Balance is the system our body uses to keep us upright, helps us catch ourselves when we trip, and lets us walk, dance, and run without falling over. Our balance system is constantly being used, even when we are sitting down! There are three systems that make up our balance system. The first is proprioception, the second is vision, and the last is our vestibular system. All three are intricate and purposeful and they all help us with our daily activities. 

Proprioception

Proprioception is our internal awareness of where we are in space and how we are moving. Proprioception is used consciously and unconsciously so that we know the angles of our joints, how much force to produce with movement, to sense how and where we are moving, and to sense a change in our velocity. We use proprioception to help us balance constantly, it specifically is helpful when we are on uneven surfaces. Our brain uses constant input from our joints, especially our ankles, knees, and hips in order to keep us upright. When we are on an even surface, like a hardwood floor or smooth concrete, our brain has an easy time keeping us standing up. Our peripheral nervous system (nerves outside the brain and spinal cord) sends signals to our central nervous system (the spinal cord and brain) to tell us where our joints are, and if we need to make adjustments to our posture. When you are on an uneven surface, your joints and peripheral nervous system send signals to your central nervous system to make chronic adjustments so that you don’t trip on the surface. If your brain begins to process this information too slowly or if you receive poor signals for any reason you will have a harder time balancing. If you practice balancing on uneven surfaces your brain will relearn how to balance on all surfaces and you will have an easier time walking on surfaces like carpet, grass, and gravel.

Vision

Being able to see is another important variable in your balance. You may notice that when your eyes are closed or if it’s dark outside you have more trouble standing or walking around. Your visual system provides extra information to your vestibular and proprioception systems to process the information being provided to them. Something as simple as putting on your glasses or turning on the light can drastically improve your balance. Vision is the most relied upon system in our bodies; it is important that we can use vision if we have the option. Going to the optometrist or ophthalmologist is vital if you have visual dysfunction! However, over-relying on your vision can also be dangerous. When we are over-reliant on our vision we don’t utilize the other systems that are important for keeping us upright, our proprioceptive and vestibular systems.

Vestibular

Your vestibular system is an essential part of your balance. Your vestibular system is your inner ear system responsible for balance when you can’t see, can’t feel the floor well, or both! Your vestibular system has its biggest job if you’re walking on grass at night. This system will help your balance, and processing information from the other two systems to adjust your body in space. In practice, we often find that there are many people whose brains have unlearned this system. 

Impairment of any of these three systems can lead to poor balance, falls, and the feeling of general unsteadiness. Additionally, some patients with vestibular dysfunction report nausea, dizziness, and swaying when they are still. Many of my patients say that they assume that falling and balance dysfunction is “just a part of aging” and that they should “just get used to it”. On the contrary, balance dysfunction should NOT be a part of aging, and it should NOT be something you just get used to. There are so many ways you can work on your balance, independently or with a physical therapist. 

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