• Einstein once said, “Life is like riding a bicycle. To keep your balance, you must keep moving.” How right he is! In this blog post, you will learn about our body’s balance system and the importance of training your balance regularly. As a physical therapist, I often work with people on improving balance and reducing fall risk. Exercising your balance is just as important as working on your strength, flexibility, and endurance. Because we use balance every day, we need to train it regularly.

    Balance is a complex system that involves many different body parts and senses working together cohesively. In the most simplistic sense, you can think of balance like a 3 legged stool, where each leg of the stool represents a body system important to balance.

    These three systems are:

    1. Your vision system
    2. Your proprioception system (a sensory observation your body makes about where your body, limbs, and individual joints are positioned in space)
    3. Your vestibular system (the inner ear sensory organ of balance).

    Each of these systems allow your brain to gather important information about your body like where your body is in space and how your body is interacting with your environment. Your brain interprets this incoming information and then sends signals back out to your muscles telling them how to adjust your body position and body movements to maintain your balance.

    The vision, proprioception, and vestibular systems must work together to give your brain a full sensory picture of your balance.  If one of these systems becomes affected, your balance suffers.  In effect, it’s like trying to sit on a 3 legged stool with only 2 legs – you are going to fall over.

    Many common conditions can affect your 3 legged stool of balance:

    • Vision can be affected by macular degeneration (a common eye condition), aging, and a number of other medical conditions.
    • Proprioception can be affected by conditions that affect sensory nerves in your body, such as lumbar stenosis or peripheral neuropathy.
    • Your vestibular system can be affected by conditions such as BPPV and vestibular neuronitis.

    Normal aging also plays a role. Chances are, as you age your balance will naturally become worse. Add this natural progression to a medical condition that affects balance and you have a recipe for falls.  But there’s good news! Balance training has been found to improve balance and reduce fall risk both in healthy adults and adults with neurologic conditions.

    There are many ways to target balance.  Make sure to consult your physical therapist for recommendations before you begin any new balance program.  Examples of balance exercises include standing in balance poses such as “rhomberg” (feet together so they touch), “tandem” (one foot in front of the other), and single leg stance. You can increase the challenge of any exercise by closing your eyes or adding a thinking task to the exercise.  You can also use equipment such as balance pads, the BOSU, and rocker boards.  Exercise programs such as Tai Chi and Yoga are also great at targeting balance.

    There are 2 important things to keep in mind when training your balance:

    1. Safety is of the utmost importance.  Create a balance “safety zone” when you do your balance exercises.  An example of a “safety zone” would be standing where your back is facing a corner (not touching the wall) and there is a chair in front of you. Or, perhaps stand next to a counter with a chair behind you. That way, if you lose your balance you aren’t going to fall.
    2. To challenge your balance, you have to wobble a little bit during the exercises. This is where your physical therapist comes in – he or she can provide you exercises that appropriately challenge your balance while not making them so hard that they cause a fall or are scary to perform.

    To find a physical therapist who can help you with balance, visit the APTA’s Find a PT website.  If you have a neurologic condition, make sure to check the neurological box before you hit search. If you are a senior citizen, you may want to check the geriatrics box.

    Many Senior Centers and community programs also offer balance and fall prevention programs. If you live in Northern California, visit this website to find a balance class near you: http://parkinsons.stanford.edu/fallprevention.html

    For further reading on balance and falling, visit:

    Balance long and prosper!


    Mansfield et al. Effect of a perturbation-based balance training program on compensatory stepping and grasping reactions in older adults: A randomized controlled trial. Phys Ther. 2010; 90:476-491.
    Silsupadol P et al. Training of balance under single- and dual-task conditions in older adults with balance impairment. Phys Ther. 2006; 86:269-281.
    Westlake KP, Culham EG. Sensory-specific balance training in older adults: Effect on proprioceptive reintegration and cognitive demands. Phys Ther. 2007; 87:1274-1283.
    Wolf SL et al. The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Phys Ther. 1997; 77:371-381.