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. Good balance is a result of several body systems working in coordination with one another. Each balance system has an important role in helping to maintain or recover balance and when one or more systems are not functioning optimally, losses of balance can begin to occur. So what are the three balance systems?

Visual System: The visual system includes the eyes, the optic nerves that carry visual information from the eye to the brain, and the visual processing centers of the brain. When the eyes take in visual information about the environment, it provides the brain with important details that impact our balance. If you have ever noticed that you feel more unsteady when you are walking in darkness or low light, you are experiencing the effect that the visual system–or lack of visual input in this case–has on your balance. Impairments in the vestibulo-ocular reflex, an important connection between the visual system and the vestibular system, can cause feelings of unsteadiness or disequilibrium as can disorders that limit vision.

Vestibular System: The vestibular system consists of a network of tiny vestibular organs located in the inner ear and their connections to the brain and brainstem. This system provides vital information about spatial orientation, motion and equilibrium. The vestibular sensory organs called the utricle and the saccule sense changes in gravity in order to detect the vertical orientation of the head and body. Simultaneously, the three semicircular canals which are oriented at 90 deg to one another sense angular acceleration of the head. When performing optimally, the organ pairs work together to alert the brain about the head’s position and movement in space.

Somatosensory System: The 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.

All of this information is integrated into the brain and spinal cord in order to produce the appropriate movements and reactions of the body to maintain or recover balance.

CONDITIONS THAT CAN LEAD TO A BALANCE DISORDER

Any injury or condition that affects one or more of these balance systems or the areas of the brain that process visual, vestibular or somatosensory information can result in a balance disorder. Some examples of conditions that can lead to a balance disorder are as follows:

• Neuropathy or nerve damage
• BPPV
• Vestibular hypofunction
• Meneire’s Disease
• Vestibular neuritis
• Concussion
• Brain injury
• Low vision
• Muscle weakness
• Spinal cord injury
• Ataxia
• Cerebellar disorders
• Dementia and Alzheimer’s
• Parkinson’s Disease
• Guillain Barre

If you decide to work with a physical therapist to help with balance related issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY FOR BALANCE DISORDERS

The main goals of physical therapy for balance disorders is to improve the patient’s level of function. Specific functional goals may include:

• Be able to walk without an assistive device like a cane
• Climb the stair safely
• Walk across the parking lot to the mall without falling
• Sitting at the edge of the bed while putting on shoes with good balance
• Stand on one leg while putting on pants

Your physical therapist will achieve these results through a personalized treatment plan. Common interventions used to address balance disorders are listed here:

Improve strength: adequate strength around the muscles in the trunk, hips, knees and ankles that help us balance or catch our balance is very important.

Improve range of motion: sometimes loss of range of motion in our joints can make our postural muscles ineffective and even make it difficult to maintain our center of balance. Loss of range of motion in the spine, the hips, knees and ankles may contribute to losses of balance

Address dizziness and disequilibrium: If dizziness or feelings of disequilibrium are contributing to your falls or feelings of unsteadiness then vestibular physical therapy may be needed to either restore the function of the vestibular system or help the brain compensate for any weaknesses.

Optimize the 3 balance systems: sometimes we become very reliant on one or two of the three balance systems and the other systems are not working optimally. This often leads to feelings of imbalance under conditions that rely on the weaker system. Physical therapists can test the strength of these systems to determine if any need special attention

Balance exercises: practicing balance is an essential component of a physical therapy program for balance disorders. These exercises are highly individualized to address specific patient impairments and to help address limitations in function.

Assistive device training: sometimes using an assistive device like a cane or walker is the best step to prevent falls. Your PT can advise you on which device is best and help you learn how to use it safely.

Fall recovery: Despite our best efforts, sometimes falls happen and practicing how to fall safely and to get back up after a fall is very important.

So, if you are feeling unsteady, physical therapy for balance disorders can help you to improve your function and quality of life. Don’t go it alone, call us today to set up an evaluation with one of our skilled physical therapists and let us help you become more balanced.