“Life is like riding a bicycle.
To keep your balance you must keep moving.”
How well do we maintain our own bodies for balance? As well as a rider would maintain their bicycle? If we want to keep both upright and moving forward, both our body and our bicycle need to be in good condition. The need for a maintenance plan and for repairs of a bicycle are determined bya professional mechanic after careful analysis of its current condition. We should also see health care professionals for an individualized plan for our balance to ensure we continue to keep moving forward. The better you maintain your bicycle, the less repair you will need. If you damage a bicycle during a crash, your mechanics goal is to restore function for a smooth ride. Similarly, if you fall, appropriate health care providers can help determine the cause, improve function and provide insight and education to prevent future falls.
Balance Maintenance Tips 101
1. Tune up services: Meet with your health care team!
- Check and review your medications with your MD
- If you experience lightheadedness, dizziness or vertigo check with your physical therapist and MD to assess the cause: low blood pressure, BPPV…
- Constipation or urinary incontinence can become the cause of a fall.Straining for a bowl movement can cause a vasovagal (drop in heart rate) response or decreased blood pressure resulting in dizziness or falls or rushing to the bathroom especially at night can cause falls
- Have your vision checked including:
- Visual acuity
- Sensitivity to contrast (color and brightness): may have problems with night vision, fail to see that you need to step down from a curb onto similarly colored pavement
- Dry eyes (decreased blinking)
- Mobility of the eyes may be slower with smaller movements decreasing available visual field.
- Convergence of the eyes may be impaired resulting in inefficient depth perception or double vision
- Problems associated with aging: glaucoma, cataracts, macular degeneration
- Be screened for a peripheral neuropathy, a condition that can decrease sensation in your feet and cause poor balance
- Have your balance evaluated by a physical therapist specializing in balance
- Discuss with your MD disturbed sleep, fatigue, exhaustion, stress
- Have your cognition checked: executive function (task-switching, planning, working memory). Impaired cognition can lead to inattention causing increased risk for falls
2. Equipment and proper fitting
- Do not wear rubber soled shoes because they grip the floor and may cause you to fall forward if your foot catches
- Wear orthotics if needed and well fitted shoes
- If you need an assistive device (cane, walking stick, walker) or wheelchair have it checked for proper fitting and use
3. Prepare and know your surroundings
- Make your home safer
- Avoid clutter, throw rugs, tight spaces
- Install grab bars and use non-slip surfaces in the bathroom if needed
- Use of adequate lighting and contrast colors especially on stairs-
- Be aware of the terrain: uneven surfaces, hills, inclines, curbs
- Know the distance and your speed to get from point A to B
4. Train for the Ride - Exercise!
- Improve your Biomechanics/ Alignment
- Alignment: Keep body centered
- Stretch and strengthen trunk for mobility
- Make your base stable and safe
- Wear proper shoes
- Control dystonia with botox or physical cues
- Decrease pain in feet and toes
- Improve flexibility and strength of ankle/foot/toes
- Improve functional strength
- Learn and practice correct technique to rise from a chair and from the floor to a standing position
- Perform rhythmical reciprocal movements
- Don't let your feet get stuck to the floor during walking, turning, negotiating small spaces or approaching obstacles; overcome freezing by shifting weight from side to side like you are dancing, count 1, 2, 3, and then step forward, try another movement or step in another direction, use a visual cue: pretend to step over something or point a laser light and step on or over it, march in place, don’t fight the freezing and try to step harder, shift your attention to move your arms rather than legs
- Stopping / Check your brakes:
- If you need to stop abruptly but feel like you will continue to move forward (festination): Stop, do not continue to try to move forward. Stand tall head over your feet, if your head is forward your feet will try to catch up to your head
- Changing gears / Dual tasking
- Switching tasks and/or performing tasks simultaneously can alter your quality of walking and increase your fall risk.
- Turning radius
- When turning try to make wide turns and shift your weight to the outside leg
- You may need to step backwards or sidestep to change directions; practice every day!
- Use your senses to manage your wobbles
- Over reliance on the visual system for balance can cause falls when in dim lit areas, turning your head to scan your environment, or crowded areas. It also changes your posture as you look down. You need to make good use of your vestibular system walk on inclines and uneven ground
- Keep your foot from catching when walking thinking of stepping while lifting your toes
- If you experience a loss of balance do you step quickly enough, use your hips and/or ankles appropriately?
- Using devices that keep a rhythmic beat, such as a metronome or music may help to walk faster and take longer steps and decrease fall risk
- Improve confidence: Fear of falling increases your risk!
Erica DeMarch, PT and Kenda Fuller, PT
South Valley Physical Therapy