Balance is an important ability that allows us to walk, stand, and move without falling. As we age, balance often declines due to a combination of factors including muscle loss, vision changes, inner ear problems, neuropathy, arthritis, and side effects of medications. Fortunately, balance can often be improved through exercise, physical therapy, vision treatment, and making changes to reduce fall risks at home.
What causes poor balance?
There are many potential causes of poor balance, including:
- Muscle weakness – Loss of muscle strength and tone, especially in the legs, affects balance.
- Neurological problems – Diseases like Parkinson’s and MS impair balance.
- Arthritis – Joint pain and stiffness can throw off balance.
- Inner ear disorders – Conditions affecting the vestibular system disrupt balance.
- Neuropathy – Nerve damage in the feet causes loss of sensation.
- Vision loss – Impaired vision or depth perception affects balance.
- Side effects of medications – Some medicines cause dizziness.
- Deconditioning from inactivity – Lack of movement leads to balance decline.
In many older adults, poor balance is caused by multiple interacting factors like weak muscles, neuropathy, and medications. A physical therapist can help diagnose causes of imbalance through examinations and tests.
How is balance tested by doctors?
Doctors use several tests to evaluate and diagnose balance problems:
- Romberg test – Assesses standing balance with eyes open and closed.
- Tandem stance – Measures ability to stand heel-to-toe.
- Single leg stance – Times how long you can stand on one leg.
- Push and release test – Checks postural reactions.
- Tinetti balance test – Scores gait and balance on a 28 point scale.
- Fukuda stepping test – Detects abnormal sideways veering.
Your doctor may also order imaging tests like CT or MRI scans to identify any underlying brain or inner ear abnormalities contributing to imbalance.
What exercises improve balance?
Balance and stability can be enhanced through exercises that strengthen muscles, improve flexibility, and train balance reactions. Recommended exercises include:
- Tai chi – Slow focused motions improve posture and proprioception.
- Yoga – Poses challenge balance and core muscles.
- Standing on one leg – Builds single leg stance time and strength.
- Heel-to-toe walking – Trains gait and control.
- Hip bridges – Strengthens glutes and hamstrings.
- Calf and toe raises – Improves ankle stability.
- Balance beam or discs – Challenges dynamic balance.
Start with simpler balance exercises and gradually increase the difficulty. Use a chair or wall for support initially. Aim for at least 30 minutes per day to improve balance through exercise.
How can physical therapy help poor balance?
A physical therapist can provide personalized treatment to enhance poor balance, including:
- Balance and gait training exercises
- Strengthening exercises for core, legs and feet
- Flexibility training to improve range of motion
- Assistive equipment like canes and walkers
- Balance aids like balance boards and cushions
- Electrical stimulation to improve muscle activation
- Massage and stretching for tight muscles
The physical therapist will tailor the program to your specific balance impairments and goals. They may also recommend follow up with relevant doctors if they suspect a neurological or inner ear disorder is affecting your balance.
What assistive devices help with balance issues?
Several assistive devices and mobility aids can help provide stabilization and prevent falls for people with poor balance, including:
- Canes – Improve stability while standing and walking.
- Walkers – Allow holding on with both hands.
- Crutches – Help support weight when standing or moving.
- Grab bars and handrails – Provide support in bathrooms and halls.
- Shower chairs – Allow sitting while bathing.
- Raised toilet seats – Make sitting and standing easier.
- Anti-slip bath mats – Prevent slips in the tub or shower.
- Hearing aids – Improve inner ear balance function.
Consult with a physical therapist to determine which assistive devices are most appropriate for your individual needs and environment.
What balance exercises can be done at home?
You can improve balance with the following exercises at home:
- Stand on one leg while brushing teeth or waiting in line.
- Walk heel-to-toe in a straight line across the room.
- Stand up and sit back down repeatedly from a chair.
- Practice getting up from lying on the floor.
- Tai chi or yoga using a DVD or YouTube videos.
- Stand with one foot in front touching heel-to-toe with back foot.
- Shift weight side-to-side while standing and swing arms.
- Dance to music which challenges balance and coordination.
Make sure to have a chair or counter nearby to hold for support when needed. Start with easier exercises and do them more frequently until you build up stamina.
How can vision problems affect balance?
Vision greatly affects balance and stability. Balance declines when vision is impaired due to:
- Blurry vision from refractive errors like near- or far-sightedness.
- Cataracts causing foggy, blurry vision.
- Glaucoma leading to peripheral vision loss.
- Macular degeneration impairing central vision.
- Diabetic retinopathy damaging the retina.
- Stroke or brain injury affecting visual processing.
Getting regular eye exams and updating prescriptions ensures you have proper vision correction. Treatment for eye diseases like cataracts also improves vision and balance.
What home modifications prevent falls?
Making home modifications reduces fall risks and improves safety and mobility if you have balance impairments:
- Install grab bars in bathrooms near toilets and in showers.
- Use non-slip mats in bathrooms and rooms with tile or wood floors.
- Ensure stairways are well-lit with railings on both sides.
- Remove tripping hazards like loose rugs and cords.
- Use chair and bedside lifts to make standing easier.
- Install ramps for entryways with steps.
- Improve lighting throughout the home.
An occupational therapist can conduct a home evaluation and recommend assistive equipment and changes suited to your needs.
How do medications affect balance?
Many common medications can negatively impact balance and increase fall risk, including:
| Medication Type | Examples | Balance Side Effects |
|---|---|---|
| Blood pressure medications | Diuretics, beta blockers | Orthostatic hypotension |
| Anti-anxiety medications | Benzodiazepines like Valium | Drowsiness, dizziness |
| Antidepressants | SSRIs like Zoloft | Lightheadedness |
| Narcotic pain medications | Opioids like oxycodone | Dizziness |
| Muscle relaxants | Cyclobenzaprine, tizanidine | Fatigue, weakness |
Talk to your doctor about potential side effects and dose adjustments if medications you take are affecting your balance.
Can inner ear disorders cause balance problems?
Since the inner ear houses the vestibular system that controls balance, disorders in this area frequently cause dizziness and imbalance. Conditions include:
- Benign paroxysmal positional vertigo (BPPV) – calcium debris in inner ear canals causes vertigo when moving the head certain ways.
- Labyrinthitis – inner ear infection irritating vestibular nerve.
- Meniere’s disease – inner ear fluid buildup causes vertigo and hearing loss.
- Vestibular neuritis – inflammation of the vestibular nerve.
- Acoustic neuroma – noncancerous inner ear tumor compressing balance nerve.
Medications like Meclizine can provide symptom relief though specific inner ear disorders may require specialized treatment. Vestibular rehabilitation exercises can also help strengthen balance.
When to seek medical care for balance problems
See your doctor promptly if you experience:
- Sudden severe dizziness, vertigo, or nausea
- New falls or difficulty walking due to loss of balance
- Head injury with vomiting, headache, or balance changes
- Double vision, weakness, or numbness along with balance problems
- Hearing loss or ear pain accompanying dizziness
Rapid onset balance problems could indicate issues like stroke, brain injury, or inner ear damage needing medical evaluation. For slowly progressive imbalance, see your doctor to identify underlying causes and appropriate treatment.
Conclusion
Balance tends to decline with age but can often be improved with a combination of exercise training, physical therapy, vision correction, home modifications, and medication adjustments. Medical attention is advised if you develop severe, sudden onset imbalance which could indicate a neurological or inner ear condition. With appropriate treatment, many older adults can enhance balance, maintain mobility, and reduce fall risks.