Five Signs You Might Have Issues
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Balance issues increase as people age, but vestibular disorders can occur at any time.
Credit:Getty / Fly View Productions
You don’t have to engage in gravity-defying acts to appreciate the extraordinary sense of balance that Olympic athletes seem to possess. Yet people often take balance for granted in everyday life—until they get dizzy or fall.
It’s not that Olympians are innately equipped to maintain their center of gravity in space. “Athletes who do a lot of flips and turns, like gymnasts or divers, are highly trained,” explains Jennifer L. Fay, DPT, a board-certified specialist in neurologic physical therapy at NYU Langone’s Rusk Rehabilitation. “They can perform these moves successfully because their brains have adapted to the motion through many years of practice and repetition.”
A sense of balance involves multiple body systems. The most important components are vision; input from the inner ear, known as vestibular function; and joint sense, or proprioception. “It’s those three systems working together that tell our brain where we are in space,” says Gene Fu, DPT, a neurologic physical therapy resident at Rusk Rehabilitation. And that awareness is crucial for navigating daily life.
But a lot of things can disrupt your sense of balance, including infection, injury, certain medications, and disease. Benign paroxysmal position vertigo is a common but treatable balance disorder that produces brief episodes of dizziness. People can get dizzy and fall after a concussion, or if their blood pressure drops too low when they stand up. While balance problems tend to increase with age, vestibular disorders can affect all ages.
These warning signs may alert you to an underlying balance problem or looming fall risk.
Head-Turning Trouble
Some people purposely avoid craning their neck to the left or the right at the crosswalk because it makes them dizzy, according to Dr. Fay. Instead of turning their head to check oncoming traffic, for example, they might turn their entire body or shift their eyes. “That’s typically an indication that they’re having a balance issue and need some therapy,” she says.
Unsteadiness at Night
People who feel ill at ease when walking in dim or darkly lit environments may be at risk of losing their balance. “It takes away that vision component of the balance system,” Dr. Fu points out. So, when they get up from bed to go to the bathroom, they worry about falling. They may actually feel increased unsteadiness or imbalance as well.
Difficulty with Uneven Surfaces
Traversing cracked sidewalks and sandy beaches can be especially challenging if your balance is off. “If somebody comes in to see me and says, ‘I feel unsteady on the broken-up walkway in front of my apartment,’ that’s a sign to me that we need to work on your balance,” says Dr. Fay.
Poor Lower-Limb Strength
To gauge muscle strength, mobility, and balance, physical therapists use the Five Times Sit-to-Stand Test. From an unbraced chair, a person sits and stands five times as quickly as possible without using their arms for support. Difficulty rising from a chair can signal the need for lower-extremity strengthening.
Waning Confidence in Your Balance
Even if you haven’t fallen, a “close miss” can be a sign that you should be evaluated to determine the cause of your imbalance, says Dr. Fu. Fear of falling, in and of itself, is a risk factor, adds Dr. Fay. “If you don’t feel confident that you would be able to catch yourself or remain upright, that can put you at an increased risk of falls,” she says.
Seeing a Physical Therapist
The Vestibular Rehabilitation Program at Rusk Rehabilitation evaluates and treats people experiencing dizziness and imbalance issues. Our physical therapists work with other NYU Langone specialists to determine the cause and create a plan of treatment.
A person who gets dizzy turning their head, for example, may be given head-turning exercises in tolerable doses. “Over time, and with practice, you become desensitized to that movement. The brain adapts so you don’t feel dizzy anymore when you’re doing that activity,” Dr. Fay explains.
Balance issues aren’t something people just need to get used to as they get older, Dr. Fay adds. “We see people of all ages and get them back their balance, to the point where they’re safe.”