Patient Education | Balance and Mobility
The balance control process
Loss of balance control
Inevitable?
Risk factors
Key physical factors
Use of medications
Social/lifestyle factors
Environmental factors
Testing your balance
Balance is vital to normal every day life activities such as getting out of a chair and walking, bending over to put your shoes on, washing your hair, driving a car or going grocery shopping. Just about everything you do in your daily life, whether for work or leisure requires balance control, and most of the time you don't have to think about it.
People with balance and dizziness problems have difficulty with even the simplest of tasks. What is alarming is that at least half of the U.S. population will experience balance problems sometime during their lives, especially as they get older. In fact, poor balance and fall related injuries account for a large percentage of emergency room visits each year.
When balance problems develop they can cause profound disruptions in your daily life. In addition to increased risk for falls, balance disorders can shorten your attention span, disrupt normal sleep patterns, and/or cause excessive fatigue.
Ability to maintain balance is a complex process that depends on three major components:
(1) your sensory systems for accurate information about your body's position relative to your environment;
(2) your brain's ability to process this information; and
(3) your muscles and joints for coordinating the movements required to maintain balance.
The sensory systems include your sense of touch (feet, ankles, joints), your vision and your inner ear motion sensors. For example, we rely on our feet and joints to tell us if the surface we are standing on is uneven or moving. We rely on our eyes to tell us if the environment around us is moving or still. And we rely on our inner ears to tell us if we are upright or leaning, or standing still or moving.
Normally, balance control is accomplished "automatically" without requiring our conscious attention. When our balance "auto pilot" is disrupted, we have to exert intense conscious effort to try to overcome the abnormal sensations and maintain control of our balance. This intense effort, in turn, is what leads to the common secondary symptoms such as shortened attention span and fatigue.
In a normal healthy individual our senses of touch (feet, ankles, joints), sight (eyes) and inner ear motion sensors work together in harmony with the brain. A person with a balance disorder, however, may have a problem in any one of these systems, or in multiple systems. In some individuals, one or more of the senses are missing and the person does not realize they are losing their balance. In other people, the brain gets confused and creates an inaccurate sense of falling when in fact the person is in balance. The risk of developing one or more of these problems increases with age as our senses or brain centers are exposed to degenerative or infectious diseases, or the effects of injuries accumulated over a lifetime.
Is a loss of balance control an inevitable consequence of aging? No. The natural aging process produces changes in our bodies as we grow older, but these changes do not necessarily result in a loss of balance control or mobility. Healthy seniors are quite able to perform daily life activities normally with few physical limitations. In fact, recent studies have indicated that, elderly fallers are different from their healthy, age-matched counterparts1,2,3. Dizziness among older adults can also be caused by a collection of subtle degenerative or infectious processes or injuries that in combination result in a balance problem4.
Some individuals experiencing balance problems have an obvious medical diagnosis such as diabetes, Parkinson's disease, or even a stroke that are primary sources of the problem. In other individuals with balance difficulties, the cause can even be subtle undetected forms of these diseases. However, diseases are not the only reason our senses and movements may be compromised. A history of injuries, such as concussions, ear infections, or serious sprains or fractures, may contribute to a loss of balance control over time. In addition, various combinations of medications, both prescription and over the counter, can be detrimental to our senses or brain and cause either temporary or permanent damage.
So how do you know if you are at risk for falling? There are several known risk factors, both related to yourself (physical fitness/ailments, psychological and social factors) and your environment (the surfaces you walk on, obstacles, lighting, etc.), that can increase your susceptibility to falling. Some common indications include symptoms of dizziness or unsteadiness, taking one or more medications, a recent period of bed rest or inactivity, loss of strength or feeling in the legs or feet, or a loss of confidence in your ability to get around. However, there are many other subtle indicators that you or your physician may not even be aware that you have. To complicate the matter, falls are not typically the result of a single cause or risk factor. More often, they are the net result of a combination of factors.
Balance problems and dizziness are obvious indicators that someone is at a higher risk for falling. It may not always be obvious that your balance is diminished, as unsteadiness may be caused by a number of smaller physical ailments that alone would not cause a person to fall. However, the combination of relatively minor problems can be a significant risk for falling. Other key physical factors include reduced muscle strength in the legs and painful or unstable ankle, knee and hip joints, which can impact your ability to support yourself and quickly recover from sudden changes to the surface you are walking on. Limited range of motion and flexibility can make stepping over obstacles and walking on uneven or inclined surfaces more difficult. Weakness, slowing, loss of feeling or coordination as a result of a stroke or degenerative disease, such as Parkinson's can have a significant impact on your balance and mobility. Even arthritis can be an indicator of fall risk because it can result in poor range of motion, reduced muscle strength, and a loss of sensation at the affected joints. Poor vision and a history of ear infections or inner ear disorders are also risk factors. While having one or two of the above risk factors will not necessarily cause someone to fall, the likelihood of falling increases with the number of risk factors that are present.
The use of multiple prescriptions or over the counter drugs can also increase your risk for falling. It is always important to understand the side effects of any medication you may be taking, both alone and in combination. Be sure to check with your pharmacist or physician if you are uncertain how a prescribed medication will interact with any other medications you are already taking. The most common drugs implicated in fall risk are diuretics, hypotensives, anticoagulants, hypnotics, psychotropics and laxatives. Drugs to treat high blood pressure or heart ailments can cause dizziness and sedatives or drugs to aid in sleeping can impact your ability to maintain your balance.
You might think that someone who leads a relatively inactive lifestyle would have less chance of suffering from a fall because they are not putting themselves at risk. Inactivity, however, is an important risk factor for falling. Prolonged inactivity can actually lead to loss of muscle strength, joint range of motion, and your ability to quickly react to a sudden slip or stumble. Unfortunately, fear of falling itself can cause someone to be at higher risk as they get stuck in a vicious cycle of immobility and progressive de-conditioning weakness from self-imposed mobility restrictions.
Your home and your physical surroundings are filled with things that you may not notice. Rugs and bathmats, uneven or loose steps, cupboards or shelves that are either too high or too low to reach easily, and dim lighting in rooms and hallways are things you may have lived with for many years. These "innocent" things, however, can be detrimental to someone whose ability to quickly recover from a slip or stumble is already compromised.
For example, if you have limited range of motion or balance problems, you may not raise your foot as high as the average person when you take a step, which makes you more likely to trip over a wrinkle in a rug. You may have numbness in your legs or feet and will have more difficulty being able to sense when you have stepped onto a slippery or unstable surface. Or possibly you have poor vision and need more light to be able to see objects clearly. Again, none of these risk factors alone will necessarily cause a fall. It is the combination of risk factors, both physical and environmental, that increases the likelihood that someone will suffer a fall.
To help determine if you may be headed for a fall, take the Balance Self Test . If you answer yes to one or more of the questions, you could be at risk. The best way to determine if you have a problem, though, is to talk with your physician who might recommend that you get a balance screening test from a qualified clinician. There are numerous clinical tests that are easily performed that can detect if you have a balance problem. Then there are tests that can tell what is causing the problem. The great news is that if you do have a problem, there is help available. There are many things you can do to reduce your risk for falling.