Four Ways to Improve Your Balance

Dr. Sean Lordan

Four easy ways to improve your balance at home:

Balance can be improved! A common misconception I hear at my physical therapy clinic in Sutton MA, is that balance is fixed and cannot be changed. This idea couldn’t be more false.

Everyone starts from a different point, but it is relatively easy to make positive changes with the right consistent habits and exercises. I’ve heard countless times, “I’m just clumsy. Can I really improve my balance?” Sure, some people are more “coordinated” than others. Both balance and coordination are modulated by circuitry derived from the cerebellum in the back of the brain. The cerebellum can be upregulated and neuromodulated to improve coordination by stressing any of the three major balance systems (I will get to that next). The key here is by working diligently on a specific exercise program that targets your lower extremity and core you will notice significant improvements and lower your risk for falls.

Balance is determined primarily by three different systems: sensory (touch/ feel) ; visual (eyes); and vestibular (inner ears). In the field of physical therapy, we work on all three in tandem in order to achieve optimal results to reduce your risk for falls and to improve your balance.

Below is an example of an exercise for each system:

  1. For the visual system, try VOR training: Fix your gaze on an object five feet in front of you and while keeping your eyes still on the object, move your head as far to the right as you can and then as far to the left as you can; then repeat. That’s one. Do three sets of 10. If you are dizzy, consult your PCP or local PT. (Note: this involves training your vestibular system, too, so its two-for-one!)
  2. For the vestibular system, try walking with head turns: Ambulate 10 feet in a straight line preferably on a tile floor to keep honest, and while ambulating, turn your head to the left and to the right. On the way back, continue to walk in a straight line, only this time, look up and down. Do that 10 times total, and once per day.
  3. For the sensory system, try SLS on a pillow: In the corner of the room, put down a balance pad or a pillow and balance on one foot. Your goal is to lift your foot 30 inches. If you lift your foot less than 10 inches, you are at risk for a fall, and if you can only hold your foot up five inches or less, you are at risk for an injurious fall (think broken hip, ankle, etc.) Try for three sets lifting your foot 30 inches each leg per day.

Poor balance increases your risk for mortality, especially in the older-than-70 age cohort. The test that I perform on all clients of mine who are septuagenarians or older is the SLS test. If, as above, they can’t hold for 10 seconds on each foot then we immediately tie in a balance program to their physical therapy treatment. Another key indicator of mortality is quadriceps strength. A functional test that I perform to determine quad strength is the five times sit to stand test. Those who are between 70 to 79 years old should be able to perform five sit to stands in less than about 12 seconds. Those age 80 to 89 should be able to perform five sit to stands in less than 15 seconds. This test shows me how powerful the quadriceps are because power is the derivative of speed over time. The faster the exercise is done, the more power the quadriceps tissue has.

Why is this all important and how does it tie to mortality you might ask? Good question! Simply put, when you can’t balance on one leg for very long and your quads are weak, it greatly affects your gait. Effects of poor balance on gait are well documented and include shuffling, decreased stride and step length, the phenomena of “staring at the ground,” to avoid obstacles, and ambulating with a bent knee posture. Have you ever tried to walk with a shorter stride length? Probably not because it feels uncomfortable, but I will tell you, it is much easier to trip when you are not getting your heel down to perform a full stride.

With a trip comes a fall, with a fall often comes a broken hip. Statistics vary, but hip fractures as the direct result of a fall can result in an 80% mortality rate within one year. Why so high, you may ask? Think about what happens after the fracture. A trip to the hospital where nosocomial infection (MRSA, STAPH) runs rampant. Plus, most likely a trip to a skilled nursing home and potentially a prolonged bout in a wheelchair and in bed which results in muscle atrophy. It is well documented that up to 12% of your muscles can waste away from lying in bed for just one week! So, what would you rather choose — some balance exercises in the corner of your room once a day, or a hip replacement?

Two types of dizziness: Lightheadedness and vertigo, and how to solve each:

We commonly see patients with vertigo at my clinic, and most often they are sent home that same day feeling 100% better from a simple maneuver we do after some testing to rule out other causes. Vertigo is a sensation of the room “spinning” around you. Similar to the sensation after getting off of a boat or a rollercoaster, it is due to an imbalance in the inner ear created potentially by a little crystal lodged where it shouldn’t be.

Lightheadedness is a different phenomena altogether. Lightheadedness, especially when felt from sitting to standing or from lying flat to standing, is from what we call orthostatic hypotension (OH). This, at times, occurs in older adults with poor peripheral blood flow and aerobic conditioning (or with a cardiovascular hx significant for another disease). The key is to be able to tell the difference and know where to go to get help. In both of these cases, I find it helpful to consult with the patients PCP in order to make sure we are not missing anything. If things are clear and we can move forward for those with vertigo, I perform the epley maneuver, and for those with OH, I move to condition their muscles and aerobic systems to improve their function and venous return.

If you suffer from impaired balance, perhaps a trip to your local physical therapist is in order. You will receive a bounty of exercises and hands-on therapy to improve your balance and reduce your risk for falls. Many times you are able to see a PT without a trip to the doctor first. If you have any questions, please, feel free to contact us by clicking here!

What others are saying about us:

Google 5 star review

“I cannot say enough about Concierge Therapy. Beginning with the receptionist who is so pleasant and always smiling! Cheryl, my therapist, is the very best (and over the years, I have had many)!! She has tailored my treatment plan to what I am physically capable of doing at a pace I can handle. She builds on that with every visit. Her supportive nature and guidance gives me the needed confidence AND motivates me to work hard on my home exercises. Highly recommend Concierge Therapy.”