To accomplish everyday activities, balance is essential. When we rise from a chair or bed, climb stairs, step into our bathtub, reach up on our toes to retrieve something overhead, bend down to pick up an object from the floor or simply walking about our body is constantly working to control balance. Balance is so routine that we never think about it. That is, until a fall happens.

How Does Balance Work?

The ability to maintain balance is a complex task that depends on two major components:

•    The sensory system—made up of vision, inner ear motion sensors and position sensors -- provides us with information about our body’s position in the environment. For instance, we rely on our eyes to tell us if the environment is moving or still; also to help us see and prepare for potential dangers and obstacles which can lead to falls. We rely on our inner ear motion sensors to tell us if we are upright or leaning, standing still or moving. We rely on position sensors in our feet and joints to tell us if the surface we are standing on is stable.

•    The musculoskeletal system—made up of muscles and joints--helps us coordinate the movements needed to maintain balance. For example, a sudden loss of balance is detected by the sensory system. Upon detection, signals are relayed to muscles and joints throughout the body, which then spring into action in an attempt to correct this loss of balance and avoid a fall. 

As individuals age, the capabilities of both the sensory and musculoskeletal system decline. As a result, the ability to maintain balance declines. Also, there is a decrease in the ability to correct any loss of balance before a fall occurs.

Balance impaired individuals typically exhibit difficulty with:

•    Rising from a chair, bed or toilet. Persons are unable to rise without using arms for support; when attempting to rise they exhibit unsteadiness.
 
•    Walking and turning (360°). Persons are unsteady and need to hold onto an object (walls, furniture) for support; when walking they stagger from side to side.

•    Standing with eyes closed (with feet as close together as possible). Persons are unsteady and need to hold onto any object for support; they are steadier with feet apart. 

Symptoms accompany balance loss may include:

•    A sensation of dizziness or vertigo (a whirling or spinning movement).
•    Lightheadedness or feeling woozy.
•    Blurred vision; difficulty seeing.
•    Disorientation; unable to concentrate.
•    A sensation of losing balance; feeling like you are going to fall.

Symptoms may appear and disappear over short time periods or may last for a longer period.

What Causes Impaired Balance?

Problems with balance can occur when there is a disruption in any of the sensory and musculoskeletal components. As we get older, diseases such as glaucoma and cataracts can alter vision. Ear disorders can disturb inner ear sensors from performing correctly. Stiff joints and reduced muscle strength can worsen attempts to maintain balance. Diseases in which abnormalities of balance exist include diabetes, Parkinson’s disease, stroke, arthritis, low blood pressure, etc. However, diseases are not the only reason for balance loss. A history of injuries, such as concussions, ear infections, or serious sprains or fractures, may contribute to a loss of balance over time. Lastly, many drugs can affect balance as well.

Can Failing Balance Be Improved?

The answer is yes, balance can be improved. Elders are able to recover from balance disorders and regain control. If elders have a problem with balance, a visit to the doctor and engaging in some form of balance exercises are the two most important steps to take.  It is not unusual for individuals with a history of balance problems to regain their balance control through accurate diagnosis followed by specific medical treatment and exercises.

The Doctors Visit 

Because of the wide variety of balance disorders, identifying the cause of a balance problem and what treatment options are the most appropriate is important. Some elders experiencing balance problems have an obvious medical condition, such as diabetes or Parkinson's disease that is the source of the problem. In other individuals, balance difficulties can be an early indication of an underlying disease condition yet to surface. In addition, reviewing medications, both prescription and over the counter that may be detrimental to balance control, is vital.

Balance Exercises

Exercises can limit the loss of balance control or improve its performance. That is why beginning a fitness program is essential in maintaining and promoting good balance. To improve balance, exercise should include both balance and strength training. Other programs that benefit balance include yoga, Tai Chi
(gentle physical exercise and stretching) and twice weekly ballroom dancing classes. These programs also help gain confidence with balance and reduce fear of falling.  

The following are 3 simple exercises (*) to help get you started.

Sitting and Standing

•    One of the easiest exercises for balance and leg strength is sitting and standing. Sit down in a sturdy chair and stand up (without using the armrests for support) as quickly as you can. Do this as many times as you can without becoming dizzy. Start off slow and gradually build up the number of times that you can stand up and sit down.

Walking Heel to Toe

•    Stand straight up and place the heel of one foot in front of the toe of the other foot. This is like walking on a high wire act without leaving the ground. Walking heel to toe is a good balancing exercise.

Heel Lift

•    Stand facing a counter with your feet shoulder-with apart. Put your hands on the counter for balance, and lift up onto the balls of your feet. Your heels should be at least 2 inches off the ground. Heel lifts help improve balance by strengthening weak ankles.

(*) There are many good exercises that improve balance. To find out what’s best for you, speak with your doctor.

Click here to read Dr. Rein Tideiksaar’s article, “Don’t Let Falls Be in Your Future”.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at drrein@verizon.net

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