Balance and Fall Prevention
What is Balance and Why is it Important?
Each year 2.5 million older adults seek help in the emergency room for injuries resulting from a fall (1). One out of every five falls results in serious injury such as breaking a bone (1). After your first fall, you’re fall risk doubles (1). Knowing these facts, it is imperative that you have your balance tested by a physical therapist to prevent or minimize your fall risk.
Balance is important for everyday activities including sitting, standing, walking and negotiating stairs as well as for reducing your fall risk. Balance is the condition in which your center of gravity is stable within your base of support. Your center of gravity is the point in your body in which gravity acts. Your base of support is created by the points of your body which contact the ground. A few examples of would be: standing with your feet close together, standing with your feet shoulder width apart or standing on one foot. You can widen your base of support and create more stability by using an assistive device (2).
Balance is created by the perfect coordination of several body systems: the visual system, the somatosensory system and the vestibular system. If one of these systems is not working properly, or if they are not working together, then your balance will be affected (2).
The visual system is composed of both focal and ambient vision. Focal vision is important to identify objects in your environment and ambient vision is important to subconsciously assess the environment around the object you identified. Here is an example of how you would use both focal and ambient vision in day to day life. Across the room you identify a chair you would like to sit in (focal vision) and as you walk towards that chair you navigate around various objects in and around your path (ambient vision) (2).
The somatosensory system uses your body’s various joint receptors to determine where your body is in space at any point in time. In order to stand, walk, lift objects or climb stairs, your brain needs to know where your ankles, knees and hips are in space so that it is able to send signals to each joint that tell it how to move to accomplish the task (2).
The Vestibular system is composed of various canals in your inner ear. Each canal acts like the bubble in a level. When you change head position the liquid in these canals push or pull against a receptor that tells your eyes to move in the opposite direction of the head movement. The opposite eye movement allows you to maintain fixation on an object while moving your head. This movement is considered to be a reflex. If this reflex is not working properly you may have symptoms of dizziness, nausea, vertigo or nystagmus (inappropriate rapid eye movements) (2).
What to Expect from your Physical Therapist
Your therapist will assess your balance in several ways including changing your base of support from wide to narrow, having you open or close your eyes or changing the surface you are standing on from stable to unstable. They may also perform a standardized balance exam which looks at your standing balance and your balance as you walk. Assessing your hip, knee, ankle, and core strength will also be important because having poor strength will decrease your balance and increase your fall risk.
To address your balance and reduce your fall risk, your physical therapist may have you practice balance activities or perform strengthening exercises in the office or at home with your home exercise program. With practice, your balance may improve and thus reduce your fall risk.
Another way to reduce your fall risk may include using an assistive device such as a cane or walker. The cane or walker will increase your base of support so that your center of gravity can be maintained more effectively. It will take more external force to lose your balance when using such device. Talk to your physical therapist regarding your balance, fall risk and to determine if an assistive device is appropriate for you.
What Are Five Steps I Can Take to Reduce My Fall Risk?
Have your physical therapist assess your balance and gait (how you walk). Chronic conditions including diabetes, stroke and arthritis play an important role in your gait mechanics. If your gait is altered in any way, your balance may be affected which increases your fall risk.
Have your vision checked annually and wear the appropriate visual aids including glasses. Please note that it is not safe to wear reading glasses when walking around your home. Wear reading glasses only when reading to improve your safety.
Talk to your doctor regarding your medications and how medications can affect your balance and gait safety.
Make sure your home is safe. Remove objects from pathways and throw rugs since they are fall hazards and have appropriate lighting available. Have someone install grab bars if needed in the shower or near the toilet.
Wear appropriate foot attire such as gym shoes or shoes that are secure on your feet whenever walking. If you do not wear shoes in your home, socks with grips are available at most clothing stores which will prevent slipping and sliding.
1. O'Sullivan S, Schmitz T. Physical Rehabilitation. 5th ed. Philadelphia, PA: F.A. Davis Company; 2007.
2. Important Facts about Falls. Centers for Disease Control and Prevention 2016. Available at: Accessed February 10, 2016.