As you age, maintaining your balance can sometimes become a problem. That’s because the systems responsible for keeping you upright are aging right along with the rest of your body.
Think of the amount of information you are constantly getting from your vision and your sense of touch that helps you maintain your balance. And from your vestibular system, which helps you maintain equilibrium and lets you know where you are in space.
Everything working together but with age, maybe not quite as robustly, says Jason Adour, physical therapist, and owner of Maine Strong Balance Center in Scarborough.
On top of normal aging, you can have certain disease processes that speed things up. If someone has knee arthritis, the somatosensory system may be aging, but then it has even more trouble because the knee is giving it poor feedback about where you are in space. If someone has a tremor or neuropathy, they may get inappropriate misfires. And the same rules apply when the vestibular system or inner ear talks to the brain. The brain goes through very normal degenerative changes. As we age, there’s a nerve between the vestibular system and the brain that degenerates over time. And then the inner ear itself gets information from hair cells. As you move your head, these hair cells are displaced and as we age, we start losing hair cells, Again, that would be considered normal age-related changes in the balance system. But some people have repeated ear infections or Meniere’s Disease and they have a crystal out of place in their inner ear. These other disease processes can make the normal age related changes accelerate.
Jason Adour, PT, Maine Strong Balance Center
Don’t get discouraged! If you have trouble with your balance, it’s not always just your age or illness and injury that are to blame. Strength, for instance, can be an issue. Or rather, lack of strength. And guess what? There are some steps you can take to improve things.
First, a few easy tests.
30-Second Chair Stand
The 30-Second Chair Stand Test checks your strength. Easy and helpful says Jason.
From a strength perspective, the most evidence-based way that we measure that is the 30-Second Chair Stand Test. It tests how many times you can stand up and sit down in 30 seconds without using your hands.
Here are the basics steps:
- Sit in the middle of a chair that has a straight back and no armrests. The seat should be 17 inches from the floor.
- Cross your hands across your chest.
- Keep your feet flat against the floor and your back straight.
- Have someone with a stopwatch keep track of how many times you can come to a full standing position and sit back down again in 30-seconds.
This brief video from the Centers for Disease Control and Prevention (CDC) demonstrates how the test is administered.
If you score lower than indicated for your age and gender, it means you have weakness in your legs and might be at risk for having balance issues. Jason says it’s possible to lower your risk by strengthening not only your legs but your whole body.
Strength is important throughout the whole body. Doing something like walking or biking or swimming or any movement at all is going to positively impact your strength. I would gauge what to do based on your comfort level and check with your doctor, as well. If you’re somebody who feels comfortable getting out there and walking and starting a gym program, I would go there. If you’re unsure, trainers are really smart about helping people address areas of weakness and a physical therapist would be able to do a comprehensive evaluation and then point you in the right direction.
Timed Up & Go
Lack of strength is not the only thing that can cause balance issues. As we age, we may not be as mobile as we once were. If it takes more than 12 seconds to complete this next test, you might be at increased risk of falling. It’s called Timed Up & Go (TUG).
- Use a chair with arms. Mark a spot on the floor 10 feet away.
- Sit in the chair.
- Ask someone to time how long it takes you to do the following:
- Stand up (ok to use your arms).
- Walk to the marked spot at a normal pace.
- Turn around and walk back to the chair.
- Sit down.
Jason says TUG captures how well people can turn and how fast or slow they walk, both evidenced-based predictors of how well somebody balances. When he and other healthcare providers administer the test, they observe how stable the person’s posture is, as well as their gait, stride length, and whether they sway when they walk. Some changes may be a sign of neurological issues and need further evaluation, but it’s not a common occurrence.
More often than not, we’re just noticing age related changes, If you’re you’re greater than 12 seconds on this test, just like there are simple strength exercises like walking or going to the gym, there are simple balance exercises that you can do.
This next test can be used to assess your balance AND as a balance exercise. It starts out fairly easy — just stand with your feet together for 10 seconds — and gets progressively more challenging. You can keep your eyes open and hold out your arms to help keep your balance. With each stage, you try to stand for 10 seconds.
- Stand with your feet side-by-side.
- Place the instep of one foot so it is touching the big toe of the other foot.
- Place one foot in front of the other, heeling touching toe.
- Stand on one foot.
Here’s another CDC video that shows how each step should be done.
If a person can’t hold the #3 position (one foot in front of the other) for at least 10 seconds, the CDC recommends attending an evidence-based fall prevention program or seeing a physical therapist for gait and balance exercises. Jason says the #3 position not only helps assess a person’s risk, but it’s also a great exercise to practice … and practice.
Standing heel to toe with your eyes closed is a typical exercise that I end up giving people. If you can train in a position that’s difficult, you’re working your somatosensory system. Your brain is talking to your muscles, your joints, and the nerves in your legs, core and arms. And it’s not something you’re thinking about, these are automatic micro corrections to keep you still. That system is plastic and changeable. If you provoke it repeatedly by doing something like standing heel to toe with your eyes closed you can strengthen it, just like you can strengthen your muscles. We find it all the time that then we can get someone who’s doing the TUG in longer 15 seconds, if we do a month of balance training we can get them down to less than 12 seconds. And then we feel pretty confident that we’ve taken them out of that fall risk category.
If you are concerned about your balance (or someone else’s) try these simple tests at home to see how you’re doing. You may find out you do better than average. If not, you may need to take action. Either way, it’s good information.
You can also take advantage of several balance assessment events that are being hosted by the Maine Falls Prevention Coalition throughout the state this month. You’ll find details and more prevention information on their website.