Our balancing act

Though not something we often think about, our balance tends to erode with time. For weekend athletes, lost equilibrium can mean more spills on the slopes or wipeouts in the surf. For the sedentary, it can bring a surprise encounter with the sidewalk.

Yet falls aren't an inevitable consequence of growing older. It's possible to regain equilibrium and compensate for permanent balance deficits.

Life in the balance

Our eyes, ears, and central nervous system are key to maintaining stability.

Vision immediately tells us where we are in relation to the rest of the world. Visual cues also allow us to adjust our body's position so we can steer around obstacles in our path.

Another important source of our sense of balance is the inner ear. Wherever you move your head, nerves inside the ear relays its precise position to the central nervous system.

The central nervous system also gets information from nerve receptors embedded in muscles and tendons.

Enemies of equilibrium

Conflicting reports from the three systems can set our heads aswim. In fact, seasickness is a prime example — the eyes say the cabin is steady, but the inner ear says you are rolling back and forth, up and down.

Balance can also suffer from malfunctions of a single system. These may be caused by a number of disorders:

Neurological conditions like Parkinson's disease, multiple sclerosis, and strokes can affect balance. Physical therapy for neurological conditions can help to maximize balance and minimize the risk of falls.

Diabetes causes nerve damage in the feet, making it more difficult not only to walk properly but also to sense the terrain underfoot.

Vertigo may come from ear disorders or simply from the aging of the inner ear's balance system.

Postural hypotension — a drop in blood pressure when rising from a chair or bed — can cause lightheadedness or even fainting. It's very common and has many causes: dehydration, anemia, medications, or abnormalities of the autonomic nervous system, which monitors and controls blood pressure.

Foot problems, such as corns, bunions, and hammertoes, are both a cause and a result of uneven balance.

Eye diseases such as cataracts and glaucoma are stealthy thieves of sight — and balance.

Medications that can cause dizziness or lightheadedness include sedatives, antihypertensives, antidepressants, and antihistamines.

Retaining and regaining

Balance is another one of those use-it-or-lose-it propositions. Sedentary people lose some of the neural connections necessary for good balance. Getting off your duff will help you stay on your feet.

Bad posture causes bad balance. You can't go wrong following the ancient alignment mantra: Head erect, shoulders back and down, stomach and buttocks tucked in, knees relaxed, and feet planted firmly, hip-width apart.

Some strength is also essential. Strong hip, knee, and ankle muscles will give you a solid foundation and help you stay upright. Tai chi has been firmly established as the exercise routine for balance. The flowing, controlled movements are a great way to improve stability and reduce the fear of falling.

When you need a little help

If you're considering using an assistive device — or if your doctor has recommended one — a wide array of canes, walking sticks, and walkers awaits. There are several factors to consider, including your height, strength, posture, and daily activities. Don't settle for something that is awkward to use. It may take some trial and error to get the aid that's the best fit for you.

August 2006 update