By Mike McCormack, Grace Cottage Physical Therapist
Winter brings its challenges, among them the risk of falling.
Falls are not just scary and uncomfortable; they’re also dangerous, especially for those ages 65 and older. According to the U.S. Centers for Disease Control (CDC), one of every four older adults will fall each year, making this the leading cause of injury and death-by-injury in this age group. As many as 32,000 deaths each year can be attributed to effects from a fall.
But falls aren’t an inevitable part of aging. Balance is like any other skill – if you don’t use it, you lose it! You can’t improve your balance unless you challenge it. That’s where physical therapy (PT) comes in. PT can help improve your balance by diagnosing the underlying cause and challenging your balance in a safe environment.
Your sense of balance is affected by three systems: your vestibular system, visual system, and proprioceptive system.
First, balance can be affected by disturbances in the vestibular system, a series of fluid and canals in the inner ear that act like a carpenter’s level, helping relay information to our brain regarding our head’s position.
One common vestibular disorder is Benign Paroxysmal Positional Vertigo (BPPV), which causes episodes of a spinning sensation known as vertigo. BPPV happens when crystal particles in the inner ear are dislodged and end up in one of the canals that act as our “carpenter’s level.” This can send mixed signals to our brain and make us disoriented. These symptoms come on quickly, often within seconds of head movements (lying down, rolling over, or looking up). Often, it’s described by patients as the room seeming to spin around them. After these episodes, balance issues can last for hours or days, sometimes with light-headedness or the feeling of floating.
BPPV can clear up on its own, but working with a physical therapist or another medical professional who treats vestibular disorders can bring improvement more quickly – sometimes in just one session! The treatment includes movements to bring on the vertigo symptoms followed by specific maneuvers that shift the crystals back into place.
The most obvious system that affects balance is the visual system. As we all know, the less we can see, the less steady we are on our feet. We heavily rely on our vision – especially as we age.
PT can’t improve a patient’s vision, but the therapist can offer ideas to accommodate for vision loss. We suggest night lights and the use of assistive devices to reduce fall risk when getting up to use the restroom at night. Also, we love practicing balance in the clinic with your eyes closed to tune-up your other systems. Don’t worry, we’ll keep it safe!
One last system that affects our balance is our proprioceptive system. Our joints, ligaments, and tendons have receptors that tell our brain where our body is in space. If I close my eyes and move my leg, my proprioceptors are relaying this information to my brain, allowing it to estimate where it has moved to. Most of the time, this sense is instinctive – we don’t have to think about it. We can adjust naturally to correct balance as we stand, move, or walk on uneven terrain.
Neurological disorders or musculoskeletal injuries can affect proprioception. For example, patients with diabetes may have decreased sensation in their feet, or someone who sprained an ankle can have delayed or inaccurate signals from their proprioceptors. Balance training with PT can help either to compensate or remediate proprioception deficits.
One of the biggest problems resulting from balance issues or in the aftermath of a fall is the tendency to be inactive, in the hopes that this will prevent another fall. This only makes matters worse. Our body does well at trying to keep us as safe as possible. But remember, you can only improve your balance if it’s challenged! PT can help do that in a safe environment.
When everything is working properly, our brains process information from our vestibular, visual, and proprioceptive systems very quickly and subsequently send signals to keep us on our feet. But when some part of the system is malfunctioning, PT can help tune it up.
Without intervention, those who have fallen once have an increased risk of falling again. PT is an important resource for anyone who has fallen, helping them to regain mobility and teaching them ways to live more independently. Talk to your doctor if you have fallen or think you could benefit from a balance assessment.
