As we get older – balance problems tend to creep up on us. Everything from poor vision to weak muscles to stiff joints can have an impact on how steady we are on our feet. Activities like Yoga and Tai Chi are great for improving balance because they help you to focus and become more aware of how your body is moving. Having a strong core and leg muscles are also key.
But what if you’ve been working on all of these areas and your balance still hasn’t improved?
There’s one other huge contributor to balance and it’s called your vestibular system. It’s one of our three major balance systems and it’s located in your inner ear – literally in your head. Your vestibular system is responsible for sensing movement and changes in your head position and when it’s not working properly, it will definitely impact your balance.
How do you know if your vestibular system is dysfunctional?
One of the most tell-tale signs is dizziness, commonly known as “vertigo”, and it’s more common than most people think. Approximately 35% (that’s 69 million) of adults over the age of 40 have experienced some form of vestibular dysfunction. This number gets even higher as we age and recurrence becomes more common with 80% of people over the age of 65. It doesn’t matter how strong you are, or how many times you practice standing on one leg – if your unsteadiness is from vertigo – you remain at a high risk of falling until you get this sorted out. Vertigo is no fun and it can be extremely debilitating. While medication can be used to reduce the sensation of dizziness, it tends to only mask the symptoms. When the medication is stopped many people are faced with the same symptoms they started with.
The most common form of dizziness among older adults is from BPPV (Benign paroxysmal positional vertigo) and is only benign to those that haven’t experienced the debilitating impact it has on your daily functions. BPPV happens when a clump of crystals move within the inner ear-control center for balance, causing a severe spinning sensation when moving your head. It’s treated by moving the crystals in a specific pattern to get them back in proper alignment. This condition becomes more common over New England winters when we do not get as much sunlight or vitamin D- which can make you more susceptible to changes in the inner ear crystals. Vestibular hypofunction can also be a reason for dizziness or unsteadiness, and it typically happens after something like a whiplash injury or sudden attack that leaves you feeling scared and unsteady.
Vestibular problems can be challenging to accurately diagnose. Here are three signs that indicate your balance problems might be due to a vestibular dysfunction:
Ever been in the middle of gardening, or getting in and out of bed, and things start spinning for no good reason? People often mistake this for dehydration or low blood pressure, which are certainly possibilities, but it could also be from a dysfunctional vestibular system. Because this system is located deep within your inner ear, it’s most affected by large head movements – such as bending over. If the system in your ear doesn’t keep up with how fast your body is moving – things start spinning. While it’s common for this to happen from time to time, if it’s happening a lot, or gets so severe that you can’t stand up, then it’s worth getting looked at.
As we get older, vision is one of the first things to become impaired. Because vision is another major player in how well you balance, it becomes critically important that your other two systems – vestibular and proprioception – are in good shape. If you have strong legs and typically don’t have a problem with balance during the day, but notice that at night or in dim lighting your balance always seems to be off – this could be a sign that your vestibular system is dysfunctional.
Many of us dislike crowds. But if the reason you avoid them is because you’re afraid of falling or you find crowds make you dizzy, it could mean that your vestibular system is off. Public, busy settings can overstimulate our nervous system, making it more difficult for your brain to coordinate with your inner ear. If you find that everytime you’re in a busy grocery store you have difficulty remaining steady while looking around, but you’re always fine in your quiet home, it could be a sign that your vestibular system needs to be checked.
If you are noticing any of these signs and are finding yourself off balance and more dizzy than usual, you could have a vestibular problem. The good news is that vestibular dysfunction can be helped without medication. It’s done by training the brain to accommodate for these changes in your inner ear. There are specialist physical therapists as well as other medical professionals who can help.
Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or learn more about physical therapy for vestibular dysfunction, email info@cjphysicaltherapy.com or call 603-605-0402.

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