I. What is balance?
Balance is a person’s ability to remain in an upright, and stable position. A person with good balance will demonstrate good postural control of their center of gravity within their base of support - whether, sitting, standing, or walking. In every position, our bodies are actively using muscles to, subconsciously, keep us balanced. Even when we are standing or sitting as still as possible, we use small postural muscles every second to stay in the desired position. If the body has to work to maintain balance while remaining still, imagine how hard the body works to maintain balance during more complex activities such as walking, running, turning a corner, sitting down, or navigating stairs!
II. What systems actively coordinate balance?
An individual is able to maintain balance through the integration of sensory information collected by our eyes, ears, muscles, and joints.
The visual system provides information regarding what a person can see in their surrounding environment. The brain is constantly receiving information from the eyes regarding where the horizon is and where the body is in relation to external objects. When the body is moving, the brain is able to calculate the speed, direction, and even the body’s safety as it navigates environmental features.
The vestibular system is a very intricate system of sense organs located deep in our inner
ear. These organs are connected to semicircular canals which, as a system, provide information about the orientation of the head in space. The vestibular system is constantly tracking the head’s position relative to gravity, in addition to the head’s acceleration (either forward or backward, left or right, up or down), and any angular combination of motion around these planes of movement.
Proprioception is the final piece of our balance system and comes from our muscles and
joints. Within every muscle, ligament, and tendon exist sensory cells that relay information to the brain regarding body position. Proprioception is a more difficult sensory system to understand because it doesn’t represent what we have all learned to be our “primary senses” - see, smell, hear, taste, and touch.
However, just like those senses, our brains
require little to no conscious attention to
process it - proprioception is our body’s “sixth sense”.
III. What causes balance changes?
Damage to inner ear structures
Loss of inner ear nerve conduction
Changes in vision
Changes in sensation in feet.
Age related changes (may include the above or further worsen them)
IV. Why is balance so important?
Poor balance can cause falls that result in a traumatic injury.
When a person loses their balance they will either catch themselves and remain upright, or fall. By definition, a fall is an event which results in a person coming to rest on the ground, floor, or other lower level. Falls are the leading cause of fatal and nonfatal injuries among adults over the age of 65, and statistically, 1 in 3 adults over 65 will fall this year, 1 in 2 adults over the age of 80 will fall this year. Of those falls, 20-30% will result in decreased mobility and functional independence. 800,000 patients are hospitalized every year following a fall. Each fall with resultant hospital stay has an average cost of $30,000, and as a nation, falls cost over $24 Billion in hospital cost per year.
Postural deficits, over time, can lead to progressive wear and tear of a person’s body.
The body is built very specifically and every person is able to activate their body’s musculature appropriately and maintain good joint alignment when actively accepting, resisting, or generating a force.
While ideal body mechanics are often discussed, encouraged, taught, and reinforced, the body’s natural tendency is to find “the path of least resistance”. In other words, the body is always on the lookout for energy saving strategies to maximize efficiency. In the short term, this is not a problem, however, when repeatedly changing how the body should move into how the body wants to move, the person will develop movement patterns that, over time, progress into overuse injury, muscle overactivation or underactivation, muscle length being too short or too long, or joint structure wearing away. All of these changes in movement patterns occur so slowly, it is often unfelt by the person, and unnoticed by family and friends. That is, until pain occurs.
V. How can Physical Therapy help balance?
Physical therapy can identify the risk factors that are related to your balance deficits, can identify the cause, which system deficiency is causing balance difficulties, and work to reduce or compensate for these deficits.
Testing to determine the source of imbalance:
Range of motion - does one side move differently than the other? The more asymmetric the body is, the more risk of muscle and joint imbalance upon load.
Strength - is one side stronger than the other? Is there a muscle group that is too strong and overpowering another group? Is there a muscle group that is too weak, or is undertrained? Is there lacking or inhibited nerve conduction affecting how the muscles are working?
Walking pattern - is there noticeable deviations that may need to be retrained?
Balance - is it easy to stand with the feet together? What about on a soft or compliant surface? Is it easy to stand with feet in line or even standing on one foot? What about these positions with eyes closed or head turns?
Vestibular system - is there any dizziness that contributes to balance difficulties? Do the eyes behave appropriately as the head moves side to side? Up and down?
Physical Therapists are exercise and movement specialists and are specially trained to assess all areas that contribute to balance. Additionally, Physical Therapists know how to restore each person to their greatest potential through movement training, strengthening, coordination training, potential vestibular rehabilitation, fall risk education and fall risk reduction training, and how to use an assistive device, if needed, to provide that extra stability.