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10 Reasons Your Balance May be Impaired

Are you afraid of falling, and is that keeping you from doing the things you love? If so, you are not alone.  More than half of people over the age of 60 feel that their balance is impaired.  Often, people do not know why they are unsteady or afraid of falling.  Many assume imbalance is due to aging, injury, or disease and do not realize there are underlying systems that may be the true culprit.  Understanding these causes is an important first step toward improving your balance and reducing your risk for falls.  Here are the 10 most common causes of impaired balance:

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1.     Sensory Systems are not working properly.  The visual, vestibular, and somatosensory systems all provide information into our brain and give us an idea of our body position, posture, and balance.  The visual system is one of the dominant ways we appreciate where we are in the world.  The vestibular system, located in the inner ear, detects changes in rotational movement and linear acceleration.  The somatosensory system uses touch and the position of our joints to provide information about our posture and how our body is oriented in relation to the ground and surrounding environment.  If any of these systems are impaired, you many have difficulty knowing where you are in space and how to maintain you balance.  Also, if there is conflicting information between these three systems (i.e. your eyes see that you moved, but your vestibular system does not sense the acceleration), you may feel off-balance, dizziness, vertigo, nausea, fatigue, or even difficulty concentrating.

2.     Poor Posture can increase your risk of falling.  A big component of balance is maintaining your center of mass within your limits of stability.  Or in other words, keeping your body properly centered over your feet as you move around in the world.  If you have poor posture (mostly commonly hunched forward), it can shift your weight one way or the other, making it more difficult to keep your body centered over your feet.  Also, poor posture contributes to muscle weakness and decreased flexibility which makes balance corrections more challenging.

3.     Fear of Falling actually increases your risk of falling.  In the short term, fear causes you to become more stiff which contributes to smaller movements and makes it difficult to generate the appropriate response with your body.   In the long term, fear can lead to a downward spiral of decreased activity level, social isolation, disuse atrophy, and ultimately heightens your fears.

4.     Stiffness and a lack of flexibility is an overlooked cause of imbalance.  In order to maintain balance in a dynamic world, the body has to make quick and fluid adjustments to prevent falls.  If your muscles are tight or overactive or if your joints do not have the motion needed, then it will be hard to make those quick adjustments.

5.     Weakness, especially in the core and legs, is a common cause of impaired balance.  In order to maintain balance and adjust to perturbations, you must be able to generate adequate force in the muscles.  Weakness will lead to slow reaction times and difficulty catching yourself to prevent a fall.

6.     Medication Side-Effects can be the source of dizziness, imbalance, or unsteadiness with walking.  This side effect could be the result of one medicine, or an interaction of multiple medicines that one might be taking at the same time.

7.     Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens with sudden changes of position.  Gravity causes blood to pool in the legs and abdomen which decreases the blood pressure because there is less blood returning to the heart. Orthostatic hypotension can make you feel off-balance, dizzy or lightheaded and is common in those who are age 65 and older. 

8.     Pain can lead to muscle weakness, loss of mobility, slow initiation of movement, and impaired somatosensation (or touch).  Pain can also make it difficult for the brain to process the information needed to maintain balance.  If you are in significant pain, your risk of falling is increased.

9.     Disuse is another common cause of impaired balance.  The Use it or lose it principle applies to many of the systems in our bodies.  If you do not challenge the balance systems on a regular basis, the response is diminished.  For example, the vestibular and visual system of a child who spins and twirls everyday on the playground will likely tolerate a roller coaster better than an adult who has not challenged those systems in many years.  Similarly, if you do not challenge your muscles, they will get weaker, possibly to the point where balance is impaired.   Pain, injury, fear of falling, and disease processes can lead to avoidance of challenging our balance systems, thus contributing to greater risk of falling.

10.  The brain processes the incoming information and makes split-second decisions in order to maintain balance.   Past experiences, confidence, planning, and judgement are all part of this higher-level process.  Any interruption (from a distraction to lack of practice to an injury of the brain) can contribute to a fall.  The great news – neuroplasticity which means the brain is very adaptable, and with proper training, there is room for improvement.