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Where Does Balance Come From?

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Updated May 02, 2012

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The ability to stand and walk upright on two legs requires a great amount of balance. This balance requires the coordination of many systems in the body. These systems work together to help keep the body upright and help to prevent falling. There are three main systems that help control balance in the human body.

  1. Visual system. The visual system provides you with a picture of where things are in your environment. It also provides information about where you are in relation to your environment. Occasionally balance can be affected by decreased visual acuity. The visual system works closely with your vestibular system to help maintain balance.
  2. Vestibular System. There are specialized structures in your inner ear that help provide your brain with information about the position of your head and the forces that are acting on your head. These structures act like levels; they are filled with fluid and as the fluid moves to one side or the other, nerves are stimulated, and the signal is processed by the brain. The vestibular system is responsible for helping to maintain proper head position, and it works closely with the visual system to coordinate head and eye movement.
  3. Proprioceptive System. There are specialized cells in your muscles, joints, and tendons that help monitor the position of your body. They also provide information about how much stress or force is on a muscle or joint. This system helps to tell the brain what type of surface you are standing or sitting on. It also allows the brain to understand what position your body is in.

Injury to one or more of these systems may result in loss of balance and increased risk of falling, and aging can also cause these three systems to work less efficiently.

The musculoskeletal system and nervous system also play a major role in maintaining balance. Frequently, impairments to these systems may affect your ability to stand or walk normally. Common impairments include:

  • Decreased strength.
  • Loss of flexibility.
  • Poor posture.
  • Slowed reaction time.

Who Is At Risk for Falling?

While anyone can lose their balance and fall, certain people are a greater risk for loss of balance and falls. These include:

  1. Older adults. Older people typically experience loss of balance and are at a greater risk for falling. This is due to changes in muscular strength, loss of flexibility, and decreased reaction time that may occur with aging. Also, eyesight may deteriorate with aging, and this decreased vision can lead to falls. As you age, your posture may change. When this occurs, your center of gravity may change, and this may lead to changes in your gait and increase your risk for falls.
  2. Those with poor vision. When visual acuity is decreased, information about where things are in your environment may be impaired, and this can lead to decreased balance.
  3. Those with lower extremity injury. Injury to a leg or legs may lead to weakened muscles or decreased proprioception. Leg weakness may alter your gait, or the way you walk. This can lead to loss of balance and falling.
  4. Those with a history of falling. It may seem obvious, but people who have fallen in the past are at a greater risk for falling in the future.

Balance Can Be Improved

The systems that help control balance can be strengthened to help improve balance and minimize falls. Exercises can be performed to help strengthen muscles, and specific balance exercises can help improve your reaction time to minimize falls. Making minor adjustments to your home can help improve safety and prevent falls. Injury to the vestibular system can cause dizziness or vertigo, and this can have a profound effect on balance. Together with your doctor, your physical therapist can help you determine the cause of your dizziness and provide strategies to help decrease the symptoms and improve balance.

It is important to check with your physical therapist to ensure that balance training is safe for you to do. Also, he or she will be able to tell you which systems are most impaired or weakened, which can help focus your exercises on the systems that need it the most. A gait evaluation can be performed to analyze the way you are walking and determine if you need assistance when walking. A physical therapist can also help you choose a device like a cane or walker to help with walking and balance.

Balance is a complex coordination of many systems in the body. By understanding which systems are impaired, you can engage in strategies to maintain proper balance and minimize your risk of falling.

Source: O'Sullivan, S. B. (1994). Physical rehabilitation: assessment and treatment. Philadelphia: F.A. Davis Comapny

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