How Good is Your Balance?

What is Balance?

Balance is your ability to control your posture, in order to remain upright and steady.

Why Is It Important To Have Good Balance?
• Prevent falls and associated injuries
• Maintain independence

How Does Balance Work?
Balance is coordinated using information combined from 3 major sensory systems in the body; the Visual system (eyes), the Vestibular system (inner ears) and the Somatosensory system (joints, muscles, skin).

These systems detect changes in our posture and send important information to the brain about our head and joint position. The brain processes this information and initiates the appropriate corrective reflex.

If any of these systems are impaired or damaged, it can greatly impact your balance.

Testing Your Balance
Do you ever have difficulty or feel unsteady when:

• walking in a straight line or changing direction?
• getting up from a seated position?
• climbing stairs?
• bending over to pick something up?

1. Heel-Toe Stance for 30seconds EYES OPEN: standing with one foot directly in front of the other with the heel of the front foot and toes of the back foot touching.

2. Single Leg Stance for 30seconds EYES OPEN: standing on one foot.

** Always complete balance tests and exercises near a wall/chair or rail for support.

How Can I Improve My Balance?
Comprehensive Assessment of Postural System (CAPS) testing at the Beaches Osteopathic Centre enables us to use highly sensitive force plates to assess your posture and balance objectively.

From these results we can decipher which sensory systems needs more stimulation and design a personalized exercise program to improve your balance and posture, therefore reducing both your risk of reoccurring injuries and falls.

Basic Balance Exercises To Get You Started
Repeat the tests above before attempting the following exercises. Always have a wall, chair or rail close by for support.

Heel-Toe Rocking: with your feet together, rock body weight forward into your toes and back into your heels. Control the movement being careful not to over balance. Hold onto a bench, rail or chair if needed.

Walking heel-to-toe: walk in a straight line with the heel of the front foot making contact with the toes of the back foot.

Step Around the Clock: keeping left foot still, step forwards with the right foot, shift weight forwards.Step right foot back to centre, shifting weight back to the centre evenly between both feet. Repeat stepping right foot in and out following clock numbers. Repeat with right foot remaining still and left foot stepping.

**Close your eyes during balance exercises for an extra challenge.

Vertigo – Symptoms And Treatment

Welcome back readers! This month we are switching focus to the head, and specifically a condition which causes a person to feel dizzy. We welcome you to the world of Benign Paroxysmal Positional Vertigo (BPPV). In simple terms, a non-serious sudden attack of dizziness brought on by a change in head position.

What Is Vertigo?

Vertigo is a type of dizziness where a person experiences the sensation of whirling, spinning or swaying. A person will usually feel that they, or objects around them are moving when they are not. There are several causes of vertigo, with the most common cause being BPPV. Other common causes include Ménière’s disease (vertigo with hearing loss and ringing in the ears) and labyrinthitis (inflammation of the inner ear).

The ear is made up of an outer, middle and inner section. The outer ear is the ear that we see on the head and the opening that leads into the head itself. This connects to the middle ear — a small area inside the head which houses the ear bones, connects to the inner mouth and also the inner ear. The inner ear is the section which houses our hearing and balance organs — the cochlea and the vestibular system. It is this most inner section which is involved with BPPV.

What Causes BPPV?

The structure of the inner ear is quite complicated. It is a maze of hollow chambers and canals all connected together and filled with fluid. There are three semi-circular canals which are expertly positioned to detect movement in the 3 planes that our head can move (nodding up and down, tilting left and right, and looking left and right). Inside the chambers live tiny crystals which, when movement of the head occurs, move and send important information to the brain about what type of movement is occurring. Sometimes these crystals become detached from the chamber and move into the canals where they can play havoc.

Basically, the crystals move through the fluid which stimulates nerve endings in the canal. The nerves then send a message to the brain which the brain perceives as movement, even though the head isn’t actually moving. Because this information doesn’t match with what the eyes are seeing and the ears are detecting, we experience vertigo. It is one big mismatch of information which is tricking the brain. And the effect is quite unpleasant!

An attack of BPPV can be brought on by a quick change in head position, when rolling over in bed, sitting up from lying down, or when looking up to the sky. A recent head injury or degeneration of the inner ear system can precede episodes of BPPV.

Signs And Symptoms

The main symptoms as discussed include a sensation of spinning or swaying. People may also experience feelings of light-headedness, imbalance and nausea. Attacks will usually only last a period of a few minutes and may come and go. It is not unusual for a person to have a period of symptoms followed by a period of no symptoms for months at a time. If symptoms persist for longer than a few minutes at a time, then it is likely the vertigo is from a different cause.

Some conditions that cause vertigo can also give symptoms of headache, hearing loss, numbness, pins and needles, difficulty speaking, and difficulty coordinating movements. Episodes of vertigo may also be much longer or constant. If you experience any of these symptoms they should be reported immediately as they could be signs of more serious issues, which will need to be investigated.

Can It Be Treated?

BPPV is very treatable. Many people with dizziness end up seeing their GP first, but it is common for a GP to refer these cases to us for ongoing management. After a thorough session of questioning and assessment, if we are happy with our diagnosis of BPPV, then we can get to work right away.

BPPV can affect any of the semi-circular canals mentioned above. For treatment, we need to first bring on the symptoms. It sounds sadistic, but it is necessary to ensure we resolve the symptoms for you. Treatment for BPPV consists of a series of head and body movements where you start seated, move into a lying down position and end sitting upright again. This series of movements is known as the Epley Manoeuvre and is used to treat the most common form of BPPV. If the source of the problem is coming from a different canal, then the treatment will be slightly different.

We then send you away with some general do’s and don’ts. You may have to keep your head relatively still for the rest of the day (sorry, heavy exercise is not recommended at this stage) and to sleep propped up for the first night after treatment. We will then organise for you to come back in within a few days to reassess and if necessary continue with another treatment.

Final Comments… 

Interestingly, we often get patients come in who think they have vertigo, but in fact, it’s other structural issues contributing to their dizziness (which we diagnose and treat). That’s why it’s so important that we have a thorough consultation, to ensure we develop the right treatment plan for you. If you think you are experiencing vertigo, please come in and speak to us.

 References:

1. Vestibular Disorders Association. 2020. Benign Paroxysmal Positional Vertigo (BPPV). [Online]. Available from: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo. [Accessed 28 Feb 2020]
2. 2018. Benign Positional Vertigo (BPV). [Online]. Available from: https://www.healthline.com/health/benign-positional-vertigo. [Accessed 28 Feb 2020]
3. HANDI project team. 2013. The Epley Manoeuvre. Australian Family Physician. 42 (1). 36-37. Available from: https://www.racgp.org.au/afp/2013/januaryfebruary/the-epley-manoeuvre/