Dizziness, Balance and the Vestibular System

Over the years, we have seen many patients with balance deficits or patients who have asked questions about balance. Poor balance affects so many different aspects of life, so it is not surprising that people would wonder what they could do to help improve it. Balance is actually controlled by three main systems: vestibular or inner ear, vision, and proprioception or the sensory nerves mostly in the ankles and feet. All three systems must be working together in order for the body to maintain good balance. A common cause of poor balance is a poorly functioning vestibular system. Also, ankle and foot weakness can wreck havoc on your balance as well as poor vision. However, for the purpose of this discussion I want to focus mostly on the vestibular system. The vestibular system is found in the inner ear and contains a group of structures called the semicircular canals. There are three semicircular canals and each canal is filled with fluid that sends signals to the brain to help us maintain correct orientation in space. The three semicircular canals also tell our brain about how fast or slow our body is accelerating forward, backward or side-to-side. Moreover, inside the inner ear is another structure called the utricle, and it contains crystals called “otoliths” which give the brain information about gravity and balance. Sometimes these crystals can become detached and they move into the semicircular canals, which results in dizziness and/or loss of balance.

Normal aging can cause these otoliths, or crystals, to become detached; additionally, a sedentary lifestyle, injuries, illness, and medication can also create detachment of the otoliths. The most common symptom of poor balance, loss of balance and/or falling is intermittent and mild dizziness, so knowing the cause of it is of the utmost importance. Many older adults experience some sort of dizziness, however, they do not discuss the problem with their doctor or therapist because they think this a normal part of aging. Dizziness is not something to ignore because even a minor problem of dizziness is linked to an increase in falls. And as we all know, a fall can lead to broken bones and unwanted strains and sprains. Activities like unloading the dishwasher, turning your head quickly, going from squatting to standing, or changing directions while walking can cause a fall if the vestibular system is not working properly. After experiencing a fall, many people decide to use an assistive device. Sadly, many people become embarrassed by using an assistive device or do not want to risk falling in public so they stay at home. Becoming isolated at home can ruin your quality of life. However, there is no need to stay home because physical therapy can help improve your balance, which would allow those afflicted with inner ear dysfunction to become more involved in their community.

Physical therapy can play a key role in helping people improve their vestibular system. On your first visit, our physical therapist will test your balance through a variety of tests to determine what type of dizziness you are experiencing. These tests can help determine if you are having difficulty with your vestibular system or if your visual and proprioceptive systems are also involved. By inhibiting one component of balance, that will challenge the other systems to a greater degree. For example, if you close your eyes while working on a balance exercise, this makes your vestibular system work harder. By starting a physical therapy program that combines exercise and mobility training as well as vestibular biased balance activities, you can achieve better balance and a greater quality of life.