There may be a problem, but you could just be out of practice
We need healthy brain inputs and outputs in order to balance. Sensory signals from our muscles, joints, skin and gravity provide constantly updated feedback about our body’s position, which our brains cross-reference with information from our eyes and inner ears.
These are rapidly interpreted (particularly in the cerebellum area) and, if necessary, our brains send new instructions to our muscles and joints, so we are constantly readjusting.
Damage or ageing changes in any of these structures can affect our stability, sitting posture, walking, and coordination, putting us at risk of falls, while motion sickness is triggered by conflicting messages from the body, eyes and ears.
Losing your balance
As we grow, we acquire good balance and ‘hardwired’ skills, such as riding a bike – they’re imprinted, so we don’t forget. But by the age of 85, half of us will have balance or walking problems.
Around one in 50,000 of us has the genetic disorder Friedreich’s ataxia, which often affects balance, walking, coordination, speech, swallowing and other body functions by early adulthood. Spinocerebellar ataxia (SCA) and other ataxias can also be inherited.
Severe head injuries (and occasionally viruses, such as measles) can impair balance at any age. Too much alcohol makes us briefly uncoordinated and wobbly, but longer term, heavy drinking can cause permanent damage.
Neurological disorders such as multiple sclerosis, stroke, Parkinson’s, motor neurone disease, Alzheimer’s, brain/spinal-cord tumours and vitamin B12 deficiency can also interfere with balance.
Viral labyrinthitis/vestibular neuritis affects the inner ear, producing acute vertigo (room-spinning), unsteadiness and nausea/vomiting. Weak muscles, impaired sensation (neuropathy, for example, in diabetes), thyroid disorders and some anti-epilepsy and other prescribed drugs can also affect balance.
Symptoms and tests
Balance problems may feel like dizziness or unsteadiness. You may notice you’ve become clumsy, or even fall over, especially if you shut your eyes, or have nothing to hold on to. Describing these accurately will help your doctor.
You may notice nausea, numbness or muscle weakness, vision disturbance, tinnitus, headaches, bladder disturbance, or other symptoms, which may provide a clue to the underlying problem.
Blood tests can detect infections, inflammation, diabetes, thyroid problems, vitamin deficiency, and biochemical abnormalities.
Your GP will also want to check your ears and test your nervous system. You may also need scans of your brain, ears and/or spinal cord, nerve conduction studies (to measure signals), and/or genetic testing.
Treating the specific cause (for example, with vitamin B12 injections) may cure the problem.
Other issues, such as motion sickness and labyrinthitis/vestibular neuritis, usually resolve in a few hours/weeks. Medication (‘vestibular sedatives’) can relieve dizziness and nausea, making it easier to concentrate on your balance.
But if there’s no specific treatment, for example if you have a chronic or progressive neurological condition, physical treatments such as physiotherapy or occupational therapy can help you regain some control, although you may need a stick or other aid.
You may also find Ataxia UK (0845 644 0606; www.ataxia.org.uk) and other disorder-related support organisations helpful when it comes to managing the condition.
6 ways to improve your balance
1. Keep moving; prolonged sitting and bed rest make our ‘balancing muscles’ rusty.
2. Deal with trip hazards, such as vision problems, poor lighting, loose slippers, and obstacles (eg, clutter and loose rugs).
3. Touch base – holding an arm or handrail helps your brain to ‘ground’ you.
4. Use walking poles on uneven terrain – they take the strain off knees and hips, too.
5. Choose supportive shoes that stabilise your ankles and allow you to ‘feel’ the ground.
6. Do exercises to preserve and improve everyday balance (provided you are not at risk of falling). Visit nhs.uk/Livewell/fitness/ for illustrated advice.