A persistent feeling of being off balance can be one of the most disabling feelings a patient can have. Many patients who suffer with balance issues don’t receive proper examination and diagnosis, so they are left without many answers for treatment besides generic anti-nausea medications or herbal remedies like ginger.
In order to best take care of people with persistent balance issues, we have to understand why balance gets disrupted to begin with.
We tend to think of balance as a function of leg muscles and joints, so we think of balance training as just standing on a Bosu ball or standing on one leg. We take balance fore granted because when it works well, we hardly have to think about it.
Truthfully, balance is the product of some complex calculations made by your brain based on 3 major senses. These senses are:
- Vision from your eyes
- Proprioception from your muscles, joints, and ligaments
- Vestibular from the fluids in your inner ear
Your brain takes information from these 3 senses and compares it to information stored in your memory, experience, and context of your current situation and develops a strategy for how your muscles should fire to keep your body up right. It’s really pretty amazing when you think about all the moving pieces involved.
Even more unique is the fact that as far as mammals go, there aren’t too may of us that stand upright on 2 feet. Most of the animal kingdom stands on 4 legs so our brains had to develop differently from an evolutionary perspective than our mammal ancestors. The time it takes for our brains to develop this skill is one of the reasons why some mammals like start walking and moving right away, while humans take about a year to get to our normal mode of transport (standing/walking).
Being a father of a 1 year old has taught me a lot about how we develop balance by watching my little one learn to navigate that skill.
So you might think that your brain relies on all of these senses equally under normal circumstances, but in reality these senses are weighted differently. Here’s the breakdown:
So normally, an adult with healthy balance does rely on their muscles and joints (particularly in the legs and feet) or your sense of balance. That’s probably why things like weight training, yoga, bosu ball exercises, and more can strengthen the balance of people with normal functioning systems. All of those things really challenge and promote neural pathways to enhance your body position sense.
But what happens when our senses starts to decline?
Balance Fails: When Senses Break, When the Calculator Breaks
If one of our senses starts to struggle, your brain has to weigh your senses differently. We can actually test this in our office by performing balance tests in different sensory circumstances. For example, if we have you stand on an unstable surface, your brain puts more emphasis on your inner ear and vision because the unstable surface is giving your brain constantly changing information that makes it hard to rely on.
The good news is that your brain is great at compensating when one sense goes down. Losing one inner ear to infection is a problem that most people can recover from and regain normal function. Usually patients that still suffer from balance issues after loss of one inner ear respond really well with vestibular rehabilitation to re-compensate the patient’s brain.
The bad news is that when multiple senses aren’t working well, it makes it really hard to make up the difference. Losing both inner ear systems from infection or Meniere’s can permanently alter your balance. The same thing can be said for having neuropathy in both feet or having a ocular misalignment in both eyes. For these types of issues, people can only hope to compensate as best as they can for permanent deficiencies.
The other possibility is that the brain itself takes an injury like a concussion or stroke disrupt the brain’s ability to make calculations. This is especially true for injuries related to the brain stem or cerebellum which are major centers for balance control.
The good news is that many of these problems can be improved with chiropractic and neurorehabilitation.
Targeting the Correct Body Parts
We often see a lot of patients with movement and balance issues after they’ve been to several other doctors and specialists. One potential pitfall is that many specialists have one area of focus which creates a conundrum commonly seen in medicine.
When you have a hammer, and you’re great at hammering, everything looks like a nail
There was a point in my practice where every balance problem that came in to my office was a problem in the neck, and we did really well with most patients!
We still address the neck as a primary problem in most patients, but working with more and more patients with balance issues and dizziness, we have taken a step back so we can see the whole picture.
Having a new perspective on patients by looking at balance as a function of the brain has helped us improve outcomes with challenging balance issues.
The first step is performing a thorough exam, not just on the neck, but on the visual, vestibular, and somatosensory system to identify how this problem might be addressed best with a personalized program of neurological rehabilitation.