Do you want to know how to improve your balance? Well, first you need to know how your balance system works in order to truly understand how to improve your balance. Read our in-depth guide to help you understand the complexity of balance and what can go wrong.
BALANCING OUR WAY THROUGH LIFE
There are many things in life that we take for granted. Balance is one of them. The human body has come a long way since the time evolution took place. We no longer need four limbs to support us. Evolution has enabled us to use just two limbs to stay upright and move about on the surface of the Earth. Though we may not give it much thought, balance requires a lot of our organs to be functioning optimally.
WHAT IS BALANCE?
To most of us balance is an art. That is mostly because we think of balance as something that one needs while walking a tightrope. However true this maybe, you will find that balance is far more than a tightrope act. It is ability that our body possesses to maintain its center of mass over its base of support.
Balance is achieved by the combined effort of many sensorimotor control systems. Sensorimotor refers to those organ systems which interpret sensation and help in motion. Hence the name ‘Sensorimotor’. Each of these systems provides information to our body that helps us maintain our balance.
The information that is required for balance comes from touch (also known as proprioception), vision (sight) and the vestibular system. The vestibular system gives us insight on motion, spatial orientation and equilibrium of our body. Along with this sensory input, there is also the sensory input that is provided by the body muscles.
As you can see, balance is a complicated process which is the output of the integration of many systems. There are three main sources of input that our body uses to maintain balance. These are the eyes, muscles and joints and the vestibular system. Let’s take a look at how each of them contributes to the process.
THE VESTIBULAR SYSTEM AND BALANCE
Most people have never heard of the vestibular system. This is because it lies buried deep inside the ear and unless we have a problem with our ears, we continue to remain oblivious of its presence. The vestibular system plays an important role in balance and spatial recognition. This is how we are able to coordinate our movements and maintain our balance.
The vestibular system is situated in the inner ear and forms part of the auditory (hearing) system. This important part of our body consists of two main parts: the semicircular canal systems and the Otoliths.
Understanding how the vestibular system works is really very easy. Imagine that you are carrying a glass of water. Every movement that you make is seen as some movement in the water. The very act of movement can cause two types of movement in the water. One is rotation or a spinning movement and the other is a linear movement.
The semicircular canal system and the Otoliths are filled with fluid which moves as we move. The semicircular canals provide information about rotations and the Otoliths provide information related to linear movement.
Another way in which the vestibular system contributes to balance is through the vestibulo-ocular reflex. From the name itself, you can draw an inference that this reflex involves the vestibular system and the eyes (ocular). The vestibular system sends impulses or signals to the neural structures. These neural structures control the movements of the eyes. It also controls the muscles that keep the human body upright.
The information that the body obtains through the vestibular system is translated into action. Changes are made in its position to ensure that it doesn’t fall.
THE EYE AND IT’S CONTRIBUTIONS
The eye plays an important role. It is the eye that helps us see and recognize how our body is placed in relation to everything in our surroundings. Not convinced? Let’s take a look at how it does this.
Most Neurological tests include a test called the Romberg’s test. This test is used to test balance. The human body requires at least two of the three senses to maintain balance (proprioception, vestibular function and vision). The Romberg’s test removes sight from these three and shows us how the person performs with just two senses.
All that you have to do is ask the person to stand erect. The person can keep their eyes open at first. Ensure that the hands are at their side. The next part of the test is to repeat it with the eyes closed and make the person stand for a whole minute in this fashion. A normal person may sway slightly as he or she maintains her balance. A person who has a problem with proprioception or vestibular function cannot. This is because since the eyes are closed the person is left with only two senses. However, one off the person’s senses is not functioning properly. He/she is now dependent on only one of the senses. This is not enough to maintain balance.
This test proves many things but most importantly, it proves that vision plays an important role in maintaining balance.
PROPRIOCEPTION AND OUR LIMBS
How often do you look at your feet as you walk? Do watch TV while you eat?
We all do a number of activities in our life without being actively conscious of our movements. We do not have to look at our limbs to ensure that they are moving towards or away from the something. This is all because of Proprioception. It allows us to control our extremities without having to constantly look at them.
What is Proprioception?
