Wellness Concept

Balance and Physical Therapy

From the Healing Bridge Physical Therapy
September 2009 Wellness Notes

By Zeyla Brandt, PT

Balance has become a modern buzzword: balance between work and play, exercise and relaxation, and in the physical therapy clinic, balance between muscle strength and flexibility. There is another kind of balance: balance that allows us to stay upright in space.

That kind of balance is determined by many things. This will be the first of two articles on balance; the second will be authored by Allison Suran about the role of awareness of the body and its position in space.

The components of the balance system include:

• the vestibular system, located in the inner ear. This is a system of canals that tells the brain when we move
• the eyes, that also give information about movement
• the musculoskeletal system, which allows the body to make adjustments based on the information from the vestibular system and the eyes
• the brain, which processes all the information, and relays instructions to the musculoskeletal system and the eyes to deal with the information it has received.

When there is a problem with any part of the balance system, the main complaints are of falling or losing balance, and of "dizziness".

Dizziness is a word that can mean many things: a spinning sensation (called vertigo), tipping, the feeling of falling or "catching" of balance, lightheadedness or faintness, or the feeling that you have a "bobble head" and are unable to keep your eyes steady. All of these may be in the absence of actual movement.

There are several reasons that this might occur: damage to the structures of the inner ear, eye problems, or musculoskeletal weakness. If we cannot move our feet or legs in response to the information from the balance organs, the result is the same as if we had faulty information: we feel as if we might fall, or worse, we actually do fall!

The treatment for the musculoskeletal system includes strengthening the muscles and improving movement patterns, allowing for accurate responses to changes in position (more on this next month).

The most common problem with the vestibular system is BPPV, Benign Paroxysmal Positional Vertigo. This is a condition that becomes more common as we age, affecting up to 30% of the population over the age of 70! These unfortunate people report difficulty accomplishing the most basic of tasks: rolling over in bed, sitting up, lying down, having their hair washed or dental work done. Classically, BPPV presents as a feeling of spinning or falling, a few seconds after the person has changed position. The cause of these symptoms is small crystals moving around in the canals of inner ear.

There is a system of treatment for BPPV that is extremely effective in moving the crystals back out of the canals of the inner ear, resolving the symptoms. While it is not a cure for BPPV, it eliminates the unpleasant sensation, and the patient is usually very happy to be able to lie down again without the feeling of their head falling through the bed!

The role of the balance organs is often overlooked or taken for granted…when they are working well. But anyone with a problem in any of the systems involved will tell you that they will do almost anything for relief from the spinning and falling sensation. Physical therapy can provide an effective solution to this debilitating problem and address any associated problems that may have resulted from long term dizziness.

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