Maintaining Proper Balance

Matthew Gordon, PT, DPT talks about how to maintain proper balance.

Today we are going to be talking about our balance and the different components that are involved. To start can you talk about what systems contribute to having good balance?
Overall there are three systems that contribute to good balance. The first is our visual system – most people know this one because when they close their eyes they feel themselves begin to sway or they will feel less balanced. The second is our proprioception system. This system tells us where we are in space – and for balance it is extremely important to know where your feet, knee, hips, and trunk are located and which direction they are moving. The third system is the vestibular system – this is a portion of the inner ear and its job is to give us information of vertical and rotational movements of our bodies. Most people have heard of the vestibular system as it relates to vertigo.

What causes our balance to be impaired?
Each of the three systems we just talked about gives us a different form of sensory input. But while these forms of input are different they should correlate. For example, “If you turn to the right, you will see the environment turn with you, you will feel the joints move in that direction, and your vestibular system will give you input that signals a right turn is occurring.” If one of these systems is not functioning properly the signals no longer correlate and a conflict arises and results in instability. An example of this instability is seen in people who have neuropathy or decreased sensation in their feet – these patients have reduced proprioception and because of this reduced sensory input their balance is greatly altered.

We mentioned the vestibular system a few times already - what does the vestibular system do?
The vestibular system is a portion of the inner ear and it gives us information about the vertical and rotational movements of our bodies. We have a vestibular unit in both the left and right inner ears and the signals from these two units should match each other as well as correlate with visual and proprioceptive inputs.

How does the vestibular system contribute to our overall balance?
The vestibular system is great at resolving conflicting information when it occurs from the two other systems and it reflexively acts to help increase out balance. When working correctly our vestibular system corrects our balance before we even are typically even aware of the instability.

What happens if the vestibular system is not working correctly?
When this happens you lose the ability to resolve conflicting inputs and instability will follow. Typically, people state that they feel “off,” “light headed,” and that they feel a few inches outside their body to one side or the other. People with vestibular issues will have trouble walking straight lines because they are less aware of these rotational movements. They also tend to not like turning quickly or transitioning from lying to sitting or sitting to standing and vise versa because they find this makes them dizzy.

What kind of training can you do to help strengthen the vestibular system?
As I mentioned before the vestibular system gives us information about vertical and rotational movements – so to train the system we have patients do vertical and rotational head movements – this may sound odd or to simple, but this is the same idea as when we are training a muscles. If you came to me and said you wanted stronger biceps in your arms, I would have you do bicep curls – the reason you would do these curls is because bending the elbow is primarily done by the biceps – thus if we do that with resistance we will stimulate growth and strength gains. The same is true for the vestibular system – it senses vertical and rotational movements – thus we train with the movements at different levels of difficulty in order to stimulate the system towards improvement.

Who benefits from this training?
Honestly, the short answer is we all need it – but anyone who is experiencing decreased sensation in their legs and feet, if your vision is reduced, and if you are suffering from dizziness or decreased balance you will greatly benefit from vestibular training.

I hear that you are starting a balance program at Mettler that also incorporates the vestibular system– can you tell us a little about this?
The class is being structured to challenge people of all levels who want to improve their balance. The class combines vestibular training, with muscular strengthening and endurance work, and proprioceptive training. The goal of the class is to not only train these areas, but to integrate the training of these systems so there is a direct carry over to their everyday lives.

If someone is interested what should they do next?
If you are suffering from any of the issues that we have talked about today or if you simply want to work towards improving your balance the next steps would be for you to call in to the Mettler center and sign up for the class. This is a class that I am personally involved in and believe that if people stick with the program they will not only see improvements in their balance, but has the ability to transform people’s lives.