BALANCE

I’m out of balance.”

“I need to get some balance my life.”

“Find the balance.”

“We all need a balanced diet.”

“It’s time to balance my checkbook.”

 Humans are upright creatures.  We are designed to stand upright, walk around, sit down, stand back up, bend over, lay down, get up and maybe even stand posed on one foot, or stand on your head—if you are really balanced.  Most of us take it for granted—just like so many other amazing functions of our amazing human bodies.

If you are out of balance, none of these actions may be possible.  Dizziness, light-headedness, vertigo, falling and clumsiness are all signs that our bodies are not balanced.  That’s when we realize what a gift it is to be balanced.

We speak of balance so often in our lives that we hardly notice the importance of that word.  It all stems from the concept of being balanced on our feet and maintaining a sense that we are upright, and we are able to physically navigate our bodies through space and distance without falling or feeling that we are off-center.  If you have never experienced this feeling, you are among the lucky ones.  If you have, then you can relate.

It is estimated that 40% of people will experience significant balance disorders at some point in their lives.  This estimate, however, may be conservative, because there are a wide range of symptoms that can be attributed to balance disorders, and the various ways that they might be detected and reported—or not.

The symptoms may range from mild light-headedness, all the way to a complete loss of the ability to remain upright and function in our daily lives.   It can keep some people in bed or chair-bound all day, because simply walking is difficult.  In the most severe cases, a feeling of continually falling, as if falling through space or endless, multiple trap doors, is reported.   Driving is out of the question for many people, as is functioning in their work, family or social roles.  A simple turn of one’s head may make their world spin, turn sideways or upside-down, or make it impossible to visually focus.

Adding to the misery is the fact that, for most people, these symptoms can come and go, and often cannot be predicted.  These disorders may be present most of the time, or they may come in a sudden attack, often without warning. They may even be caused by something as simple as turning over in bed—a common trigger.

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 There are many sign that a balance disorder is present, including:

  • A feeling of unsteadiness/increased clumsiness/feeling “woozy”
  • Falls/near falls/running into obstacles
  • Impaired mobility/gait
  • sensation of spinning/swaying—also known as vertigo
  • confusion/disorientation
  • reflex delays
  • headache/migraine
  • nausea/vomiting
  • fatigue/difficulty concentrating
  • visual disturbances, including nystagmus (erratic and rapid eye movement) and oscillopsia (sensation that objects in line of view, or the entire room or visual space is spinning or moving erratically).

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According a subsidiary of the CDC (Centers for Disease Control), 4% of adults—8 million Americans—report a chronic problem with balance, and an additional 1.1%–2.4 million Americans—reported a chronic problem with dizziness.

One disorder in particular, Benign paroxysmal positional vertigo—herein referred to as BPPV—accounts for half of all reported cases in adults.   It is most commonly described as a brief, sensation of spinning that occurs when there are changes in position of the head with respect to gravity.  This sensation may be reported when rolling over in bed, getting out of bed, moving the head quickly, or looking up.  As the name suggests, it is benign and not a serious disorder in terms of health, but it can seriously affect one’s function.

The cause of BPPV can be best explained by this analogy:  The inner ear, which plays a key role in balance, has crystals floating smoothly and evenly when they are functioning properly.  Imagine a snow globe:  when you shake it up and the snowflakes float freely and evenly, all is well and beautiful. When they cluster and cease to float evenly and smoothly, it’s not so pretty.  It’s much the same in the inner ear.  If the crystals float smoothly, all is well.  If they cluster, stop moving or fall from this space, then a sensation of spinning is caused.  The information sent to the brain from the inner ear doesn’t match the actual head movement.

Other causes include:

  • An inner ear infection
  • Low blood pressure
  • Trauma—injury to the skull or a brain injury
  • Surgical trauma
  • Meniere’s Disease—an inner ear fluid balance disorder
  • Perilymph fistula—a leakage of inner ear fluid
  • Other, less common medical disorders

Balance disorders should always be examined medically.  Starting with your primary care physician, a balance disorder can be assessed, and you may be treated or referred to a specialist, perhaps an  otolaryngologist, who is a physician specializing in diseases and disorders of the ear, nose, throat, head, neck; and sometimes specializes in balance disorders.

Treatment is determined by the underlying cause.  As there are many causes, so too are there many treatments, which is why anyone with a balance disorder should be medically examined.  Often, there is no one, single cause. Rather, there may be an interplay of factors such as ear infections, drug reactions, low blood pressure, central nervous system disorders such as a stroke.

As a person ages, all these factors tend to coalesce, and create increased risk for balance disorders  There is no magic age in which these disorders are caused by age, but “older” adults experience them more than younger ones do.  One doctor reports that otherwise healthy patients in their 40’s have complained of symptoms consistent with balance disorders:

“I am not as steady on my feet as I used to be.”

