How To Improve Your Balance

How To
Improve Your
Anatomical Causes,
Common Disorders,
Treatment Options, and
Advice For Improving
Balance & Preventing Falls
Dr. Eric Oltmanns D.C.
Dr. Eric Oltmanns D.C.
 Crossroads
Chiropractic Clinic
 Located inside the St. Cloud Medical
Group Across From Hennen’s Furniture
 Access to Over 50 MD’s and Urgent Care
 Access To Digital X-ray, MRI, and advance
 Access to Physical Therapy
 30-40% of adults over 65 years old fall
each year
 Less than half talk to their doctor about
their balance issues or recent falls
 This group has a higher rate of hip
fractures, head injuries, lacerations, and
other fractures.
Our Balance System
 Our
Nervous system, Eyes, Inner ear,
Muscles, Joints, and Bones all play major
roles in our balance
 These
structures function together to
ensure that we remain upright and
prepared in our environment
 Our nervous system receives information from our vision,
Proprioception (Touch), and Vestibular System (motion,
equilibrium, and spatial orientation)
 Our Brain Interprets the sensory input, and creates a motor
response such as muscle control to maintain balance.
Eyes (Visual Cues)
 Visual
cues provide our balance system
with important information such as depth
perception, spatial awareness, and a
general sense of the objects you come
into contact with.
Inner Ear
Our inner ears contain 3 semicircular canals
that contain a fluid called endolymph that
functions to provide information on the
position of our head and its movement in
space in relation to gravity. This occurs when
Ca+ crystals within the endolymph strike
micro sized hairs within the canals.
 Sensory organs located in our muscles and joints help provide
information to our brain. When we lean forward, pressure is
detected on the front part of the soles of the feet detecting
the change in movement sending a signal to the brain.
 Muscles also help us regain balance when it is lost by using the
interpreted signal from the brain to contract the necessary
muscles that bring us back into balance.
• If one of the areas of our balance system are not functioning
optimally, we will be at higher risk for loosing balance and
falling. Knowing these anatomical structures gives us clues on
what to work on to improve our balance.
 General
term for describing everything
from feeling light-headed, weak, or
 Many
Causes are possible for the general
term “dizziness”
1. Stand next to your chair or table.
2. Hold your hands above the table surface incase
you need support.
3. Close your eyes and lift one foot of f the
4. Balance on your other foot.
5. Count to yourself the number of seconds you
can hold this position without loosing balance
or opening your eyes.
 The shorter your balance time, the older
your equilibrium is.
 If you balanced for…
 22 seconds = Balance of a 20 year old
 15 seconds = Balance of a 30 year old
 7 seconds = Balance of a 40 year old
 3.5 second = Balance of a 50 year old
 If you tipped right away, you are 60+ in
Balance years
Common Disorders That Cause
 Vertigo
 Menieres
 Acute vestibular neuritits (Inflammation of
the inner ear)
 Vestibular Migraine
 Other
a sensation of whirling and loss of
balance, associated particularly with
looking down from a great height, or
caused by disease affecting the inner ear
or the vestibular nerve.
There are different causes of vertigo but
primarily stem from the inner ear
(Benign Paroxysmal Positional Vertigo)
 Benign
paroxysmal positional vertigo
(BPPV) is one of the most common causes
of vertigo
The sudden sensation that you're spinning
or that the inside of your head is spinning
when changing positions such as getting
out of bed, or standing up from a sitting
BPPV Continued….
 The
problem is in the inner ear where
Ca+ Crystals are getting stuck in the
semicircular canals
 This
causes the sensation of spinning
along with other possible symptoms
 Usually
lasts 20 seconds but no longer
than one minute
 Sensation
 Slightly
 Loss
can cause nausea or vomiting
Blurred vision
of balance
The Epley Technique
This technique is used
to reposition the
crystals in the inner ear
and is initially done at
the doctor’s office to
ensure that you are
doing it correctly.
You can do this once
per day to lessen your
Meniere’s Disease
 involves
the excessive buildup of fluid in
your inner ear. It's characterized by
sudden intense episodes of vertigo lasting
as long as several hours, accompanied by
fluctuating hearing loss, ringing in the ear
and a feeling of fullness in the affected ear.
