Balance and mobility

--What are balance and mobility problems?

Good balance and mobility requires a number of body systems to be functioning well.

The brain plays a crucial role in balance and mobility—planning movements, as well as receiving information from the body senses, such as vision. The brain then sends messages to the muscles on how to respond to this information in order to achieve safe and successful balance and mobility.

Good balance and mobility depends on the ability to activate the appropriate muscles at the right times, with the correct amount of force for the task in that certain environment. For example, someone with good balance and mobility may still struggle to walk on icy ground, while someone with poorer balance and mobility may find walking across a room difficult or be unable to walk or stand without help. Although these people are quite different, the same issues in matching balance abilities to the task and environment apply.

The vestibular system located in the inner ear is also important for balance. Mobility also requires good cardiovascular (heart and circulation) and respiratory (lungs and breathing) function to ensure enough oxygen is getting to the muscles for them to work.

As your balance and mobility relies on so many body systems, a range of health conditions can affect them. Shakiness when walking or turning, or having falls or near-falls, are indications that your balance and mobility are not as good as they should be. If this is happening you should have an assessment by your GP or physiotherapist.

--Why am I likely to experience balance and mobility issues?

Health conditions affecting balance and mobility include:

• neurological problems (such as stroke or Parkinson’s disease)
• inner ear problems (such as Meniere's disease)
• eye diseases
• diabetes (which can affect the sensation and vision)
• respiratory problems
• cardiovascular problems
• pain and joint stiffness can also affect balance and mobility.

People can also experience balance and mobility problems without any of these health conditions or with just mild conditions. This may be due to the normal deterioration of body systems with increased age (this actually starts happening after the age of 30). Much of the deterioration in balance and mobility that people attribute to age or health problems is actually due to physical inactivity with reduction in strength and mobility. Our bodies require movement to function well and they deteriorate without movement.

--How do I know if need physiotherapy or other medical attention?

It can be difficult to establish whether balance and mobility problems are due to health conditions, ageing or insufficient physical activity.

An assessment from your physiotherapist as well as discussion with your GP can help establish this. Even if you do have a known medical condition that is contributing to balance and mobility problems, physiotherapy may be able to improve your balance and mobility by improving your muscle coordination or the function of other body systems not affected by the health condition.

--Should I be worried?

It is important to investigate any deterioration in balance and mobility to establish its cause and start appropriate treatment.

Without treatment, balance and mobility problems increase the risk of falls and subsequent injury, as well as the risk of deterioration to the point of needing help with daily activities. Some serious health conditions (eg, motor neurone disease, brain cancer) affect balance and mobility, but most balance and mobility problems have less serious causes and can be greatly improved with treatment.

You may be thinking, ‘I’m always careful, I’ve never had a fall’, but reduced balance may catch individuals off guard at any time—its much better to identify balance problems and do something about them rather than experience the trauma of a severe fall.

--How can physiotherapy help with balance and mobility issues?

Your physiotherapist can assess your balance and mobility. They can help establish the causes of any problems identified and set up an appropriate exercise program for you. The exercises should involve practise of the aspects of balance and mobility you find difficult. This may involve balancing on one leg or walking with both feet on a line. If your balance is more severely affected, just standing without hand support may be a suitably challenging exercise for you.

It is important that exercises to improve balance and mobility are undertaken safely but are difficult enough to lead to improvement. Therefore, the exercises need to be targeted to your level and modified as you improve.

Well-designed exercise programs can help with balance and mobility. This is because the role of the brain is so important in coordinating movement and the brain responds well to practise (neuroplasticity). Other benefits, depending on the type of exercise, can include increased muscle strength, better cardiovascular fitness and better function. Your physiotherapist can also assess your need for a walking aid and prescribe the most suitable one for you.

If you have a vestibular problem, such as benign paroxysmal positional vertigo (BPPV), an experienced physiotherapist can treat this with exercises that involve certain head movements. If you have a neurological condition you will require a physiotherapist with expertise in the treatment of neurological conditions.

--How effective is physiotherapy for these conditions?

There is evidence that exercises can improve balance problems in older people but more research is needed as many of the studies have been small and poorly designed. A 2011 update of the Cochrane Collaboration systematic review on this topic concluded that, ‘there is weak evidence that some types of exercise (gait, balance, coordination and functional tasks; strengthening exercise; three-dimensional exercise and multiple exercise types) are moderately effective, immediately post-intervention, in improving clinical balance outcomes in older people." While the Cochrane review has not since been updated, there has been substantial new research towards strengthening the case for balance training, including papers providing stronger evidence to support the effectiveness of exercise to improve balance-related outcomes.

A recent systematic review of randomised controlled trials confirmed that well-designed exercise programs can prevent falls in older people living in the general community. Programs that safely challenge balance and involve three or more hours of exercise per week are most effective. There is mounting evidence that exercise also has a role in falls prevention in people with Parkinson's disease and dementia, but the exercises would need to be delivered by a physiotherapist with experience treating older patients or those with neurological conditions.

--What can I do at home?

Balance exercise needs to safely challenge you, so it is recommended they are done next to a stable surface such as a bench or table to steady yourself if necessary.

An example of an exercise that is often suitable is to stand with your feet together and to rock slowly onto your toes and then onto your heels. If this is too hard, you may find it easier by starting with your feet shoulder width apart. The exercise can be progressed to faster movements, and holding for several seconds at the toes and heels positions. Another good balance activity is to stand on both feet and practise controlled body movements while reaching in different directions or doing Tai Chi moves. Make sure you move your hips rather than holding them stiffly.

Try to get into the habit of doing these exercises for at least 10 minutes on most days. Try to do another form of exercise such as joining a group exercise class or going for walks too (as long as you feel steady enough to walk outdoors). Make sure the exercises don't cause you pain or feel too difficult for your balance. See your physiotherapist if this happens.

As balance and mobility problems can have many different causes, your physiotherapist can assess you to design an exercise program suited to your needs. Many physiotherapy practices, community health centres or hospital-based physiotherapy departments offer group classes specifically designed to improve your balance.

--How long before my condition improves and I get better?

If you start an exercise program you should notice some changes in a few weeks. Unfortunately, the benefits will be lost quickly if you stop exercising. Remember to see your physiotherapist if you are not sure about the best approach for you.