“I feel more clumsy as I age.”

“I have to hang on to stair and step railings now.”

“I can’t bolt up and down the stairs like I used to without feeling a little off balance.”

“I am lightheaded and more dizzy as I age.”

No matter what age, however, a person should always report any balance disorder symptoms to their doctor.  They may be signs of a disease or disorder that can be treated, controlled or cured.

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The vestibular system is a complex structure of fluid-filled tubes and chambers that constitutes part of the inner ear.  Specialized nerve endings inside these structures detect the position and movement of the head, as well as the rest of the body in space known as proprioception.  As a child grows and develops, this system matures as the child physically matures.  This system almost begs for stimulation as a child, which explains why children delight in spinning their bodies, riding merry-go-rounds as well as amusement part/carnival rides that spin them at high rates of speed, playing games that require spinning like Ring Around the Rosie, and being spun by someone else.

If you are an adult reading this, simply reading the above spinning scenarios may make you a little dizzy.  That is because as we age, our vestibular systems mature, and stop craving such stimulation.   At some point in adulthood, they typically reach a zenith of function, where everything is balanced, and normal, everyday activities provide just the right amount of stimulation.  No balance problems are experienced, and no more extra spinning is necessary.  Then, at some point later in adulthood, many adults seem to have decline in this happy medium, and their bodies don’t feel so stable anymore.  Even the thought or mention of spinning can bring a whiff of dizziness.

Anatomical studies have shown that the number of nerve cells in the vestibular system decreases from about age 55, but have been reported earlier. Blood flow to the inner ear also decreases with age.  One of the leading health concerns for people over 60 is falling, which is often caused by balance problems.  For adults over age 65, it is estimated that 30% of those who live at home fall in their homes.  One of the greatest risks for these people is the high probability they will fracture a hip, and of those who do, the risk of death as a result of a downward spiral of health after that fracture is a great concern.  Too often, recovery from this fracture is too complicated for the already-compromised health of the individual.  Falls are the leading cause of accidental death and injury in people 65 and older.

**33% of older adults fall every year, but only half of them talk to their doctor about it. **

If you have an older parent or a loved one who may be at risk to fall, have a frank, open discussion with them about this risk.  Perhaps they are one of those who don’t report a fall.  They may be scared to bring it up because they may fear loss of control if they admit it, and this may threaten their independence if they live alone.  They need to be made aware of the risk, these statistics, and what can happen if a hip is fractured.  Other broken bones or a head injury are also considerable risks.

There are many factors that play into good balance in this population, including reliable input from the vestibular system and the proprioceptive system (both were discussed earlier).  The sensors that determine the messages of our proprioceptive systems weaken, as the nerve endings are not as reliable as they once were.  The feet are full of such sensors that tell the brain how and when to move in order to maintain balance.  One suggestion experts make is to go barefoot in your home and whenever possible to keep these sensors stimulated and working as they should so that they can send accurate messages regarding position and balance back to the brain.

The older adult is also more likely to suffer from other disorders that will affect this system, including vision disorders.  Cataracts, glaucoma, diabetic retinopathy and macular degeneration all affect vision with age, and will likely in turn affect the older adult’s ability to see clearly to make safe judgements about movement.  Diabetic peripheral neuropathy affects position sense in the feet and legs, and, finally, overall degeneration of the vestibular system creates a decreased sense of balance.

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Aging brings a host of challenges to one’s health.   It seems we must work harder to maintain what once was effortless.  With a little focus, dedication, and work, good balance can be the norm throughout the aging process.  Remaining in good physical shape through regular exercise is important not just for balance, but for every aspect of good health.  Good nutrition cannot be ignored either.

To reiterate these and other important considerations, please keep these suggestions in mind:

  • Regular exercise—walking is one of the best forms.
  • Maintain good eating habits.
  • Be aware of stressors and keep them in check.
  • Strive to get enough good-quality sleep.
  • Get regular checkups from you primary care doctor.  He or she can be alerted to any symptoms that   may cause imbalance and increase fall risk.
  • While most adults are aware of the signs and risks of high blood pressure, many  don’t know that    low blood pressure carries its own unique set of risks, and light-headedness is one symptom. Keep tabs on your blood pressure, and report any concerns to your doctor.
  • At any age, don’t take unnecessary risks when icy conditions prevail outdoors.   The number of falls and broken hips increase exponentially on ice.
  • Seek out physical therapy if your doctor feels it would help.
  • Consider yoga or Tai Chi.  Both are structured forms of exercise that focus on stability and balance. There are classes that cater specifically to the older adult.

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While balance disorder and falls may be common as a person ages, they are NOT normal.  Common and normal are not to be confused.  There are many things a person can do to maintain good balance and vestibular health.  It may take extra effort, but it is worth it.

We are upright creatures.  Please stay that way.