Video and Transcript: An Explanation of Standing Balance and Postural Control

Hi everyone, Doctor Orit Hickman here, physical therapist, and I want to give you a really quick explanation of balance and how that works in the body. And then I'm going to talk about why it is that in physical therapy we take people and we have them do balancing with different surfaces.

So, your balance in your body is modulated by three main systems. Probably the most important system, believe it or not, is your visual system. Right, we have a lot of information from our visual system. So what we see from the environment around us gives us a lot of information about where we are moving and how we're moving in space. So that's a pretty important one, so your visual system.

Number two is your inner ear. So your inner ear has your own personal level in your inner ear and it’s how you're able to know if you're standing upright, if your head is tilted off to one side. If you’ve ever been on a boat, your inner ear gets quite a workout. That is always having to adjust to a moving surface. So your visual system and your inner ear.

The third for us as physical therapists, probably the most important, are your joints.

So in all the joints of your body you have nerve endings called your proprioceptors. And the job of these is to tell you where you are in space and it's the way I'm able to know that I'm standing right now. It's the way I'm able to know that my arm is up overhead. It's the way I'm able to know that I'm tilted to the left side. There's a lot of information that comes from the joints and the nerves in the body to help us know where we are in space.

A lot of times when we’re having difficulty with balance, any one of those systems can have an issue. All three of them can have an issue where the different systems might not be communicating well with each other. So sometimes what can happen is, there are different conditions that affect the inner ear that can affect balance and we see patients in physical therapy all the time for that.

But even more simply, let's say you have a shoulder injury and you're in a sling for a bit of time. As soon as we take one arm out of the picture, it becomes much easier for me to push a patient over, which I never do, but from a balance standpoint, if you take away one of your limbs, you take away one of your arms, that can really affect balance.

When we walk we move our arms. We use our arms as counter forces as counterweights and they help us. You know that helps to rotate our trunk and it's how we're able to, is part of how we're able to, stay upright and stay balanced.

So if you have a shoulder injury or if your shoulder pains and you do something different with your arm, that might affect your balance.

In the clinical setting we also see patients who come in for a variety of different lower-body injuries and you know - knee pain, hip pain, ankle sprains, knee surgeries, and back pain. Any one of these things can affect balance.

So it's not surprising that one of one of the most common things that we’ll do in physical therapy is, we’ll evaluate your balance. Even if you're coming in for something that you think, well there's nothing wrong with my balance I'm coming in for, you know my right knee pain. At some point in your treatment, we will probably assess it. And we will probably try to treat it because, whether you believe it or not, you are at a greater fall risk as soon as something happens to your musculo-skeletal system.

So there are different ways that we are challenging balance and, if you check out my video on basic or beginning balance exercises, you can see a bunch of different exercises that we do there. But one of those most common things we’ll do with patients is, we’ll do on an uneven surface.

So this is a foam pad that we use in the clinic setting. So as soon as a patient is on a foam pad… What does it do? It challenges their joints because their ankles now have to work really hard to find where they are in space. And if I want to be particularly mean and challenging to my patients, I'll have them stand on the foam pad and close their eyes.

And you probably see that I am now swaying a lot more. I am having a harder time figuring out where I am in space. My ankles are working a lot harder to try and figure out.

So for a lot of the patients that we see, we will challenge their balance system by putting them on a surface like this foam pad. And as soon as we do that, it makes it so that the inner ear has to work harder. The joints have to work harder. And if we take out the visual system, the joints have to work a lot harder.

So then when you come off of the foam pad and have to walk on a stable surface it's a heck of a lot easier. So that is one of the things that we do in physical therapy and it's one of many treatments that we utilize to help and treat balance.

I hope that was really informative. Feel free to comment and let me know what you think.

Have a great day. Bye!