Physical Therapy for Balance Disorders
Stopping Falls in Their Tracks With Physical Therapy
Feeling Wobbly? Physical Therapy Can Help
Balance typically follows something like a bell curve as we progress through life. As babies, we have little balance but we practice and practice until we run, stand on one foot and walk on balance beams like champions. Most of us maintain good balance through early and middle adulthood but notice a decline as we enter older adulthood or experience an injury or health condition that impacts the balance systems.
Falls or a reduced sense of balance confidence can quickly lead to decreased participation in social or recreational activities, a lower overall activity level and a fear of future falls. The less active and more fearful we become, the more likely we are to keep falling. So what can be done? A lot can be done to manage balance disorders and working with a healthcare professional like a physical therapist allows you to receive personalized balance training and fall prevention strategies.
WHAT HAPPENED TO YOUR BALANCE?
Balance generally refers to the ability to distribute one’s weight in a way that allows you to sit, stand and move without falling and to recover if you trip or begin to lean. Most of the time we think very little about the complex mechanisms of balance going on behind the scenes in our body. At every moment sensory receptors in the joints, muscles, eyes, and inner ear gather information about the environment around you and how you are positioned and send signals to your muscles to make adjustments that keep you balanced. In a healthy person without a balance disorder, this works most of the time. Sure, we all fall sometimes. We trip on an unseen toy in the living room or slip on some ice but most of the time we stay upright.
Good balance requires a well-functioning sensory system, strong and efficient muscles and a processing system that takes in the sensory information, integrates it and sends signals through the brain and spinal cord to contract the appropriate muscles in the correct way. Anything that impacts one or more of these systems can cause a balance disorder.
Many balance disorders come from abnormalities in the central or peripheral nervous systems. The central nervous system includes the brain, brainstem and spinal cord. An injury to the central nervous system can affect the nerves that transmit sensory and motor information and the areas that process the information. Even in the absence of an injury, the brain can have difficulty processing and integrating sensory information which can lead to a balance disorder.
Peripheral nervous system disorders involve the nerves that travel from the spinal cord or brainstem to the eyes, inner ear, joints, skin and muscles. When there is a problem with these sensory nerves the brain and spinal cord may not receive accurate information about your body position or the terrain around you or under your feet. Because of this, the commands to your muscles may be inaccurate, delayed, or absent which can lead to a fall or loss of balance.
Three sensory systems control most of our balance. Our inner ear or vestibular system is extremely important to our equilibrium. The organs and hair cells that line these organs give our brain and body important information about how our head is aligned and moving through space. Injuries or conditions that affect the inner ear like BPPV, Meniere’s Disease or vestibular hypofunction can cause dizziness, vertigo and a mild to severe sense of imbalance or motion.
Our somatosensory system gathers important sensory information from the muscles and joints about how the body is positioned in space. Sensory input from the hips and ankles, for example, indicate whether the body is leaning to one side or another. Increased pressure on the outside of one foot can tell the brain that the ankle is rolling outward. Similarly signals from the sensory nerves in the neck give information about where the head is turned. Anyone experiencing numbness or tingling in their feet may notice balance becomes more difficult.
Finally, we use our vision to help us detect changes in terrain and to check our alignment against vertical objects in our field of vision. Typically, the vision is used to double-check and verify information provided by the other sensory systems but disease, injury or aging can modify the weighting of these three systems and many older adults become highly reliant on their vision. This can lead to feelings of imbalance, dizziness or falls when they close their eyes, turn their heads or move through low light.
The sensory system is not the only culprit in balance disorders. Muscles can also be a culprit. Even if the sensory system does a great job telling the brain what is going on, weakened or shortened muscles may not be able to make an adjustment that is powerful or quick enough to stop a fall. Add onto this pain in the legs or back, poor endurance, limited range of motion in the legs, and impaired cognition and you have many ways balance can decline.
WHAT CAN WE DO ABOUT IT?
The best way to manage falls and injuries related to falls is to prevent them from ever happening. Nonetheless, if you are already falling much can still be done. Physical therapists are experts in balance and have a deep level of knowledge about the conditions that often cause balance disorders. Working with a physical therapist skilled in treating balance conditions or a vestibular therapist can increase your balance confidence and decrease your likelihood of falls. Rather than trying a generic balance program, your therapist will identify specific impairments causing your imbalance and treat them with an individualized plan.
There are many treatments available to address balance disorders. Strengthening the muscles needed to maintain and recover balance is important. We will address muscle length or range of motion impairments that impact your center of balance or ability to catch your balance. We treat dizziness and vertigo and address vestibular disorders. Optimizing the three balance systems and practicing a wide variety of balance exercises is also included. Finally, we practice fall recovery for the times when a fall can not be prevented and prescribe assistive devices as needed to keep you safe.
Balance is not something to mess around with. Injuries caused by falls have serious physical, emotional, social and financial ramifications, and taking steps to improve your balance as soon as possible is recommended. Our team of therapists here at Evolve are here to better your balance and we are waiting for your call to schedule the iphysical therapy for balance disordersnitial evaluation.
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