It is the ability that our body possesses to sense movement within our joints and due to our joint positions. Proprioception makes most of our complex daily tasks seem easy. We do not need to look at our steering wheel while driving nor do we need to look at our feet while running. We do not have to look at our game controllers while playing nor the keys of the piano while playing from a music sheet.
Do we have a specific system that controls proprioception? No! The human body does not possess one. It however uses the entire nervous system for this purpose. We all know that the nervous system of our body is like a well connected network of roads in a country. There is no muscle or cell in our body that is not in contact with our neural pathways. This helps the nervous system collect information quickly.
What information are we talking about? Information regarding the posture, the amount of tension and the degree of contraction of all the muscles in the body gives a composite picture of how the body is placed in its environment. The nervous system helps to control just this and provides us with the sense of proprioception.
As we have seen before, there are three senses that work together to help us balance. The human body is so well planned that in the advent of failure of one of these three senses, the other two can work to compensate for the failed or diminished sense. That is the reason why many of us do not even realize that we have issues related to balance.
Even though we have a backup plan in place, there are so many things that can go wrong. Let’s take a look at how our balance can get unbalanced!
Yes, there are a number of diseases that target our senses. The disturbance that they cause can be mild or it can be severe. The diseases can occur because of old age or because of infectious processes. When the disturbance caused by the diseases is mild, we usually overlook it and do not realize that it exists. This is usually because the other senses are working to compensate for the deficit. Larger disturbances are much more obvious.
Most diseases result in the person feeling dizzy, lightheaded and disoriented. Since vision is one of the senses that can get affected, some people also present with problems in reading and difficulty in seeing. There are many associated signs that can occur simultaneously. These are nausea, vomiting, fainting etc. Each disease manifests in a different way.
DISEASES THAT AFFECT THE VESTIBULAR SYSTEM
‘Itis’ means inflammation. Hence if you split up the word ‘Labyrinthitis’, you will understand that this disease affects the middle ear and causes an inflammation or an infection. The person who is affected with this condition will manifest with dizziness and hearing loss. Dizziness because the function of the middle ear is diminished and hearing loss because… Well the ear is affected!
This affects the Vestibular neuron, better known as the vestibular nerve. This infection results in vertigo. You may wonder how the inflammation/infection of the vestibular nerve can result in vertigo. Even though the vestibular system is functioning optimally, the vestibular nerve transmits impulses from it. A diseased nerve will not be able to do this. Hence the person feels giddy.
Trauma can have two causes. It can be caused by an accident in which a fracture or a concussion can throw us off balance. The other form of trauma can occur during surgery. Though this is rare, vestibular symptoms can appear to be quite pronounced. The person can have dizziness and instability that can persist for months to over a year.
A perilymph fistula is another condition that can occur due to trauma. It results in the leak of the fluid in the middle ear. This fluid is a key element that helps us maintain balance. Loss of this fluid means that our ability to maintain our balance gets severely affected.
Most of the conditions that occur involve only one ear. Bilateral Vestibulopathy affects both ears simultaneously. This is because it involves the loss of inner ear function of both ears. This is largely due to its cause. Bilateral Vestibulopathy can be caused after taking certain antibiotics, chemotherapy and other drugs. Another known cause is chemicals like heavy metals and solvents that are ototoxic (harmful to the ear). Syphilis and other autoimmune diseases have also presented with bilateral vestibulopathy.
THE NERVOUS SYSTEM
The Brain is the kingpin in the nervous system. It isn’t a wonder that when the brain is affected, we see the effects throughout our body and that includes our balance. It is very similar to a country. Topple it’s leader and the country can and will disseminate into chaos. Here the brain is the leader and the country is the body.
A number of diseases that affect the brain can affect the way a person maintains his/her balance. Let’s discuss a few broad categories.
Degenerative diseases are faced by older individuals. It involves all things age related. The functioning of the motor functions of the brain diminishes as the brain is slowly affected by the progression of the disease. This leads to a lot of motor related issues which in turn can affect balance.
Some examples of these diseases are Huntington’s disease (characterized by involuntary movements), Corticobasal Degeneration (affects the cells that control a person’s walking, balance and vision) and Lou Gehrig’s disease (degenerative motor neuron disease).
