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  • Writer's pictureDavid Wilderman

What You Need To Know About Balance Issues.

Updated: Mar 4, 2021

If you’ve ever had an episode where you lost your balance it can be extremely scary! And the older you get the greater the chance you’ll lose your balance. As a matter of fact, 75% of Americans over 70 years of age are diagnosed as having “abnormal” balance. This makes it difficult for individuals to maintain stable upright positions when standing, walking, and even sitting. Among the elderly, balance problems are slightly higher in women, although the difference is rather small. And when people reach their 80s, balance problems increase by 30%. That’s why it’s extremely important to see a Physical Therapist who can develop individualized physical activity plans to help improve mobility, stability, and strength of people with balance issues.

What are some causes of balance issues?

If a person has trouble maintaining a stable and upright position, then they have balance issues. There are a multitude of factors causing balance issues, including:

  • Simple aging

  • Lack of activity or a sedentary lifestyle

  • Muscle weakness

  • Joint stiffness

  • Inner ear problems

  • Some medications (such as those prescribed for high blood pressure and depression)

Certain medical conditions can also lead to balance issues, including:

  • Parkinson’s

  • Stroke

  • Multiple Sclerosis

  • Traumatic brain injury

  • Spinal cord injury

  • Diabetes

  • Arthritis

  • Cognitive diseases

In addition, when 1 or more of 4 systems in the body are not working properly, balance issues can occur. They are:

  • Muscular system

  • Inner ear

  • Vision

  • Proprioception (awareness of one’s own body position)

You can begin to lose muscle strength and flexibility due to disease, lack of exercise, or a sedentary lifestyle. Inner ear problems (linked to your vestibular system), can occur due to disease, aging, poor nutrition, or trauma. Visual problems can arise from eye disease, eye tracking issues, or just age in general. And proprioceptive issues can occur as a result of trauma or a disease, such as diabetes.

Your brain is responsible for coordinating all of your sensory inputs from your inner ear, eyes, and body position sense. It then relays information to your muscles to make them move or to make adjustments to maintain balance. However, if one or more of your senses is not relaying accurate information to the brain, or if your muscles are not capable of carrying out the necessary movements, then an individual may not be able to maintain or correct their balance.

What do balance issues feel like?

If an individual is experiencing balance difficulties, they may experience stumbling, swaying, dizziness, vertigo, and ultimately falling. Even though someone’s static balance may be alright when standing still or just performing a single task, dynamic balance issues may be exposed when that person is moving about or attempting to multitask (e.g. walking while looking for something in your purse) or when there is minimal light (e.g. trying to walk to the bathroom at night in a darkened room without turning on the light). If you have a problem with your dynamic balance, you are more likely to fall, leading to possible injury.

There are also psychological factors at work here as well. If an individual has balance issues they can become fearful of doing even simple day-to-day activities. This apprehension can lead to muscle weakness and frailty because they are avoiding challenging or strenuous movements. This can ultimately lead to frustration and depression.

What does a Physical Therapist look for to determine if an individual is at risk due to balance issues?

Your Physical Therapist is a great place to start for getting you on the right track to resolve your balance difficulties. Of primary importance is a detailed evaluation that includes your medical history. Some questions you should be asked include:

  • How frequently are you experiencing balance issues?

  • What are you doing at the time you are experiencing your balance issues?

  • Does it feel like the room is spinning?

  • Are your balance issues worse at night or in dark rooms?

  • Have you fallen in the past year? If yes, how many times?

  • Did you sustain any injuries from your falls?

  • Have you had to alter your daily routine or limit your activities due to your balance issues?

  • When was your last eye exam?

  • When was your last hearing test?

  • Are you currently taking medications? If so, what are they and for what condition(s)?

  • How active are you? Do you exercise?

  • What are your balance issues preventing you from doing?

  • What would you like to be able to do if your balance issues were no longer a problem?

Aside from the above questions, your Physical Therapist should also perform tests to determine your strength, mobility, coordination, visual tracking, and balance deficits. It is also important that your Physical Therapist collaborate with any medical professionals involved in your care to determine if additional diagnostic testing is needed.

What can you expect from Physical Therapy?

Your Physical Therapist should be trained to evaluate multiple body systems such as joints, muscles, eye tracking ability, inner ear, proprioception (position awareness in the joints), neurological (reflexes), and skin sensation. They would then prescribe an individualized treatment program based on your particular deficits and goals that would most likely incorporate stretching, strengthening, visual tracking, inner ear retraining, and balance/coordination activities that you would also be able to do at home. Let’s look at the specific ways in which Physical Therapy can help you:

Improve mobility–To help you move with more ease, coordination, and confidence.

Increase strength–To be able to address muscle weakness by improving overall strength, especially in your hips, trunk, and core. Exercises can utilize bodyweight, resistance bands, dumbbells, kettlebells, cuff weights, etc.

Improve your quality of movement–To help you restore normal movement in any of your joints that may be stiff, these motions can begin passively (your Physical Therapist performs them on you) and progress to active and resisted exercises that you perform on your own.

Improve posture–You will have a postural assessment performed by your Physical Therapist so you can learn exercises to improve your ability to maintain proper posture. Good posture leads to decreased risk of balance issues.

Increase your activity level–This will depend on your current physical state. An individualized exercise program will be designed to address your individual needs and goals.

Reduce fall risk–This can include education on proper footwear as well as identification of safety hazards in your home such as loose (throw) rugs, poor lighting, unrestrained pets, and other potential obstacles.

Reduce fear of falling–This will allow you to regain confidence in your balance and your ability to move freely so you can resume performing your necessary daily activities. As your confidence grows, your sense of frustration and dependence diminish.

Can you prevent balance issues from occurring?

Here are some top tips your Physical Therapist should include when discussing prevention of the possibility of balance issues from occurring:

  • Stay active–The best piece of advice is to avoid a sedentary lifestyle. Try to do physical activities such as walking, gardening, climbing stairs, and even washing dishes by hand. If you follow an exercise routine, stick with it!

  • Get yearly checkups–Specifically for vision and hearing. And certainly make sure your eyeglasses prescription is up-to-date!

  • Keep track of your medicine–If you think you are taking one or more medications that may be affecting your balance, let your Physical Therapist of physician know right away.

  • Manage chronic disease–In particular, diabetes, since long-term side effects generally include balance issues. A check of your medications and diet is also imperative.

If you or someone you know is experiencing balance issues, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at to schedule your FREE 30 minute consultation to see how Physical Therapy can help. Don’t delay–schedule now!

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