Acute Vestibular Neuritis
(Inflammation of the inner ear)
Signs and symptoms of inflammation of your inner
ear (acute vestibular neuritis) include the sudden
onset of intense, constant vertigo that may persist
for several days, along with nausea, vomiting and
trouble with balance. These symptoms may be so
severe that you have to stay in bed. When
associated with sudden hearing loss, this condition
is called labyrinthitis. Fortunately, vestibular neuritis
generally subsides and clears up on its own. But,
early medical treatment and vestibular
rehabilitation therapy can be helpful in speeding
Inflammation of the inner ear
Vestibular Migraine
 Migraine
is more than a headache
disorder. Just as some people experience a
visual "aura" with their migraines, others
can get vertigo episodes and have other
types of dizziness due to migraine even
when they're not having a severe
headache. Such vertigo episodes can last
hours to days and may be associated with
headache as well as light and noise
Other Disorders
Rarely, vertigo can be a symptom of a more serious
neurological problem such as a stroke, brain
hemorrhage or multiple sclerosis. In such cases,
other neurological symptoms are usually present,
such as double vision, slurred speech, facial
weakness or numbness, limb coordination, or
severe balance problems.
If you experience any of these more severe
symptoms, call 911 right away to rule out Stroke
Other Causes of Dizziness,
Balance loss, and Falls
 Medications
 Low
blood pressure (hypotension)
 Heart
 Muscle
weakness/Joint Instability
 Loss
of balance can be a side effect of
certain medications, such as anti-seizure
drugs, sedatives and tranquilizers.
 Always
ask your Doctor or Pharmacist
about drug interactions when starting or
stopping a medication.
Low Blood Pressure
dramatic drop in your systolic blood
pressure — the higher number in your
blood pressure reading — may result in
lightheadedness or a feeling of faintness.
It can occur after sitting up or standing
too quickly.
Heart Conditions
 Inadequate
output of blood from the
heart. Certain conditions such as any of
the various diseases of the heart muscle
(cardiomyopathy), an abnormal heart
rhythm (arrhythmia) or a decrease in
blood volume may cause inadequate
blood flow from your heart.
Muscle & Joint Weakness and
 Muscle
weakness and osteoarthritis — the
type of arthritis that involves wear and
tear of your joints — can contribute to loss
of balance when it involves your weightbearing joints such as hips, knees, lumbar
(low back) spine
What Can I Do To Improve My
 Strengthen
Lower Extremities and core
 Join an exercise class
 Practice balancing throughout your day
during your down time
 Remove clutter from your environment
 Avoid quick movements while getting out
of bed, or standing up.
 Regular eye exams/yearly physicals
 Regular medication reviews with your
Exercises for Strength and
1. Stand with your feet slightly apart and raise one
leg off the ground while keeping your arms to the
sides and your shoulders relaxed (photo).
2. Try to balance for 30 seconds. Repeat two
times, then switch legs. Try to work up to two
3. If you have difficulty balancing with no hands,
try placing your fingertips or one fingertip on a
hard surface until you are able to balance with
no hands.
You can make this exercise more difficult by
closing your eyes while you balance. Here are
some other variations on the stork:
• Once you have mastered standing still as a
stork, try swinging your arms as if you are running
in place.
• When this is easy, hold water bottles or light
weights in your hands and swing them.
• To make the stork even more challenging, fold
up a bath towel so that it is several inches thick,
and do the stork while standing on it. Be careful
not to cheat by gripping the floor or the towel
with your toes.
Side Leg Raise
1. Stand next to a sturdy
surface like a chair. If you
need to use your fingertips
for balance, do so.
2. Raise one leg off the floor
to the side, and hold it 6 to
12 inches off the floor, then
lower it (photo).
3. Do not bend forward at
the waist (engage your
core). Repeat 10 to 15 times
per leg.
4. Make this more difficult by
removing your fingertips
from the chair (if you are
using it) and even more
difficult by closing your eyes.
Somatosensory Training
1. Stand with arms crossed and eyes closed
First with feet sided by side, then with one foot slightly
infront of the other, hold balance. Attempt to avoid
swaying in any direction. Add a backwards head tilt
as if looking at the ceiling.
Next, begin leaning as far forwards, backwards, and
sided to side without loosing balance. Attempt to
hold the position for a few seconds before changing
the direction of leaning.
Somatosensory Training
 2.
Walk a strait line with eyes closed as if
you are on a tightrope.
After completing this open your eyes and
walk the same line while turning your head
sided to side and up and down
Stability trainer
Resistance band exercises
 Refer
to the handout provided
 Different colors for different tensions
Chiropractic and Acupuncture
 Adjustments
improve the efficiency of
your nervous system
 Reduces the pressure on nerves and in
turn increases the function of those
 Neck adjustments increase blood flow to
the brain
 Acupuncture treatments works well for our
patients with balance disorders