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Balance and Fall Prevention Part II - How We Balance and Risk Factors for Falling

By David Drinks

Last week, I introduced the importance of balance and preventing falls. Falling in older adults is tragically one of the most rapidly growing causes of injury and death in the United States.

If you missed it, you can look at Part I to see some of the stats on fall-related deaths.

Fortunately, however, it is not all bad news. As I alluded to in the introduction to this series, you have great power over your ability to balance, remain resilient and independent as you age, and prevent yourself from falling!

This week we are going to start into this journey to better balance and function by first overviewing what balance is, how we maintain our balance and function, and what puts you at risk for falling.

What is Balance?

I’m glad you asked!

Balance, of course, is your ability to remain on your feet.

But there is a lot more to it than that, and that is what I want to go over today.

The way I look at it, there are three main categories of balance:

  • Static Balance

  • Dynamic Balance

  • Functional Balance

Static balance refers to your ability to maintain your center of gravity within your base of support while standing or sitting. This one is typically easy to maintain – unless you are a baby just learning how to stand up, you have vertigo, or you had a little too much to drink…

Dynamic balance is a little trickier. It refers to your ability to maintain an upright position while your base of support is moving underneath you. In this scenario, your center of gravity is moving outside of your current base of support, so you must dynamically adjust your base of support to remain upright.

This may sound complicated, but it is really what you do every time you walk somewhere. When you take a step, your base of support is dynamically moving under you to keep your center of gravity from moving too far outside of your base of support.

If you start to fall while walking, it is simply because your center of gravity and base of support got out of sync with one another.

Functional balance is your ability to perform daily movement tasks that require you to balance, such as picking up an object from the floor, standing on one leg while getting dressed, or turning around to look at something while walking.

These functional activities of everyday life that require balance are the most crucial to focus on when it comes to training your balance and preventing falls.

What Does the Ability to Maintain Balance Involve?

Balance is a complex task made up of input and output from multiple systems in the body. We utilize what is known as “sensorimotor control” to both take in information through the nervous system and to translate that sensory information into coordinated motor control.

That means that both your system for input (sensory ability) and your system for output (motor control) must be functioning and functioning well. If you are not receiving good input from various sensory systems, or you are not translating that into an appropriate motor response, balance becomes a problem.

Sensory System

To take in information about our environment and body position, we rely on three sources of input:

  • Visual

  • Vestibular

  • Somatosensory

The visual system is pretty straightforward (really, it’s quite complex, but we’ll keep it straightforward for our purposes!). One of the primary drivers of balance and postural control is your visual input. Your brain takes in information about your body position relative to your environment through your vision and uses that input to react and adjust movement and balance accordingly.

Losing vision as you age can be one of the largest factors in losing balance. Vision problems result in a deficit of essential input to the brain, which can result in a deficit in appropriate motor output to maintain balance.

So, the first step to maintaining balance may be to go to your eye doctor!

The vestibular system is a very sophisticated and remarkably accurate postural and balance control system. Located in the inner ear, the Peripheral Vestibular System is sensitive to the position of the head in space and sudden changes in the direction of movement of the head.

This system allows us to sense and perceive motion and provides information about the movement of the head and its position with respect to gravity and other inertial forces.

This complex inner ear system allows us to orient to our environment and maintain equilibrium. It allows us to rotate our heads, look in all different directions, and experience rotational forces without feeling all out of sorts.

This system usually works just fine, but some disorders can happen to your vestibular system that cause you to feel dizzy. If you have ever experienced positional vertigo, then you know what this is like. You suddenly feel like the room is spinning around you when you are not moving at all.

While vertigo is a rather common disorder of this system, there are many other reasons why your vestibular system may not be functioning optimally. If that is the case, you will not be balancing optimally.

Even minor deficits in the input from your vestibular system or your brain’s response to those inputs can leave you wobbling the moment you turn your head to look at something while walking. If you have any issue with positional awareness or dizziness when turning your head or bending over, then seeing a healthcare professional may be warranted.

Lastly, the somatosensory system is how your brain knows where the rest of your body is in space.

Thanks to this system, you can sense things like the surface you are in contact with under your feet. You can sense when your limbs are moving, and at what speed. You can sense pressure, movement velocity, temperature, and other sensory inputs.

This is due to a complex system of sensory neurons throughout your body known as “mechanoreceptors”. These receptors send information to your brain that is collected from your skin, joints, tendons, ligaments, and muscles.

Based on the information you receive from these mechanoreceptors your brain and nervous system can then send responses through conscious and subconscious pathways. This is where your reflexes arise from (for example, when you touch something hot and instinctively jerk your arm away).

While the somatosensory system gives us the ability to sense things that we interact with externally as well as the ability to sense things inside our bodies, the most important component of the somatosensory system as it relates to balance is known as proprioception.

Proprioception is your ability to sense your movements. The feedback you get from joints, muscles, ligaments, and tendons allows you to perceive and then control your body’s movements.

Altogether, proprioception, vision, and vestibular input give us the remarkable ability to balance.

Balance is a result of a complex series of interactions between these systems in the body. A deficit in any one system can lead to a lowered ability to balance and control your body during movement.

A lack of proprioception due to a joint or muscle injury can result in inadequate feedback from that part of your body. That inadequate feedback can lower your ability to reactively control your body when stepping off a curb or onto a less-than-stable surface.

Likewise, a lack of visual input from impaired vision, or a lack of proper vestibular input from an impaired vestibular system can lead to an inappropriate balance response.

Risk Factors for Falling

On top of the problems with balance that can result from impairments to any of the systems mentioned above, before we talk about how to prevent falling and improve your balance, I need to highlight a few other risk factors for falling.

Muscle weakness is one important risk factor for falling that we can have a large impact on through proper physical training. The natural loss of muscle mass, strength, and power as you age can put you at a much greater risk of losing balance and falling.

While this loss of muscle, strength, and power is natural, the rate at which it occurs, as well as the ultimate amount of loss is largely up to you.

Continuing to train your body to maintain strength, agility, and power will ensure that you do everything that you can to maintain these crucial physical characteristics even as you age.

Loss of mobility is closely related to a loss of strength. This not only refers to a loss of flexibility but also to a loss in the ability to get around in general. A loss in mobility can result from pain, lack of flexibility, and a lack of physical strength.

Limited endurance can result in a fall simply because muscular fatigue can result in a loss of motor control. A loss of coordination, dragging the feet, or simply misstepping due to fatigue can result in a fall.

All these risk factors for falling can be eliminated or greatly improved by a properly maintained physical training routine.

You see, while balance is a complex ability and losing balance with age is quite common, that does not have to be the case. Once you understand what factors go into maintaining your balance, and what factors affect your risk of falling, you can develop a lifelong training routine that will ensure you maintain your balance and avoid falling!

Next week, we will start talking all about how to set up your training routine for better balance, so stay tuned…


Want to learn more about training your body to Move Better, Feel Better, and Live Better? Our exercise programs at The Med Gym are custom-made to get you exactly what you need.

Our expert coaches will assess your fitness and balance, and design an exercise routine specific to your goals. We can help you get on the right track with your movement and fitness!

Contact us here to talk about how we can help you develop an exercise routine that improves your balance and so much more!

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