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  • Tara Albright DPT

Balance Awareness Month

Human beings are capable of amazing feats. Throughout all of human history, we have seen and heard of individuals whose physical prowess has elevated them to legendary status. The hard work and training needed to reach elite performance in any domain cannot be understated here, however there are also innate abilities that all humans possess that make these things possible. One major domain of physical ability that is relevant here would be the concept of balance.

Balance is defined as the ability to maintain one’s center of gravity over their base of support in a consistent manner. In other words, balance refers to one’s capacity for keeping the body upright against gravity, which is pulling perpetually towards the center of the earth in a consistent fashion at 9.8 meters per second. The concept can also be looked at in terms of equilibrium, which is a state of being where external forces acting on the body (gravity, traction under the feet, momentum of body mass moving) are negated by internal forces generated by the body (muscular force production, soft tissue stretch, muscle tone) resulting in a stable system.

Balance can be looked at as a confluence of several different parts of the human body – multiple regions of the brain combine with the inner ear to analyze the body’s orientation in space, which then directs the muscles and bones to move accordingly. We tend to study three main contributors to balance: the sense of vision, the vestibular system and proprioception.

  • Vision: likely the most familiar of the three domains, the sense of vision is crucial for balance. The information gathered by your eyes will be analyzed within the brain to account for things like the relative level of terrain and depth perception, as well as movement speed and accommodating environmental disturbances to balance. It is possible to maintain balance without visual input of any type, just as it is possible to have too great a dependence on vision to maintain balance. In physical therapy, we perform assessments to determine how much the visual analysis of the environment effects an individual’s ability to maintain balance and train the other systems to remain strong with or without visual input.

  • Vestibular system: this is often likened to being the “level” that the body has to determine our body orientation in space. This is a great analogy, but the vestibular system does much more than just function as a level. This tiny structure that lives within a small space in the skull, known as the inner ear, is also sensitive to acceleration, deceleration and rotational movement of the body relative to gravity. The vestibular system is composed of a series of semi-circular canals that allow for fluid movement within them and sense movement based on the flow of this fluid, which will move small hair-like cells and allow for detection of motion. Because of the orientation of these semi-circular canals within the inner ear, the vestibular system also is sensitive to the ambient presence of gravity and can inform the brain of even slight movements against gravity’s pull.

  • Proprioception: this term refers to a collection of sensory information gathered by the body and is often likened to a “6th sense” in this way. Through the combined efforts of pressure receptors in the skin, stretch receptors in the tendons/ligaments, and many other bits of information gathered, proprioception provides the awareness of body parts in space and location relative to the environment around an individual. Additionally, the sense of proprioception offers protective measures against potential tissue damage due to excessive stretch or force going through soft tissue (muscle, ligament, tendon). This domain of balance tends to be more or less robust depending on individual factors, which may help explain why some athletes excel in certain contexts compared to others, but certainly can be trained just like the other components of balance.

Through a combination of the above components, the human body is able to maintain itself upright against gravity the majority of the time. Through things like advanced age, physical deconditioning and general inactivity, any and all of these components can become less robust and lead to poor balance. Additionally, weak muscles or poor cardiovascular stamina can negatively influence balance by limiting how well the muscles and bones can move to respond to lost balance. Having a significant fear of falling can similarly reduce musculoskeletal performance by “locking up” the body when a loss of balance is experienced and limiting ability to respond appropriately.

Physical therapy treatment has been shown to be quite effective in improving balance, but also assisting to strategize optimal responses to a loss of balance. Your physical therapist will perform a series of tests and measures to identify the areas in need of most work, then put together an exercise plan to improve the areas of greatest need. If you wish to know more about balance and how physical therapy can help, reach out to any of our knowledgeable staff for more information!

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