Balance plays a key role in the vast majority of typical activities we perform throughout our day. Whether it is reaching for a dish, standing while talking to a neighbor, or swinging a golf club; the importance of maintaining the highest functional level of balance cannot be understated. Balance tends to decline as we age; which puts older adults at an increased risk for falls, and subsequent injury. However, difficulties with varying levels of balance can affect people at all ages. Impairments in balance can often be a secondary effect of many other conditions, including stroke, arthritis, multiple sclerosis, and neuropathy; just to name a few.
There are multiple systems of the body that impact balance; they include the visual, somatosensory, vestibular, and musculoskeletal systems. The visual system plays a role in balance by allowing you to see any obstacles in your path, and react accordingly. The brain also receives visual signals to help perceive how the body is oriented in regards to its surroundings. The somatosensory system includes tactile sensation (touch), and proprioception (positional awareness). Tactile sensation in our feet allows us to feel them on the ground below us. This allows us to be aware of any changes in the surface we are walking on. Our proprioceptive system allows us to understand the position of our joints, this is particularly important in our ankles in order to be aware of any postural sway and react accordingly to correct balance. The vestibular system is located in the inner ear; it functions in balance by detecting movements of the head. This allows for clear vision with motion, and maintaining upright positioning. The musculoskeletal system involves our muscles, bones, tendons, and ligaments. It is important to maintain good flexibility and strength in our muscles; as they help to stabilize in balance tasks. If muscles are overly tight, they will be unable to allow for motion required to move correctly, or to compensate if you are losing your balance. Maintaining good muscular strength is important throughout the body. Our postural muscles (i.e. those in the shoulder, back, and abdominals) help to sustain optimal positioning for good balance. Lower extremity strength, from the hips down to the ankles, is important to preserve stability in both static (standing still) and dynamic (moving) tasks. Should one of these systems become compromised, it is important that the remaining function at the highest possible level to overcome that deficit.
Physical therapy can be utilized to rehabilitate areas that have been weakened or injured and to increase the functional level of the others. For example, in a patient with visual impairments, physical therapy can be utilized to improve the function of the vestibular system; as well as increase muscular strength and flexibility. Physical therapy allows you to challenge your balance and perform activities that are difficult, while in a safe setting with professionals who can properly cue you for methods to better perform these activities. Your therapist will perform a comprehensive examination to determine where your particular deficits lie, and will then establish a program focusing on your individual needs. Programs tend to encompass all areas that impact balance; including stretching muscles that are overly tight, strengthening those that are weak, using varied surfaces/directions of movement, performing tasks with eyes closed, and decreasing base of support. There is also a focus on incorporating functional tasks into therapy treatments. A common complaint we hear from people who are coming to therapy for balance is they find they have increased difficulty maintaining their balance while walking in crowds, or in grocery stores when trying to look for objects. Therapy will mimic these scenarios by providing patient with perturbations (similar to being jostled in a crowd), and teaching appropriate reaction strategies. Another common exercise is having a patient walk while both nodding and turning their heads, similar to what we do in a grocery store to look for the box of cereal we want while still moving down the aisle. These are just a few examples of the many activities a patient may perform in therapy as part of a balance training program.
It is extremely important to feel safe and confident with functional mobility to uphold a high quality of life. Having feelings of limitations in balance will decrease the possibility of this. Fortunately, there are treatment options available to improve balance and mobility, to uphold your personal lifestyle goals.
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