Balance Systems

The Balance Systems: Falls Leading Cause of Death and Disability

 By: Karli Lynch 

How Dangerous is the Problem?

According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of deaths relating to injuries. In fact, more than one third of adults aged 65 and older fall every year in the U.S. The CDC states that deaths due to falls have increased 30% from 2009 to 2018 for people aged 65 and older. If the rate continues to rise, there will be 7 death falls an hour in the elderly population in 2030. So, the fall itself may not have caused the death, but the injury sustained from the fall could have.1


What are the Long-Term Effects of Falls?

Experiencing a fall can have significant long term effects on a person's health. According to information obtained by the CDC, falls are the most common cause of traumatic brain injuries among older adults. Up to 30% of people who fall suffer moderate to severe injuries, including bruises, hip fractures, and head traumas, all of which can limit independent living and increase the risk of elderly death. Many people who fall and develop a fear of falling, reduce their mobility and increase their chances of future falls, due to less physical activity in their daily living.1


What Increases the Likeliness of Falling?

People of all ages fall, however the likelihood of experiencing a fall greatly increases with age. People who have chronic conditions such as Vitamin D deficiency and vision problems can increase the likeliness of falling. There are also many medications that people take that can cause dizziness or imbalance. Even items around the house are found to be common hazards such as rugs without non-skid mats, broken stairs and excessive clutter.1


How Can You Prevent Falls?

There are a few steps that can be done to prevent the risk of falls. One is to ask your medical care provider if any combination of your medications is potentially dangerous for sleepiness, dizziness, and imbalance. It would be helpful to also ask a loved one or home care provider to check your home for potential fall hazards. Removing these hazards are key to preventing falls. Lastly, it is very very important to keep up with health care recommendations regarding physical activity and perform daily balance exercises to prevent the deterioration of your balance systems.1


What are the Balance Systems?

Balance is your ability to maintain the body’s center of mass over its base of support. Balance is achieved and maintained by a complex mechanism made up of three separate systems that includes sensory input from vision (sight), proprioception (touch), and the vestibular system (motion, equilibrium, spatial orientation).



Many people rely mostly on the visual input to maintain their balance. For instance, while walking most people are able to visually see a ramp or incline leading up to the entrance of a building, or can see when the pavement meets the grass. The brain takes that information and sends a signal to the muscles of the body before that person walks up the ramp or across the grass, which allows them to easily maintain their balance and stability. However, depending on visual input for balance reduces the amount of proprioception and vestibular input the brain receives, which can reduce a person’s ability to maintain balance in dim light when vision is impaired, for example when going to the bathroom in the middle of the night.



Proprioceptive information from the skin, muscles, and joints involves sensory receptors that are sensitive to stretch or pressure in the surrounding tissue. For example, increased pressure is felt in the front part of the soles of the feet when a standing person leans forward. With movement of the legs, arms, and other body parts stretch and pressure cues are signaled to the brain which help the brain determine where our body is in space. The sensory receptors in the ankles are especially important for balance. The sensations from the ankles indicate the body’s movement and or sway relative to both the standing surface (floor or ground) and the quality of that surface (hard, soft, slippery, uneven).


Vestibular System

Sensory information regarding motion, equilibrium, and spatial orientation is provided by the vestibular system which is located in each inner ear. There are three main balance organs to the vestibular system, two of which detects gravity and linear motion, and the other detects rotational movement. This system can be disrupted if there is a hypofunction of the vestibular nerve or if the patient experiences vertigo. Having one vestibular system that is “weaker or impared” compared to the other can send the brain false signals which can impact balance.


Putting it all Together

Information from your vision, muscles, tendons, joints, and balance organs in your inner ear are all sent to the brain. Your brain can control balance by using the information that is most important for a particular situation. For example, in the dark, when the information from your eyes is reduced or may not be accurate, your brain will use more information from your legs and inner ear. If you are walking on a sandy beach during the day, the information coming from your legs and feet will be less reliable and your brain will rely on the information coming from your visual and vestibular systems more.


How Can Physical Therapy Help Improve Your Balance?

If you feel off balance or dizzy, one of these systems may not be working properly, or the information from these systems may not be being integrated correctly. One of our physical therapists can help determine how you are using these systems (or not) to keep your balance and can instruct you in exercises that can improve how your body and brain use all these systems together.


Please reach out to one of our three locations, Glenside Physical Therapy, Hatboro Physical Therapy or Willow Grove Physical Therapy, if you have been experiencing dizziness or unsteadiness and one of our physical therapists will be happy to assess your balance systems.




  1. Centers for Disease Control and Prevention, Older Adult Fall Prevention. [online].