Introduction

Definition of balance and stability

Balance is your ability to maintain your centre of mass over your support base in both static and dynamic conditions, which is responsible for keeping you upright. Stability, on the other hand, is your ability to control your body when moving. The more stability you have in the base of your movements, the more you can control the force throughout your body.¹ Therefore, balance prevents us from falling, while stability allows us to navigate our environment confidently.

Balance and stability are foundational components of movement; therefore, they affect our daily activities and overall health and well-being. Improving balance and stability affects various populations differently:²

1. In older adults, improvement in balance and stability can reduce the risk of falling, as age-related changes can diminish joint flexibility, muscle strength and sensory functions
2. In athletes, it can help them execute complex movements efficiently and safely while reducing the risk of injury
3. For those recovering from muscle injury, improving balance and stability can help them restore normal muscle function and increase recovery speed

Overview of physical therapy

Physiotherapy is crucial for the assessment and improvement of balance and stability. They use a range of tools such as balance tests, postural analysis and functional assessment to identify weaknesses in your body and develop an individualised treatment plan. Physical therapy intervention for balance and stability includes targeted exercises, balance training, proprioceptive training, etc. 

Common causes of balance and stability issues

Balance and stability involve the interaction of your muscular, skeletal and nervous systems, and any disruption in any of these systems results in impairment of your balance and stability. Below are some common causes of balance and stability issues:

Medical conditions

The cerebellum of the brain has a wide range of functions, including control of movement, balance and posture; therefore, certain neurological conditions can result in disruption of balance and stability. Some examples include Parkinson's disease and multiple sclerosis (MS), where the brain’s ability to control movement is affected, and ultimately, with the progression of the disease, your ability to maintain balance is impaired.⁴

In our inner ear, we have the vestibular system, which is responsible for keeping balance and spatial orientation. Therefore, disorders that affect this system can cause loss of balance, dizziness and a spinning sensation. Some examples of disruption of the vestibular system include vertigo, Meniere’s disease and vestibular neuritis.⁵

Lastly, musculoskeletal issues that affect joint stability, such as arthritis, ligament damage, and hypomobility, as well as muscle strength – especially in the core or lower limb – can affect balance and stability.

Age-related factors

As people age, natural changes to the body can result in imbalance and instability. These changes include muscle and joint weakness and a decline in coordination. Furthermore, older adults may also experience reduced proprioception, which leads to slower reflexes and a lack of body awareness.⁶

Injury and surgery

Injuries, especially to the lower limb, can result in instability and difficulty bearing your weight evenly and maintaining balance. Furthermore, surgeries such as knee or hip replacement can often result in muscle weakness, joint stiffness and reduced range of motion. To address this issue, a long rehabilitation period is crucial to restore stability, balance and strength. 

Lifestyle

How active you are now or were in your childhood, when your bones were growing, can affect your balance and stability. Choices related to nutrition, daily activity and sleep can affect your overall health and muscle mass. Although lifestyle may not have a direct effect on your balance and stability, poor lifestyle choices can cause secondary conditions that affect these factors. For instance, if you are suffering from obesity, you are at a higher risk of arthritis that weakens your joints and hence stability. 

Physical therapy evaluation for balance and stability

For an optimal rehab treatment balance, accurate analysis of the patient’s balance and stability is essential. Physical therapy evaluation involves an initial assessment followed by more specific tests. This evaluation aims to identify your weaknesses and their root cause. They provide quantifiable data on your current level of functioning, highlighting weaknesses in your joints and muscles and serving as a baseline to track your progress throughout the treatment plan.

Initial assessment

In the initial process, a physiotherapist reviews your medical history to understand your overall health status and lifestyle. They will observe and assess the way you walk, your posture and general body mechanics to identify any weakness or abnormality.

Specific tests and measures

The more specific tests are done to further assess your balance and stability. To do this, they evaluate your ability to maintain balance with both your legs and closed eyes, as well as with one leg only.⁷ The balance test also involves the Berg Balance Scale (BBS), which measures your balance through different movements and tasks such as reaching, standing and turning.⁸ 

Physical therapy interventions

Physical therapy can help improve balance and stability, ultimately leading to an increase in quality of life by improving functional independence, increasing engagement in physical activity and social events, and reducing risk of injury. The interventions of physical therapy focus on strengthening muscles and tendons through a wide range of motion. Some examples of physical therapy interventions include:

Strength training

The aim is to maintain and strengthen muscles by lengthening and loosening your muscles, particularly around your problematic area, in which you must show control throughout all of these exercises. Targeted exercises can be both weight training and stretches. Some examples include the single-leg deadlift, plank, and overhead press.³

Balance exercises

These exercises focus on balance and can be in static or dynamic positions, ranging from simple, low-impact to complex exercises. These include standing on one leg, heel-to-toe walking, step-ups, etc.

Gait training

This includes techniques to enhance walking patterns, stability, and coordination. This kind of training is crucial if you are recovering from lower limb surgery or injury. Examples include practising different gait patterns and assisted walking direction changes.⁹ 

Proprioceptive training

This training aims to increase your somatosensory and sensorimotor function by focusing on your movement awareness, joint stability and reflex. One example is single-leg activity on unstable surfaces.¹⁰

Vestibular rehabilitation

Vestibular rehabilitation can reduce symptoms and promote adaptation, leading to improvement in your balance. During this treatment, you will be repeatedly exposed to movements that trigger your dizziness, and you will be taught how to adapt. Furthermore, you will practise focusing your eyes on stationary objects while moving your head, which will help you improve your coordination between the visual and vestibular systems.¹¹

Conclusion

Optimal balance and stability are crucial to a high quality of life, as they are foundational components of our daily movement and can significantly affect our daily activities. Impairment in balance and stability might stem from several causes, ranging from medical conditions to injuries, age-related conditions or lifestyle. Following appropriate assessment and evaluation, your physical therapist will prescribe a treatment regimen to improve your balance and stability, depending on the root cause of your problems.

Q&A for physical therapy for balance and stability

Q1: How does physical therapy improve balance and stability?

A1: By focusing on strengthening muscles, enhancing coordination, and increasing proprioception. 

Q2: Who can benefit from physical therapy for balance and stability issues?

A2: Everyone can benefit from physical therapy, including older adults, people with medical conditions (neurological, vestibular, etc.) or people who are recovering from surgery or injury. 

Q3: How is a patient’s balance assessed?

A3: Physical therapists use various tests to assess balance, posture and gait, and they will use the results of those assessments as a baseline to track progress.

Q4: How long does it typically take to see improvements in balance through physical therapy?

A4: The timeline depends on your condition and the root cause of your problem.