gaze was focused 1 meter or 3 meters (2&1/2 to 6 feet) in front of where they stood, postural sway decreased, but when the looked down at their feet, it increased. Interestingly, they study subjects were asked to stand in what seems to be essentially a Mountain Pose with feet close together!


This reminds me of a suggestion I heard back in the day from some of my early yoga teachers. When doing poses like Tree pose, some instructors would suggest picking a spot 6-8 feet out in front of where one was standing on the floor to direct the gaze. Now, not all of them suggested this, and some, as our questioner suggests, often ask us to focus our gaze on the horizon in front of us. There may be factors at play as we age that could make this horizon gaze more challenging, such as changes to the processing of information by the brain related to spatial awareness.


In the studies I reviewed, it was not clear whether downward gaze was accompanied by forward flexion of the neck. It is certainly possible to gaze downward 2-6 feet out in front without dropping the head forward and down. And given the propensity for older adults to develop spinal kyphosis (rounding of the upper spine) and head forward syndromes, I am more likely to encourage the eyes to look down while maintaining a neutral position of the head and neck.


One other interesting aside from another study was the impact of what is called Gaze Stabilization exercises on balance and postural stability. These are fairly accessible exercises involving placing your gaze on a fixed object at varying lengths in front of you while moving your head in different directions. Often used for those suffering from vertigo or dizziness, they seem to have benefits in general from improving balance. Here is one website that describes some of the exercises, used for dizziness. A few of the simpler ones could certainly be added into a seated or Mountain pose practice!


So, what is the bottom line on where to place the gaze when doing your yoga balance and agility practices? Like almost everything in yoga and life, it depends! But there is certainly growing evidence that downward gaze can be helpful in stabilizing posture and balance in older adults (and even younger adults, too), but let’s consider instructing that with attention to good overall posture and head placement! Remember, also, that balance and agility have multiple factors that contribute to healthy functioning, such as feedback from the skin receptors (exteroception), feedback from the joints that tell you where you are in space (proprioception), and overall strength and flexibility. So, although our vision is an integral part of overall balance and posture, it is part of a greater whole. Let’s make sure we are tuning up all parts of the balance system as we practice yoga.


 

Sources and Studies:


Downward Gaze is a Good Thing?


Study on Gaze and Gait 2018


Study on gaze stabilization exercises on elderly with dizziness

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