Balance Disorders

The basics of balance disorders

  • People with balance disorders find it difficult to maintain an upright and stable body position during motion or when being still, either standing, sitting or lying down.
  • Balance problems can be due to a variety of causes including vestibular impairment, foot/ankle injury, traumatic brain injury or as a side effect from medications.
  • There are several different systems within the body that work together to maintain a person’s balance. If there is impairment in one or more of these systems, one may start to feel off balance.
  • Physical therapy can improve these malfunctioning body systems with exercises, vestibular therapy and balance retraining.

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What are balance disorders?

Depending on the cause of the balance impairment, individuals may experience dizziness, unsteadiness while on their feet and fear of falling when moving around.

These problems are not the same as when a person has a dizzy spell every now and then. Balance disorders can have a serious impact on daily activities as simple as walking, which can lead to further emotional distress and other physical impairments.

Balance problems are fairly common, with approximately 40% of people in the United States experiencing some form of balance problem or dizziness at some time in their lives. Falls are one of the biggest concerns for someone with impaired balance.

Who can treat balance problems?

Physical therapists and occupational therapists can treat these issues to improve a person’s balance and reduce the risk of falls. People with impaired balance can make an appointment with Spine & Sport Physical Therapy without a doctor’s referral and begin treatment. (See more on physical therapy treatment below.)

If the balance impairment comes on suddenly and/or severely, that person should see a primary care physician to determine the cause of the problem. He or she may be referred to either an otolaryngologist or an audiologist depending on the suspected cause of the imbalance. The otolaryngologist specializes in disorders of the ear, nose, throat and neck; an audiologist is a clinician who treats hearing and vestibular system issues. Other courses of action include referral for imaging, referral to physical or occupational therapy, and medication.

What causes balance disorders?

Three primary bodily systems contribute to our balance: vision, the vestibular system in the inner ear and proprioception, which is sensation and the awareness of the body’s position in space. The brain is responsible for integrating the information received from these three systems to maintain balance. If one or more of these systems is not functioning properly, a balance disorder can result.

There are a variety of causes for such problems in the body’s systems resulting in balance difficulty. Trauma, weak muscles, hearing impairments, medications, inner ear issues, inactivity and problems with vision can cause balance issues. Age increases the risk of having difficulty with balance.

Many problems with balance are caused by underlying medical conditions, including:

  • Vestibular impairments.
  • Neurological conditions.
  • Traumatic brain injury including concussions (see below).
  • Stroke.
  • Diabetes.
  • Multiple sclerosis.
  • Parkinson’s disease.

Disorders causing balance problems

Some of the more common disorders resulting in balance issues we see at Spine & Sport Physical Therapy follow.

Following traumatic brain injury (TBI)

Anywhere from 30% to 65% of people with traumatic brain injury (TBI) have balance problems some time during their recovery. Concussions, which we treat, are mild forms of TBI. Dizziness, lightheadedness and imbalance are common symptoms. These will vary depending on the severity of the TBI and where it occurred in the brain.

The brain may have difficulty synthesizing the information from visual, vestibular and proprioceptive systems following a brain injury leading to imbalance. Other common causes of balance problems after TBI include medications, a drop in blood pressure when suddenly sitting or standing, and sensory impairment.

Benign paroxysmal positional vertigo (BPPV)

This is a common cause of dizziness, which can be successfully treated with physical therapy in as little as one session. BPPV causes a sudden and usually intense sensation of dizziness that lasts up to 30 seconds. Specific changes in head positioning, such as rolling over in bed or looking up, usually trigger BPPV.

BPPV is caused by the displacement of small calcium carbonate crystals, which normally are located just outside of the canals of the inner ear that are called the semicircular canals. Normally these crystals function to detect motion of the head. If a crystal becomes dislodged and lands in a semicircular canal, the brain receives confusing messages from the ear and leads to a sensation of dizziness. A physical therapist can dislodge this crystal from the semicircular canal, which will stop the dizziness from occurring.

