Are You Dizzy Or Do You Have Poor Balance? Here’s Why & What To Do – Part One

Remember as a child when being dizzy was fun? You probably recall hopping off a merry-go-round with your friends and trying to walk a straight line or attempting to stand still without falling down. It was all fun and games because you were able to recover quickly and run off to your next adventure.

But what if you have these symptoms without being on the merry-go-round and that feeling is actually causing you or a loved one to limit their activities? Maybe you see them walk nervously from one piece of furniture to another in their home. Or perhaps worse, that feeling contributes to you falling. Why are you feeling this way and what can you do about it?

Sometimes a medical condition such as an irregular heartbeat, excessively low blood pressure, or an intestinal bleed can cause these symptoms. In absence of a medical issue being the problem however, feelings of being off balance or dizzy are attributed to “aging”, “being out of shape” or “slowing down”. While these symptoms can certainly creep up on us as we age, aging alone does not explain the cause of these symptoms.

Our body maintains a stable and upright posture through the interactions of three primary systems – our visual system, our somatosensory system and our vestibular system. Let’s explore each of these.

Visual System

The visual system is quite obvious. It’s what we see in the world around us! Are we oriented to vertical? We determine this by comparing ourselves to objects around us such as a door, a light post or a building. This is a very powerful reference for us. When we can’t see a clear reference point, we are unsure of our position. Think of what you feel in an airplane that is banking left or right when while taking off. Our sense of vertical can become quite compromised without an accurate visual reference. The same can be felt in a dimly lit room or while being outside at night.

Somatosensory System

The second system that helps us is our somatosensory system. This system collects information through our skin and joint receptors by way of contact with our environment. If you are sitting right now you feel the surface of the floor under your feet, the chair contacting your legs and spine. If you’re standing, you feel the floor under you and perhaps your shoulder leaning against the wall. This is your somatosensory system doing it’s job.

Vestibular System

Finally, our vestibular systems acts as our internal gyroscope. Inside of each ear is a system of boney loops that hold fluid that moves with any slight motion of our head. If there is a problem in one of the loops themselves, as in the case of benign paroxysmal positional vertigo or BPPV, then one might feel very acute vertigo, such as the world spinning around, resulting in very poor balance. Remember the merry-go-round? That same sensation can now be quite scary as you contemplate a fall! There is one more important role that the vestibular system also performs. It coordinates all the information taken in from what we see (visual), what we feel (somatosensory) and the motions of the head and computes the information through the brainstem and prompts us to physically react in order to maintain an upright and secure position. Many times it is a problem with the coordination process that can lead one to feel insecure, imbalanced or prone to falling.

“It’s our ability to effectively collect and act on the information our systems detect that allows us to maintain good balance and avoid falls”, says Matt Whitaker, Physical Therapist. A physical therapist trained to assess and treat each of these systems can help you increase your confidence and get back to safely walking in the home and community and returning to the activities you want to do, or what we call being Active For Life! If you or someone you know has these type of problems, don’t wait for a fall and more potential problems that come with it, contact us today to schedule an appointment to get back on track to Move Better, Feel Better & Live Better.

Next week we’ll explore balance problems, how we treat them and what you can do to start helping yourself.

Matt Whitaker has treated the dizzy and imbalanced patient for over 19 years with certification in Vestibular Rehabilitation through the University of Miami School of Medicine Division of Physical Therapy.

Balance Therapy, Part Two – Plus 3 Balance Exercises

In Part One of this series, we discussed what systems our body uses to help us maintain our balance and remain stable. In this post, we’ll review how physical therapy can help address balance challenges and help you be more confident with your movements.

Vertigo, Dizziness or Imbalance?

These terms are often used interchangeably by people that have a vestibular or balance problem. The key to proper treatment is to determine if you have a sensation of spinning or if you are feeling unstable and off balance. If you have a spinning sensation called vertigo, then a complete assessment by a certified vestibular physical therapist is critical to correctly identifying your problem. “You want to ensure that you are being treated by someone who has extensive training in this area of care”, says Matt Whitaker, PT. “Proper identification of your problem is essential to successful treatment”.

If the problem you have is a feeling of poor balance and being insecure on your feet then your evaluation will focus on assessment of your strength, agility, muscle length or flexibility and the range of motion of your joints. A challenge with any one of these can create a sensation of poor balance and fear of falling.

What is Vestibular Rehabilitation?

Let’s take a closer look at what therapy entails. If you have vertigo or spinning, treatment is often referred to as vestibular rehabilitation. First we determine if the problem is peripheral or central in origin. Generally this means it may originate from a problem in the boney loops in the inner ear (peripheral) as in the case of BPPV or benign paroxysmal positional vertigo or your brain may have trouble coordinating the information received from your vision, what you feel and your head movements (central). For either problem you should see a physical therapist with experience working with neurologic conditions to receive very specific treatment to resolve your symptoms.

What is Balance Therapy?

If the problem is having poor balance without sensation of spinning you need balance therapy or retraining. Treatment will focus on your flexibility, leg, hip and core strength and your ability to control large or small movements of your body with and without foot movement. It’s how you control those movements that makes your balance effective or not. A complete balance therapy program will address all of these and potentially more.

Three Exercises for Balance

Matt Whitaker, PT states, “Not all balance problems are treated the same, but often they share a number of things in common that simple exercises can help.” Below are three balance exercises that you can perform to start improving your balance right away.

Stretch the lower leg muscles

The “runner’s stretch” is a great way to keep your ankle joints and surrounding muscles flexible to help your balance. You’ll feel the stretch in the gastroc or “calf” muscle of the back leg.

  • Assume the position below with your hands on the wall or perhaps a counter, only for a little support.
  • Apply pressure through the heel of the back foot as you push your hips toward the wall
  • Gently bend the front knee to increase the stretch.
  • Don’t let your back heel rise off the ground!
  • Gently hold for 30 seconds, alternating each foot and repeat 3 times on each leg.

Balance on One Leg

Just as it sounds, you want to practice standing on one leg so your foot can control your balance. Try to feel your toes and foot doing the work. If this seems too hard, don’t feel bad about holding on to a counter or the back of a sturdy chair. Over time gradually let up the pressure on your hand and control the balance through the leg only. Set a goal of 20 seconds on each leg. Repeat 5 times on each side.

Sit to stand transition

Finally, perform a sit to stand exercise from a medium height surface. Follow the sequence below and try not to use your hands to rise. If you need your hands, work from a higher surface. If this is easy, try a lower surface which will make you work a little harder. Also doing this a bit slower makes it more challenging! Repeat 10 times, rest 30 seconds and repeat it twice more.









If you perform each of the exercises above you will have completed a stretch, a balance and a strengthening exercise and be well on your way to Move Better, Feel Better and Live Better!

Matt Whitaker, PT has been providing vestibular rehabilitation and balance therapy patients for 19 years with 10 years exclusively treating neurologic patients. Call to schedule an appointment today for a balance evaluation and assessment.