Balance
/“My balance isn’t what it used to be.”
“I’m nervous to walk around in a dimly lit place because of my poor balance.”
“I keep losing my balance and falling.”
“I don’t go out as much as I used to because of my balance.”
These are all common statements we hear as physiotherapists in our daily conversations with clients. Balance is a big concern for many people!
Our sense of “balance” is complicated. Our brain receives information from three main input systems to give us our sense of balance:
Vision: Our sense of vision is important to orient our bodies to what is vertical and what is horizontal. Functions such as peripheral vision and depth perception are important to let us know where we are in the world. Vision impairments will absolutely affect our sense of balance!
Vestibular: Your vestibular organs are located in the inner ear and their job is to tell your brain where your head is moving in space; if it is going forwards or backwards, turning to shoulder check, tipping down to tie up a shoelace or looking up to get something from a high cupboard. Impairments in these organs in the inner ear will affect your sense of balance.
Proprioception: This refers to the sense organs in your muscles and joints that tell your brain what your limbs and spine are doing; for example, if your knee is bent or straight,or if your neck is rotated. The sense organs in your feet are also important in order to feel the ground underneath you and tell your brain if it is smooth, rocky, icy, etc. Neuropathies, or sensation changes, from conditions such as diabetes or chemotherapy side effects, may cause numbness or decreased sensation in the feet which will result in a balance impairment. At the other end of your body, an injury to the muscles in the neck such as a whiplash can also cause a sense of dizziness and imbalance.
Brain: Your brain has the very complicated job of amalgamating all of this information and then telling your muscles what to do in order to keep you upright in the world! This means that any condition affecting the brain, such as a stroke, Parkinson’s, and MS, will affect your balance.
The beautiful thing about our bodies and brain is that they have the ability to adapt and change. For example, if you have had damage to the vestibular organs in one ear, your brain can learn to rely more on the other ear, your vision and your proprioception. Similarly, if the sensation is diminished in your feet, your brain will make more connections to your vision and inner ear systems to give you your overall sense of balance. However, none of these adaptations will happen if you don’t challenge your current balance limitations! A physiotherapist can give you exercises to safely and efficiently accomplish this.
There is almost always something that can be done to improve your sense of balance and reduce your risk of falling. Talk to a physiotherapist who can assess your home and identify fall hazards, assess if you are in need of a gait aid, and teach you simple home exercise to improve your balance and your confidence.