A number of infections can result in meningitis (inflammation of the meninges of the brain), encephalitis and epidural abscess. All these diseases eventually have some effect on the way a person balances himself. This is because of a multitude of reasons. The inflammation affects the brain tissue which makes the transmission of impulses slower and more difficult. This is one of the primary impairments that can worsen balance.
Another issue that you will find, is that these infections lead to the increase in the intracranial pressure. What is this? The brain lies within a skull which is a closed and protected area. Due to the inflammation the brain tissue can swell and since it doesn’t have enough place to expand into, it is finds itself constrained. This increases the pressure. It has a similar effect to squeezing the brain, which means that this brain is going to have a great deal of difficulty in functioning. One of the various signs that can be seen in people suffering from these conditions is impaired balance.
Circulatory diseases have always been known to cause a lot of damage to the brain. Diseases like strokes affect a person’s balance tremendously. This is because a stroke can cause paralysis of a part or the whole of the human body. Which means our neuromuscular system ceases to function or functions erratically. A stroke can affect one or more limbs. This can result in grave difficulty in walking. Imagine maintaining your balance while dragging a non functional leg along… Difficult isn’t it?
Circulatory diseases occur when the circulating blood decreases or ceases to flow to a part of the brain. This reduces the amount of the blood that reaches that quadrant of the brain. Blood provides tissues with oxygen and nutrients which are vital for their function. It also removes the harmful byproducts of metabolism. A decrease in the circulating blood means that a part of the brain is not receiving adequate nutrition. This soon leads to death of the tissue in that area.
If this hits the parts of the brain that are responsible for our motor functions, our balance invariably gets affected.
While most people do not know what a neoplasm is, they will quickly recognize it by its more common name… CANCER! Neoplasms in the brain can cause great damage because of their uncontrolled growth. This is because a neoplasm occupies space. We all know that the space inside the skull is limited. With the increase in the size of the neoplasm, it becomes more and more difficult to occupy the brain as well as the neoplasm within the skull. This is when we will begin to see the effects of increased pressure on the brain. This in turn can affect various aspects of our lives. Balance is just one of these aspects.
So as you can see, it doesn’t matter if the neoplasm is benign or malignant. All kinds of tumors are dangerous when they are located in a sensitive place like the brain.
VISION AND BALANCE
Vision has always been closely associated with balance. The eye shows you your surroundings and helps you navigate through the environment around you. In fact, around twenty percent of the nerve fibers of the eye interact with the vestibular system. From our previous discussions you will be able to see the importance of this.
This disease causes the person to view objects with a significant difference in the magnification. Each eye sees the object with a varying magnification. When the difference is very high it can cause disorientation, dizziness and balance disorders. This is simply because of the inaccuracy of the information that the person’s eyes supply.
Imagine that you can see two of everything. How would you know which is the real deal and which isn’t? There are people who face this issue in a condition called double vision. The condition is so bothersome that some people even cover up one eye to prevent it from happening.
As you can imagine, each eye presents the body with two different sets of data. The body finds this hard to interpret and this is what causes issues in balance.
Eye Movement Disorders
These disorders are popularly known as a ‘Squint’. They can occur from birth or they can occur after that. Irrespective when they occur, these disorders cause a disturbance in visual perception. One of the major problems occurs when it is an acute acquired event. This means that the squint has a cause and is not congenital. In such conditions, the brain doesn’t perceive that the eye is shaking, it rather perceives that the world is moving. This is called oscillopsia and is the cause of giddiness and disorientation in these patients. You can now see how eye movement disorders affect the balance of those affected by them!
Alcohol is another well known cause of balance related issues. Many may have even experienced it’s effect first hand. The alterations that alcohol causes however, lasts only for short durations. These alterations are caused due to the variable viscosity of the blood and can result in two situations.
In the first situation, the alcohol concentration is higher in the blood as compared to that of the vestibular system. This makes the endolymph seem more dense. This occurs when you just ingest alcohol. That is when the levels of alcohol are the highest in your blood. The difference in the density is what causes subjective vertigo.
The second situation is slightly different. Here the alcohol levels are lower in the blood. The levels in the vestibular system are higher. This makes the endolymph relatively dilute in comparison. This difference is what causes subjective vertigo in the second case.
