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  • Writer's pictureAscend Physical Therapy

3 Balance Systems

Your balance systems help you stand, walk, turn, and move throughout your day without falling. Falls increase your risk for injury, and repeated falls also lead to a fear of falling and decline in activity levels.

According to the U.S. Centers for Disease Control and Prevention:

  • One in four Americans aged 65+ falls each year.

  • One out of five falls causes a serious injury, such as broken bones or a head injury

  • Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.

  • Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.

These might be startling statistics, so lets take a minute to understand the factors that affect your balance.

Your brain uses information from 3 balance systems: vision, somatosensory, and vestibular. Here is a little further explanation.

Vision: our eyes provide feedback of where you are in relation to the world around you.

Somatosensory: special sensors in our skin, muscles, and joints respond to stretch and pressure, and give our brain information on how our body is positioned in space. Particularly, sensors in our neck help us sense head movement and head position, and sensors in our feet and ankles help us sense what type of surface we are standing on and our body’s sway.

Vestibular: part of your inner ear, which is a complex system. Have you spun around as a kid, stopped, but still continued to feel dizzy? Well that is your vestibular system at work! To keep it simple, your vestibular system helps you sense a variety of movement and provides our brain information about spatial orientation and equilibrium. Various parts of the inner ear help detect gravity, linear movement (forward, backward, up, down), and rotational movement.

Our brain uses information from these 3 systems to help us maintain balance in various environments. If one of these systems is impaired, disadvantaged, or disrupted, you will rely more heavily on another. For example, if you are walking in the dark, you cannot use your vision so you rely more on your feet and inner ear. Or if you are walking on the sand at the beach, your feet have more difficulty providing accurate feedback so you rely more on your vision and inner ear.

There are other factors that contribute to balance, including muscle strength, endurance, posture, flexibility, medication side effects, visual impairments, pain, and other health conditions (such as diabetes and arthritis). But there is good news! An active lifestyle, balance physical therapy, and fall prevention training can help!

So here are a few beginning balance exercises that you can trial at home.

Set Up: we recommend you stand in the corner with a chair in front of you, to provide you with arm support as needed to maintain your balance.

1. Eyes Closed, Firm Surface

Stand with feet apart on a firm surface, and close your eyes. Stand steady while maintaining eyes CLOSED for 60 seconds.

2. Eyes Open, Compliant Surface

Stand with feet apart on a cushion (i.e. pillow, seat cushion). Stand steady while maintaining eyes OPEN for 60 seconds.

3. Eyes Closed, Compliant Surface

Stand with feet apart on a cushion (i.e. pillow, seat cushion). Stand steady while maintaining eyes CLOSED for 60 seconds.

Exercise Advancements: when you are able to complete the above with minimal body sway, without touching walls, and with confidence, you are likely ready to increase your challenge! Pick one of the following advancements to further progress your balance training.

Narrow your base of support:

  • begin with feet shoulder width apart

  • then progress to feet together position

  • then lastly, one foot partially in front of the other (semi-tandem). In semi-tandem position, always repeat the exercise with the other foot in front

Perform with a dual task: we are often multi-tasking during our daily activities, such

as walking while talking, so here are a few examples of how to add a secondary task

  • When your eyes are open, toss a tennis ball from hand to hand while

  • When your eyes are closed, turn your head in a consistent motion side to side (like you are nodding “no”)

  • Add a cognitive task, such as counting in threes (3, 6, 9, 12, etc.), naming foods of the alphabet (apple, blueberry, cherry, etc.), or talk to someone

If these exercises are new or challenging, you are not currently exercising regularly, or you have had a recent fall, you will benefit from a balance assessment from a physical therapist. A physical therapist can determine your level of functional balance while pinpointing areas of concern that can be addressed through an individualized balance program.


Author: Kelli Baruch, PT, DPT

Dr. Kelli Baruch, PT, DPT is the Director of Rehabilitation of Ascend PT- Garden Grove. She graduated Magna Cum Laude with her Bachelor of Science degree in Kinesiology with emphasis in Exercise Science from California State University, Long Beach.  She then earned her Doctorate in Physical Therapy from Western University of Health Sciences where she graduated with honors. She has clinical experience working in home health and outpatient settings. Her clinical interests include treating patients with vestibular, balance, neurological, and facial disorders. She has completed the Emory University Vestibular Rehabilitation Course, regularly participates in support groups through the Facial Paralysis & Bells Palsy Foundation, and has also completed an advanced orthopedic series for evaluation and treatment of various orthopedic injuries. Her treatment philosophy is centered around compassionate and individualized care to assist patients in reaching their personal goals. In her free time, you will find her enjoying time with her husband, daughter, and dog.

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