By Laura Stewart, BScH, MScPT
It is a common misconception that impaired balance is an inevitable and irreversible consequence of aging. In reality, the impairments that lead to poor balance can often be significantly improved if they are identified and treated appropriately.
Before we are able to correct and improve our balance, it is helpful to understand what processes in our bodies keep us oriented, upright and safe.
A critical component of balance is the sensory systems that help us glean information about our position in space. This includes our vision, our vestibular system located within our inner ear, and the sensory input we get from our joints and muscles that tell us where in space our limbs are located. When one or more of these systems aren’t functioning well, our balance can be significantly impaired. Examples include poor vision, vertigo from an inner ear infection, or if you havediabetes with neuropathy that effects sensation to your feet and legs.
Other issues with balance can arise when our brains have difficulty processing this sensory input, which can happen after a brain injury, stroke or with neurological diseases affecting the brain.
Finally, the brain needs to send messages to the muscles and joints to coordinate the body to maintain balance at rest and during movement. This coordination can also be affected by injury or by neurological disease.
If you or a loved one answer yes to any of the following questions, there may be some impairment in one of the processes that keeps our body stableand balanced.
• Have you had one or more falls?
• Are you afraid of falling?
• Can you stand on one foot without using your hands for 10 seconds?
• Do you find yourself holding onto furniture when you’re walking in the house?
• Do you feel especially unsteady when you are walking in dim lighting?
Some of these changes are very stressful to contemplate, and can make one anxious, sedentary and socially withdrawn. But there is help available, and it is very likely that something can be done to improve balance, reduce the risk of falls and/or help slow further decline.
1. Get a checkup
The first step is to identify any (there may be more than one) medical contributors to poor balance. At least once a year have a thorough checkup with your family doctor to identify and treat any problems with your vision, inner ear, blood pressure and neurological systems. Have your doctor or pharmacist review your medications for interactions and side effects that may contribute to falls.
Check with your doctor to make sure your blood pressure is well regulated, and that you take any medications for blood pressure as prescribed. Fluctuations in blood pressure such as when you stand up suddenly can cause dizziness and lead to falls.
2. Don’t ignore your injuries
If you have had strains, sprains, fractures or surgeries in your feet, ankles, knees or hips, these may be contributing, even if they are old injuries. Stiffness or lack of movement in your leg joints as well as weakness in injured muscles can lead to a lack of stability. Consult a physiotherapistwho can assess your injury in more detail and give you specific recommendations including exercises tailored to your particular issues.
People are often surprised to hear they can improve their balance by practising.
Try some of the exercises below while supporting yourself by holding onto a stable surface, such as your kitchen counter. It’s ok to feel a bit “wobbly”; it’s a sign that you are challenging your balance. Ask a friend or family member to assist you if necessary. As you get stronger, gradually decrease the amount of support you use through
your hands, working towards the goal of not holding on at all. For an advanced exercise, try the activities with your eyes closed.
• March slowly in place, bringing your knees up as high as you can. The more slowly you move the more challenging it will be. Repeat 10-20 times.
• Try to balance on one leg for as long as you can. Start with 10 seconds per leg and try to hold longer as your balance improves.
• Stand with one foot directly in front of the other, heel to toe, as if you are standing on a tightrope. Try to hold 30 seconds per side.
• Bring your feet close together so they are side by side. Keeping your hands on the counter or hovering just above it, try to turn your neck and shoulders to look behind you. Repeat 5-10 times each direction.
4. Strengthen your stabilizing muscles
In healthy individuals, the muscles of the legs and trunk are constantly working to keep the body stable. These automatic corrections to restore equilibrium will be more effective when the muscles are strong. Try the following basic exercises to strengthen some of these muscle groups.
• Standing at the counter, rise up onto the balls of your feet, lifting your heels as high as you can. Slowly lower your heels back to the ground. Repeat 10 times.
• Stand up and sit down from a chair, using your arms as little as possible. Make an extra effort to lower yourself slowly. Repeat 10 times.
• Standing at a counter, lift your leg straight out to the side. Keep your toe pointed straight ahead. Hold this position for a few seconds if you can, then slowly lower your leg back down. Repeat 10 times per side.
5. Assess your footwear
Wearing socks or floppy slippers indoors can be dangerous, particularly if you have wood or tile floors. Wear a shoe that fits well with a closed heel and a thin, non-slip sole with good tread. Ensure the laces are tied!
6. Use a gait aid
For some people with impaired balance a cane or walker may help you walk more safely and with more confidence. Speak to a physiotherapist or occupational therapist to help with choosing an appropriate aid, fitting it properly and learning to use it correctly.
The processes in our body that keep us physically stable and balanced normally work on autopilot. Trying to maintain these processes consciously takes a lot of concentration, and can make you feel very distracted and fatigued. By adopting some of the above suggestions, and keeping an eye out for signs of the onset or worsening of balance, you can reduce the risk of falls, be less fearful, and more independent.
Laura Stewart, BScH, MScPT, is a physiotherapist working in both private homecare and community clinics in Toronto.
The most common reasons for falls
• Your vision may decrease which can lead to falls due to not seeing clearly.
• Your hips and legs can become weaker making it harder to walk.
• We can develop poor posture or have spinal degeneration making it harder to stand erect.
• Our ability to lift our feet decreases and we can stumble.
• It takes longer to react when something is in our way causing us to fall.
• Many drugs interact causing dizziness or decrease balance.
• Low blood pressure can lead to light-headedness increasing our risk of falls.
• Balance problems involving vertigo and ear infections. Talk to your doctor about any of these symptoms.