We, as physical therapists, encounter numerous opportunities to positively impact the lives of our patients. Some of our most rewarding endeavors include assisting patients with balance concerns. Individuals seek our care for unsteadiness with walking, dizziness, or recent history of falls. Interestingly, we include balance training for a large percentage of our patients, as a component of their total program, when our screening tests show deficits.

Balance takes a coordinated effort on behalf of the musculoskeletal, visual, somatosensory, and vestibular systems. Your muscles and bones must be strong and coordinated in their movement patterns to keep your body stable. It is easy to see how your vision sense provides vital feedback. Less obvious, is the role of proprioceptors housed in your feet and ankles that notify you where your body is positioned in space (somatosensory system). Even your inner ear is related to balance because it sends messages to your central nervous system to help control eye and postural muscles to keep you upright(vestibular system).

Vision deficits, whether it is inadequate corrective lenses or poor lighting in an area, dramatically disable our optimal balance. To demonstrate briefly how much we rely on our visual field for feedback to remain upright and stable: first stand with your feet together; next close your eyes; now notice how your body sways more without the visual feedback (do not try this demo if you have current balance issues).

With a muscle/tendon injury, receptors housed within our anatomy are likely to become damaged as well, causing the proprioception system to be less effective. In therapy, we often ask our patients to stand on the injured leg and then on the uninjured leg to compare differences. Patients with hip, knee, ankle, or foot injuries are typically unable to balance on their involved side for the same length of time as on their uninvolved side.

Certain conditions involving the vestibular system require treatment by therapists specially trained in vestibular rehabilitation. Individual conditions such as BPPV (benign paroxysmal positional vertigo - small particles in the inner ear become dislodged and cause dizziness) can be effectively treated by most physical therapists trained in the EPLEY maneuver. Family practitioners often refer patients with BPPV for therapy. However, individuals with certain conditions involving dizziness such as Me’nie’re’s disease (abnormality of the inner ear producing dizziness, ear pain, hearing loss, and feelings of pressure) would best be treated by vestibular rehab specialists.

Also affecting balance are extrinsic factors like lighting, unlevel terrain, inappropriate shoewear, medication, slippery surfaces, cluttered walkways, out of date eyeglasses, etc. Research to determine the most likely causes of balance dysfunction and falls is ongoing, as is research to find the most effective treatments.

Note: Not all balance disturbances should be treated with physical therapy. Medical conditions such as inner ear infections and orthostatic hypotension (significant drop in blood pressure upon standing) require medical intervention. Sometimes, dizziness can be a sign of more serious medical conditions. Don’t wait to be a patient before focusing on your balance abilities. Take a step today toward better balance. 1) Contact your physician or trained healthcare provider if you have current balance concerns.

2) Discuss your current medications with your pharmacist or physician to learn about possible drug interactions or their effects on balance.

3) Contact your eye doctor for a current eye exam.

4) Participate in regular physical activity.

5) Wear firm soled shoes without heels - Do not walk around in socks or slippers.

6) Consider visiting a physical therapist for assistance in adjusting your cane or walker.

7) Perform activities that challenge your balance to reduce fall risk - for safety reasons, first ask your healthcare professional for specific and appropriate exercises.

8) Complete a home safety checklist. Visit cdc.gov/healthy homes for a free download titled “A Healthy Home Checklist.” Also, at stopfalls.org see “Home Modifiation” from the Fall Prevention Center of Excellence. In general, your home should have adequate lighting, minimal clutter, rails at stairs, grab bars (not towel bars used as grab bars) in bathrooms, and nonslip mats on bathroom floors. 9)Read “Preventing Outdoor Falls” (at www.stopfalls.org) by Caroline Cicero, MSW, MPL, for sound advice regarding outdoor tips for fall prevention for yourself and your community.

Please contact Sarah Ferguson, MPT, or Melanie Humphries, MPT, of Village Physical Therapy of Holly Springs if you have any questions or feedback regarding the information presented in this article. They may be reached at 919-577-9200 or via email through their website at villageptnc.com.