American Physical Therapy Association

What You Need To Know About

BALANCEANDFALLSA Physical Therapists Perspective

1Anyone who has ever slipped ona patch of ice knows how unnerving it can beto lose your balancefor a moment yourworld is literally turned upside down. Yet bal-ancethe ability to control and maintain yourbodys position as it moves through spaceissuch an integral, ever-present part of daily lifethat most people rarely give it consciousthought. There are conditions, however, thatmay impair your sense of balance and con-tribute to falls. The effects of aging are themost common causes of balance problems;injury and disease can also trigger problems.Because falling is such a common and

1999 APTA All rights reserved.

This brochure is not intended as a substitute for professional health care.

What YouNeed ToKnow AboutBalance AndFalls

potentially serious problem1 in 4 peopleover the age of 65 (who live at home) will fallduring the next yearits important to find outwhat you can do to decrease your risk andimprove your general health and mobility.

In this booklet we will discuss: How your body maintains its balance; Common problems with balance seen

in older adults; and Advice and exercises for improving

balance and preventing falls.

How Balance Works

Your brain, muscles, and bones worktogether to maintain your bodys balanceand to keep you from falling, whether yourewalking, rising from a chair, or climbing stairs.They also let you navigate sloping or unevensurfaces.

Balance relies on three types of sensoryinformation. The first of these is visual: Youreyes tell you about your environment and

your place within it. They help you senseobstacles and potential dangers, and formmotor memories that prevent falls. The sec-ond type of sensory information comesfrom your bodys internal sense of spa-tial orientation, independent of vision. Thisallows you, for example, to close your eyesand then wiggle your foot in any direction,

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Drugs, Alcohol, And Balance

Certain drugs (including tranquilizers,heart medicines, blood pressure medi-cines, and mood-altering drugs) andalcohol are major culprits when it comes toincreased risk of falling because drowsiness,dizziness, and slowed reflexes are commonside effects. Be especially aware of potentiallydangerous drug interactions when taking mul-tiple drugs (including over-the-counter med-ications and/or alcohol).

All Fours Balance Exercise1. Get on all fours, with your knees and alsoyour hands 12-18 inches apartlike a table.2. Pull your stomach muscles in tight. Keepyour shoulders pinched back and your back flat.3. Keep your chin in and your head straight.4. Now lift each arm by itself and hold for 3-10seconds.5. Return arms to floor. Now lift each leg byitself, no more than 6 off the floor. Hold for 3-10seconds.6. Finally, lift the opposite arm and leg togetherno more than 1 and hold for 3-10 seconds.Reach out only if you feel steady. Repeat onopposite sides.

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while stillknowing which

way your foot ispointed. The thirdtype of sensoryinformation is pro-vided by yourinner ears, whichcontain fluid-filledsemicircular canals.These canals pro-vide your brain andeyes with crucial

information onthe position of

your head and itsmovement in spacewith respect togravity. (Commonproblems related tothe workings of theinner ear includedizziness on esca-lators and sea-sick-ness.) When yoursense of balance is

in good work-ing order, the

three elements ofbalance worktogether automati-cally with your mus-culoskeletal systemto keep you mobileand to prevent falls.

There are vari-ous reasons why

your sense of balance can become impaired.In older adults, poor postureparticularly ifyou tend to slouch forward and have roundedupper shoulderscan sometimes causeunsteadiness. Furthermore, your base ofsupport is important in keeping you balanced: if youhave a wide pyramid-type stance, youreless likely to lose your balance or fall than ifyour feet are close together in a pencilstance. Disease can also rob you of a strongsense of balance. People with diabetes, for example, may suffer from numb-ness in the lower extremities and feetaproblem that makes detecting obstacles ordangers more difficult. People with arthritis, orwho have had surgery on their hips, knees, or

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Toe, Heel, And Leg Rises1. Stand straight and tall,with your knees slightlybent and your toes pointedstraight ahead. Line yourknees up over the point ofyour shoes. 2. Look straight ahead.Keep your chin tucked andyour shoulder bladespinched straight back.Tighten your stomachmuscles.3. (A) Rise up on yourtoes. Lower yourself backdown and repeat.4. (B) Keep your posturethe same. This time, how-ever, raise the front part ofyour foot, lower, andrepeat. Remember to keepyour stomach musclestight.5. (C) Keep standingstraight and tall, as before.Shift your weight forwardto the front half of yourfeet. Lift one leg, keepingyour standing leg in properalignment. Hold 10-30 sec-onds. Lower and repeatwith the other side.6. Slowly and carefullyrepeat each exercise 3-5times.

A

B

C

1. Focus your eyes ona target 10-20 feetaway while youchange from sitting tostanding and backagain with your eyesOPEN. Make sure thatyou land softly whenyou sit!2. Repeat with youreyes CLOSED.3. Feel the position ofyour body as youmove. Be sure thatyou keep your weightforward on the front ofyour feet, knees apart,chest forward, andspine erect.

Eye Exercise For Balance

feet, may lack the flexibility and range ofmotion necessary to avoid falling.

Strength, flexibility, and endurance arecrucial to maintaining balance and preventingfalls. Even if your basic perception of balanceis goodyou have normal vision and no

inner ear problemsyou can still be at riskfor falls if your muscles are weakened or stiff,or if you tire easily. Older adultsparticularlythose with osteoporosis (the disease thatcauses brittle bones)have very legitimateconcerns about falling and often restrict theirphysical activities to prevent such a mishap.Ironically, lack of exercise only makes it morelikely that a fall will occurand a viciouscycle has been put into motion.