Vestibular neuritis

Vestibular neuritis is an inflammatory disorder affecting the vestibular nerve that connects the brain and the inner ear, causing prolonged vertigo. The condition usually comes on quickly and in addition to vertigo can prevent one from walking straight or maintaining balance. Vestibular neuritis can also cause nausea and vomiting.

Vestibular migraine

Vestibular migraine is a disorder of the nervous system related to the inner ear that results in vertigo and dizziness in people who have a history of experiencing migraine headache symptoms. But vestibular migraine doesn’t always come with a headache and the most common symptoms are dizziness that occurs off and on. Other symptoms can include balance problems, nausea, heightened sensitivity to motion, confusion and disorientation.

Meniere’s disease

Meniere’s disease is a balance disorder of the inner ear that often affects just one ear and is a common cause of hearing loss. Meniere’s disease can cause bouts of dizziness that can come on quickly, or occur after a short episode of tinnitus (ringing in the ear). In some people, the disease causes drop attacks in which dizziness is so extreme that it causes the person to lose balance and fall down.

Balance disorder symptoms

Symptoms of balance disorders vary with the individual and the cause, but the general feeling is one of unsteadiness. Balance can be fine when standing or siting still (static balance), but problems arise with movement or doing more than one thing at a time (dynamic balance). Balance disorder symptoms include:

  • Feeling wobbly when standing up or sitting up.
  • Stumbling or staggering when walking.
  • Vertigo or dizziness.
  • Falling down or the sensation that one is going to fall down.
  • Lightheadedness or a sensation of floating.
  • Blurred vision.
  • Feeling unsteady when bending down.
  • Difficulty with walking or maintaining balance in the dark.

Risks of not treating balance problems

People with untreated balance disorders can avoid movements that cause dizziness or instability, and this lack of activity weakens muscles and makes the balance issue worse. The risk of falls also increases, which can lead to further injury, even death especially for the elderly. Frustration from reduced activities can lead to depression in those with untreated balance problems. It is important to determine the underlying cause of imbalance as this can be a side effect of a more serious condition.

Physical therapy for balance disorders

Physical therapists or occupational therapists may provide treatment, depending on the specific balance issues. Our team of physical or occupational therapists will first assess the extent of the balance impairment and the systems of the body that may be contributing to them: muscles & joints, inner ear, vision, and sensation and awareness of body position (proprioception). Our team will test and evaluate the patient’s movement, strength, coordination, vision and vestibular function.

After completing a thorough examination, the physical or occupational therapist will prescribe treatment based on the root cause of the problem. A thorough exam may also involve additional testing such as imaging and blood and hearing tests, which need to be completed by a physician. The therapist will work closely with the team of medical providers to determine the cause of the imbalance. Some issues may require medications or surgery. In such cases, our therapists will refer the patient to the proper provider for those treatments.

Physical therapy treatments are tailored to the person’s condition, specific challenges and goals.

Physical or occupational therapy can’t always cure balance problems, but at the very least it can help patients compensate for having less balance and improve safety with daily activities. Specific treatments can vary according to the type of disorder and may include:

  • Eye exercises to improve vision and vestibular function.
  • Strengthening exercises for any weak muscles contributing to imbalance.
  • Balance retraining.
  • For patients with BPPV, maneuvering the head to remove foreign objects from the inner ear.
  • Lifestyle and diet changes may help with certain types of balance disorders.
  • Education on ways to minimize risk of falling in the home.

Reducing fall risk, which may include assessing the home environment, is often a primary goal. Our therapists will guide patients on ways to improve their safety within the home and community, as well as prescribe activities and exercises that make the patient less fearful of falling.

Building this confidence is important to get the patient more comfortable with movement, and therefore more likely to re-engage in activities of daily living he or she has been avoiding.

When to see a doctor for balance issues

A person should see a doctor if the balance issue:

  • Comes on suddenly and severely.
  • Is associated with impaired vision (vision loss, double vision).
  • Is associated with slurred speech.
  • Includes neck pain or headaches.
  • Causes vomiting.
  • Results in fainting, falling or difficulty walking

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