Have you ever lost your balance while walking on a rocky surface and wondered WHY? What is it about a grassy hill or a rocky trail that makes it more difficult to stay upright? Why do I have to look down when I’m walking to keep my balance? These are all great questions. There are many factors that affect our balance, such as our strength, flexibility, and endurance. However, one of the most important factors is the sensory input we receive from our body.
In order to maintain our balance, there are three things that need to happen. First, we need to receive sensory input from our bodies. Second, that sensory input needs to be processed correctly by the brain. Third, we need to generate motor output to activate our muscles.
Commonly, balance problems occur when there is a breakdown in the sensory input component of the process described above. There are three main systems that we use to generate this sensory input: vision, proprioception (touch), and the vestibular system (inner ear). Under normal circumstances, these systems work together to collect information about our environment that is then sent to the brain for processing. However, when there is a deficit in one of these systems, our balance can become compromised.
The visual system is often the easiest of the three systems to understand. When our eyes are open, they are constantly providing the brain with information about where we are in relation to our surroundings. However, when we close our eyes, we are eliminating one of our most important sources of sensory input. This will force us to rely on our proprioceptive and vestibular systems to keep our balance. Similarly, when we are in a dark environment or have conditions that compromise our vision (such as cataracts or macular degeneration), we are decreasing the quantity and quality of the sensory input that the brain receives from our visual system.
2. PROPRIOCEPTION (TOUCH)
Our proprioceptive system, also called the somatosensory system, involves our sense of touch. Our skin, muscles, and joints all contain receptors for touch. When we are standing, the touch receptors in our feet provide the brain with information about the surface we are standing on and how our weight is distributed. When a person with normal sensation in their feet starts to shift their weight to one side, the proprioceptive system sends that information to the brain, which then tells the body to shift our weight back to the other side. This allows us to stay upright and avoid falling to one side.
There are several reasons that people may have diminished or absent sensation in their feet. This condition is called peripheral neuropathy and is commonly seen in people with diabetes or may also start to develop this condition as we get older. When the sensation in our feet is diminished, our brain does not receive adequate proprioceptive input, and we are forced to rely more on our visual and vestibular systems. Similarly, when we walk on an uneven surface such as a rocky trail, the proprioceptive input from our feet is altered, and we may find ourselves using our visual system to compensate by looking down at our feet as we walk.
3. VESTIBULAR SYSTEM (INNER EAR)
The vestibular system involves a complex apparatus located in our inner ear (which is inside of our skull). This apparatus contains three fluid-filled semi-circular canals. Each time we move our head, the fluid moves inside the canals and stimulates hair cells inside the inner ear, which are sensory receptors. This information is then sent to our brain, which interprets where we are in space.
There are a number of conditions that can affect the function of the inner ear, such as Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis, labyrinthitis, Meniere’s disease, and many others. People that have these conditions receive altered input from the inner ear which causes the brain to receive incorrect information about where the head is in space. This can cause a sensation of spinning, called vertigo, and can greatly affect balance.
While the vision, proprioception, and vestibular systems are not the only factors that can affect our balance, they do play an important role. When we are healthy and active, these systems work together to provide our brain with the sensory input it needs to help us maintain our balance. However, when we have a condition that affects one of our sensory systems, the sensory input to our brain is decreased or altered, and our balance can be affected. It is also possible to become reliant on one sense, even if we do not have a condition that affects one of the sensory systems. This can become problematic when the sense we rely on is challenged. For example, if we become reliant on our vision over time and are then tasked with navigating a dark environment, we may notice that we have a much more difficult time maintaining our balance.
The good news is that we can retrain our brain and our body to utilize sensory input effectively. In other words, our balance can improve with training! Balance physical therapy can be an effective way to improve your ability to navigate challenging environments and decrease your fall risk. As they say, an ounce of (fall) prevention is worth a pound of cure!
If you feel that your balance has declined or if you are experiencing issues with dizziness, please let us know! We treat these areas all the time and are happy to help. You can request an appointment by emailing us at firstname.lastname@example.org or calling us at 301-948-4395.