Fortunately, physical therapy can help youlearn to cultivate and maintain higher levels ofstrength, flexibility, and endurance in a waythat still feels safe and secure. Research indi-cates that the risk of falling in older adults canbe reduced dramatically when specific exer-cises, activities, and interventions are pre-scribed by physical therapists. There areinstances, however, in which physical therapyalone may not be appropriate. If you have aninner ear disorder, for example, you will needto consult a physician.

Half-Circle SwayIf you have experienced falls or problems withbalance, get your physical therapists permissionbefore doing this exercise.1. Stand with your feet shoulder-distance apart.Hold onto the kitchen sink counter for safety.Breathe deeply and relax.2. Lean forward slowly from the ankles, withoutbending at the hips. Feel how about 70% of yourbody weight is now on the balls of your feet.3. Return to the neutral starting position. Now,lean slowly to the left. Feel how about 70% ofyour body weight is onthe left sides ofyour feet.4. Return to theupright position. Thistime lean slowly tothe right, feeling theshift in your weight.5. Now put it all togeth-er: Practice makinggraceful half-circlesways from left to centerto right and back again.Begin with small half cir-cles, and graduallyincrease to see how faryou can move your bodywithout taking a step.

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Making Your Home Safer

Preventing falls is easier than treatingthem. Your physical therapist can helpyou evaluate your home environmentwith the goal of minimizing clutter, loose rugs,slippery conditions, uneven surfaces, andunsecured cords and wiresin short, anythingthat could cause a fall. Good lighting and well-thought-out placement of furniture can alsohelp prevent mishaps.

How Physical Therapy Can Help

If you consult a physical therapist about fallsand balance, he or she will likely reviewyour medical history and determine your gen-

eral physical condition, as well as conduct aninventory of tests specifically designed tomeasure balance and gait (your individualstyle of walking). If you have fallen before,your physical therapist will ask you todescribe the accident in some detail to findout what caused the fall. (Just as importantas actual falls are near-fallsinstances inwhich you were on your way down but managed to hang on.)

After your physical therapist has deter-mined what is impairing your balance, he orshe will design a program of exercises andactivities just for you, with an emphasis onstrength, flexibility, and proper gait. All exer-cises would be planned for maximum safetyand security. Your physical therapist may alsoperform specific interventions to increaseyour range of motion and musculoskeletalflexibility. These may include electrical stimu-lation, massage, hydrotherapy, heat, cold,and ultrasound. If you have balance problemsrelated to the inner ear, your physical thera-pist may also try interventions known asvestibular rehabilitation. Vestibular rehabilita-tion includes techniques that help the innerear respond to a change in position. Condi-tions that may require vestibular rehabilitationinclude vertigo, dizziness, or nausea.

If necessary, your physical therapist mayalso prescribe assistive devices for walking(such as canes, crutches, or walkers). Makesure the tips on canes and crutches are large(and spiked, if necessary, for icy conditions),and that canes are high enough (they shouldcome up to your hip).

Appropriate footwear is another major con-98

Tai ChiThe ancient martial art of tai chi has becomevery popular in the West in recent years, andclasses are often available through communitycolleges, local recreation centers, YMCAs, community centers, etc. Research has shownthat people of all agesincluding older adultsoften find it to be helpful in promoting balanceand preventing falls. An added bonus is that taichi may add to your sense of emotional well-being.

sideration. Wearing a good pair of lace-upwalking shoes will help support your foot andprovide necessary cushioning for your joints;this will make walking safer and more com-fortable. Avoid high heels, slippers, and open-toed sandals, which can cause you to trip.

Balance Is A Skill You Can KeepOr Recapture

The good news is that balance is a skillthat almost all of us can keep throughoutour lives. Much of the deterioration in balanceassociated with age is simply due to not using

this skill. Sometimes this happens because ofchange in lifestylemost of us become moresedentary as we grow olderor it can hap-pen due to fear of falling.

Working with a physical therapist can pro-duce exceptional results in many cases. Evenif some of your innate sense of balance hasbeen diminished over time, physical thera-pists are experts at retraining your body tomake the most of its capabilities.

About APTAThe American Physical Therapy Association(APTA) is a national professional organizationrepresenting more than 74,000 members.

Physical therapists are vital members ofthe multidisciplinary health care team. Theyprovide treatment and can refer clients toother health care specialists. APTA serves itsmembers and the public by promoting understanding of the physical therapistsincreasing role in the health care system.APTA also promotes excellence in the fieldwith improvements in physical therapy education, research, and practice.

AcknowledgmentsDale Avers, MSEd, PT Carleen Lindsey, PT

Other APTA Brochuresq Fitness: A Way Of Lifeq For The Young At Heart: Exercise Tips

For Seniorsq For Women Of All Agesq Taking Care Of Your Back

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In Your Physical Therapists OfficeYour physical therapist has many ways of work-ing with you to enhance your sense of balance.Pictured here is a patient practicing balanceskills using a therapeutic ball.

q Taking Care Of Your Foot And Ankleq Taking Care Of Your Hand, Wrist,

And Elbowq Taking Care Of Your Hipq Taking Care Of Your Kneesq Taking Care Of Your Shoulderq The Secret Of Good Postureq What You Need To Know About

Carpal Tunnel Syndromeq What You Need To Know About Arthritisq What You Need To Know About Neck Painq What You Need To Know About

Osteoporosisq You Can Do Something About

Incontinence

Bulk quantities available. See the APTAResource Catalog at svcctrapta.orgor send your request by mail to APTA,1111 North Fairfax Street, Alexandria, VA22314-1488.

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American Physical Therapy Association1111 North Fairfax StreetAlexandria, VA 22314-1488