At some point in time, everyone has experienced a fall. Maybe the last time you fell was as a child, maybe it was last winter when stepping out onto an icy sidewalk, or maybe it was just yesterday walking your 7-month old German Shepherd puppy like me and the laws of physics were against you.
But what happens when you start experiencing trouble with your balance on a daily basis, or, even worse, start to experience more than one fall in a year? Do you find yourself tripping when walking? Do you feel unsteady just standing in place? Have you become fearful of going up and down stairs? Have you been limiting your daily activities for fear of falling? Do you feel that all this is normal as you age? It doesn’t have to be. Let’s take the time to talk balance.
What is balance? The technical definition of balance is the ability to maintain your center of mass over your base of support. Maintaining your balance involves sensory input from your 3 balance centers, your vestibular system, your vision, and your proprioception. In less technical terms, it’s being able to stay upright and not fall by using your vision, your feet (proprioception1), and your inner ear (peripheral vestibular system2) all in sync.
Your peripheral vestibular system involves your inner ear, which is responsible for maintaining balance, stability, and spatial orientation. This involves coordinating eye and head movements to keep an object in focus (VOR3), activating the neck muscles to stabilize the head (VCR4), and maintaining your posture and stabilizing your body to maintain and upright position (VSR5). Your vestibular system lets your body know that the elevator is going up/down. It tells your body that you turned your head left/right to look at the shelves while walking down the aisle at the grocery store. It tells the brain that you have bent over to pick up the lucky penny that you found while going for a walk in the park. But your vestibular system can also play tricks on you. It can make you stomp on your brake when the car next to you starts to move forward, but you are still stopped. Or worse yet, it can make you feel dizzy just rolling over in bed. How very complicated for such a small area in your inner ear.
Proprioception is our awareness of where our body is in space. In your legs, it involves knowing where your foot is and how the ground feels under your foot. Proprioception allows for your foot and ankle to identify that you are walking on concrete versus sand and this allows for your brain to send a signal back to your muscles to keep you standing.
Because our eyes play a key role in balance, getting routine eye exams is important. Any small changes in vision can affect your balance and your reliance on the other balance systems. Conditions such as cataracts and glaucoma affect vision significantly.
If there is a problem with one of the balance centers, the other areas need to compensate and work harder. If you start to lose sensation in your feet, this affects your proprioception. So, you rely more on your vision and your vestibular system. When there is a problem with your vestibular system, you will rely more on your vision and proprioception. And if there is a problem with your vision, then your inner ear and feet need to help the brain keep you balanced. When there is problem with all three areas, then we need to learn compensatory mechanisms to keep us safe and upright.
A proper assessment of your balance by a skilled physical therapist can be very beneficial whether you are currently having balance problems or if you just have a concern about your balance. A thorough evaluation will allow for an appropriate treatment plan to provide you with exercises to improve balance and prevent falls.
1. Proprioception: perception or awareness of the position and movement of the body. 2. Peripheral Vestibular System: the inner ear and the pathways to the brainstem. 3. VOR: Vestibulo-ocular Reflex; reflex that coordinates eye and head movement to keep an object in focus. 4. VCR: Vestibulocollic Reflex; reflex that acts on the neck musculature to stabilize the head. 5. VSR: Vestibulospinal Reflex; a reflex body movement that maintains your posture and stabilizes your body below the neck.