How to Improve Your Balance
TREATMENT OF BALANCE RELATED DISORDERS
The treatment of balance related disorders is never simple. This is because to treat the condition you need to know what the person is suffering from. The large variety of balance related disorders makes it difficult to isolate and pick the cause.
The easiest way is to characterize the disorders on the basis of the sense affected (vestibular, vision and proprioception). A vision test will tell you if the person has any problems with their sight. If you find the problem at this point, it is easy to rectify. If not, you need to go ahead and do an entire neurological assessment. This will give you an idea about the person’s proprioception and even problems related to the vestibular system.
Once you identify which of the three senses is affected, it is easier to find and locate which disease has affected the person. Treatment of the cause is the best way to treat balance related issues.
There are however a number of exercises that can help you improve your balance. This can help an average person as well as those who find that they don’t have the best balance in town.
The Stork Swim
The Stork Swim is an exercise that helps to improve balance by making you shift your weight continuously. The exercise is relatively easy. Start with your left foot. Keep your right foot firmly planted on the ground and raise your left knee up till it is at hip level. Use both your hands and reach in front of you. Start bending forward while extending your left foot backwards. Hold the same position for around ten seconds before returning back to the starting position. Repeat the exercise with the other leg.
This exercise is meant to develop your core. If you think that standing on your toes is easy, this exercise will make you put that theory to the test.
Keep your feet together. This will be your starting position. Lift your heels of the floor and continue to balance on your toes. While the average person will find this relatively easy, people with balance related issues will find this more difficult. The next step is to reach your hands out on either side and start to move one inch forward and one inch backward. It is a simple motion that you will find bears a strong resemblance to a pendulum.
The Leg Swings
The Leg swings is another easy exercise that helps improve your balance. All that you have to do is stand erect and firmly place your left foot on the floor. Raise your right foot a few inches above the floor. Now do exactly what the name suggests. Swing your leg forward and backward. Ensure that you touch the floor to help you maintain balance. Once you are done with one leg, switch legs and repeat the drill.
The One Legged Clock With Arms
A rather funny name for an exercise but it does describe the exercise well. The one legged clock with arms bears a strong resemblance to a clock. The points on the clock that concern us are twelve, three and nine.
Stand on one leg and extend your hand out such that it resembles the hand of a clock. The other hand should remain firmly planted on your hip. Now move your hand from the twelve position to the three position and then circle and reach the nine position. Make sure that you don’t lose your balance while doing this.
Switch your arms and legs and then repeat.
The One Legged Squats
For those of you who are used to doing squats in the gym, one legged squats will sound like a very difficult exercise. Make no mistake, this exercise is challenging.
Place your feet at a distance apart. The distance should be equal your hip width. Point your right foot out in front of you such that it just barely touches the floor for balance. Now, progress into your squat by lowering your body down on to your right foot. Always ensure that your posture is maintained. Your back should always be in an erect position.
Switch feet when you are done with your repetitions.
Toys and Balance
Challenging your own balancing abilities doesn’t need to be a chore. It can also be fun. This can be done in many ways. You can start out by just standing still and closing your eyes. If you continue doing this for a few second you will find that your body begins to sway. This in itself is a very interesting phenomenon because you have cut out the data that your eyes would provide. Without the visual stimulus, the other senses have kicked in and are working overtime.
You can take this one step further by standing on one leg with your eyes closed. This is in fact a part of an exercise in yoga which helps to perfect your balance.
For those of you who love weights and other tools, gadgets and toys. Try incorporating them in your exercises. Use weights while standing on one leg with your eyes closed. You can use a number of other devices like balance boards and balance cushions too.
Balance is a very important part of our daily lives. It is because of our ability to balance that we can navigate our way through most of our tasks in life. Take away our balance and you can very well take away our ability to be self sufficient.
While not all of us may suffer from diseases that affect our balance, we all have the scope to improve it. Exercises help our systems function optimally and help fine tune our senses. Just like how a pianist or guitarists moves their fingers without having to glance away from the music sheet, we too go through life doing things without glancing at our actual movements.
The very act of acknowledging the importance of balance is a great step forward. While perfect balance may not be on your agenda, improving your balance should always be at the top of your to do list!