One of the biggest challenges we face as we age is loss of balance and risk of falling. "About one third of people over the age of 65 and almost half of people over the age of 80 will fall at least once this year." Injuries from falls can lead to life threatening problems and loss of independence.
There are many factors that correlate with being at risk for falls including: being 80 years or older, leg muscle weakness, difficulty walking, decreased vision, medical complications such as stroke or diabetes, confusion, depression, multiple or specific medications (4 or more), using an assistive walking device, home hazards like pets and rugs, low blood pressure, and prior history of a fall.
Your balance system is a very complex system that is made up of many parts. Your eyeballs tell you what you see, your inner ear tells you how fast your body weight is moving, your legs tell you what your feet feel to keep you standing, and your neck tells your brain where your head is positioned. Your brain is the computer that processes all this information from these sensory parts and then quickly calculates a strategy to keep to you balanced. This normally happens quickly without thought. There are many examples of reasons why your balance would no longer work efficiently. A couple common issues include, but are not limited to: vertigo and neuropathy.
When you have “true vertigo”, your inner ear crystals leave their containment area and get stuck inside one of 3 canals. These canals normally tell you how fast you are moving through space by fluid inside of them splashing around as you move. When these crystals are in the canal, it is like throwing a rock into a pond. The crystals make the water splash around inside these canals when your head changes position. When this happens it tells the brain you are accelerating faster even though you may not be. You will perceive this as a “spinning” and your eyes will flicker because your brain is trying to see where you are moving towards to avoid falling. This “bad signal” that comes from your inner ear can cause the brain to get bad information about how you are moving through space.
Neuropathy and leg weakness is a very common problem. Neuropathy impacts the brain because your leg sensory nerves either do not work or send a very weak signal. They are responsible for your proprioception or your ability to know exactly where your feet are under you and what they feel as they move through space. This is often combined with leg weakness. When you cannot feel your feet very well and your hips, knees, and ankles are not strong; then they struggle to do what the brain wants them to do to you keep moving.
These are only 2 common examples of balance related issues, but it illustrates how complicated the sense of balance is for the body and the brain. Everything has to work like a “well-oiled machine,” and if one part is broken, the machine slows down.
Finding the cause of your imbalance will help to determine what treatment is appropriate. Specialists such as ENT MD/Audiology, Primary Care MD, Cardiologists, and Neurologists may be necessary for certain imaging or testing to rule out some pathologies. The primary method of improving your balance is to work with a physical therapist. Physical therapists are trained in diagnosing many of these problems that can affect your balance. Many of the treatments for balance problems are simple. “True vertigo” can be corrected through head positions that realign the crystals. Simple leg exercises can improve leg strength and balance sense. Your physical therapist will do an assessment of your medical history, vision, walking, strength, conditioning, and home environment to help make determinations as to what treatments are needed. Your physical therapist can work with you on a specific program to maximize your safety and function with appropriate treatment techniques, devices, referral for community programs, or changes in living strategies. Your physical therapist will help you to maintain an active and safe lifestyle.