Balance Problems and Gait Disorders

Feeling uneasy with balance problems?

Do you feel afraid, unsafe, or uncertain when you have trouble balancing?

It is not uncommon to feel uneasy about balance problems.

Let’s talk what causes poor balance and balance problems, how to diagnose them, and how physical therapy can help.

Contents

What Causes Balance Problems?
Signs of balance disorder
How do you diagnose balance problems?
How does physical therapy help balance problems?
What causes gait disorders?
How do I check my gait?
Why do I have a hard time walking after sitting?
How do you fix a gait disorder?

What Causes Balance Problems?

The three systems involved in your balance:

• Sensory – ability to feel the ground and awareness of your feet positioning, as well as the awareness of moving through space. If your sensory input becomes impaired, either with altered sensation or poor proprioception (awareness of position/movement in space), then your balance can become impaired.
• Vestibular – in your inner ear, there are feedback systems on each side. These correspond to head movements which alert your body to where your head is in space. Small crystals can loosen and move within the ear canal. The crystals can severely impair your balance, and even create nausea, vomiting and vertigo. Known as benign paroxysmal positional vertigo (BPPV), this is considered a peripheral vestibular disorder. Central vestibular disorders require other treatment outside of physical therapy.
• Vision – If you cannot see where you are supposed to be stepping, or have a poor sense of distance, you are more likely to misstep and potentially fall. The ability to see and coordinate your foot placement for stepping is essential in maintaining your balance during dynamic activities.

Any deficit in 1 of these 3 systems can lead to increased reliance on the other 2 systems.

As we age, our vestibular and vision systems decline. With increased reliance on these systems, a person becomes more prone to falling and potential severe injury.

Signs of balance disorder

If you begin having trouble standing still or react to terrain changes when walking, this could be signs of a balance disorder.

Symptoms could also present as dizziness when sitting, standing, or changing positions. Some slight dizziness with a quick change of position is normal. If this dizziness doesn’t subside or if you have trouble focusing your eyes after a longer period of time, this could be an important sign.

Other signs include the feeling you’re moving or spinning. You might feel faint or lightheaded. There can be a feeling of unsteadiness or as though you’re losing balance. Often, you feel like you might fall. You could suffer with vision changes like blurriness.

How do you diagnose balance problems?

Your therapist assesses the 3 systems listed above. We do this in order to determine which system may be more diminished and causing the balance changes.

We evaluate your sensation and proprioception to determine the feeling in your legs. Also, we look at your ability to control movement to a fixed point/determine position in space.

A test that provides input to specific impairments is called the “foam and dome”. You stand on a high-density foam that alters sensory input from the feet. Then, you have your eyes open, closed, and then an object is placed over the eyes to decrease visual input. Depending which combination of these proves most difficult, the test indicates which system(s) are most heavily affected.

How does physical therapy help balance problems?

Similar to improvements in strength with strength training, your balance and balance strategies can improve with exposure to higher-level challenges. Just as lifting heavier weights makes lifting light weights easier, practicing balancing on one leg on a foam surface. This improves your balance in less dynamic situations.

Your therapist can also discuss and practice common balance strategies. These strategies improve your ability to stabilize your balance when exposed to an external stimulus or balance challenge. Your therapist can also discuss fall recovery and strategies to ensure safety after falling. We show you how to come back to a stable position if you are very concerned of falling outside of PT.

If you are feeling uneasy with poor balance and want to improve your coordination, then understanding what causes these difficulties helps you take the right steps to improving your balance.

What causes gait disorders?

Gait disorders can be caused by leg, foot, or ankle pain. These pains affect your balance and function. Stroke, brain injury, and other neurologic disorders often affect gait. Weakness or strength deficits from low back pain or nerve impingement can lead to abnormal gait patterns.

How do I check my gait?

When walking, you can look for and feel for any “hitches” or imbalances in your gait, and also be in tune to any pains you might have when walking. If there is any way to walk near a mirror, you may notice any lean or shifts in your gait pattern that may provide input to portions of your gait that are abnormal.

Why do I have a hard time walking after sitting?

Often, if you are sit for a long periods, your joints and muscles may stiffen up. This changes how you walk initially after coming to standing from sitting. Sometimes, when changing quickly from sitting to standing you will feel lightheaded or sense visual changes. This can affect your ability to walk.

How do you fix a gait disorder?

Your therapist observes your gait pattern over ground or on a treadmill. This determines any abnormalities of your gait pattern. After discussing and educating you on these deficits, your therapist may work on “pre-gait”. These broken down portions of the gait cycle address certain deficits, before we implement them into a full gait cycle. Being aware of your gait impairments and correcting them, helps you to work on your gait outside of PT. This repetition helps you gain more lasting changes.