Balance Exercises in Physical Therapy

When thinking about physical therapy exercises, many people consider strengthening and stretching exercises—the common exercises that many people do at the gym. But what about balance? Did you know your physical therapist can help improve your balance with specific exercises?

Young man exercise with cat on his back
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If you have fallen, then you understand how important it is to keep your balance as you walk or sit. Your physical therapist is a movement expert who can help you improve your balance so you can maintain safe functional mobility.

So who may benefit from balance exercises in the PT clinic? People who may engage in balance exercises might include:

  • Older persons with limited functional mobility
  • People who have fallen
  • People with neurological conditions, such as a stroke, that may cause balance impairments
  • Athletes who are injured
  • People who have had surgery
  • People with vertigo

When you first meet your physical therapist, he or she may assess your balance. If it is determined that your balance is impaired, a treatment strategy may be developed that includes exercises to help improve your balance to maximize your safe functional mobility.

Where Does Balance Come From?

Three systems in your body work together to help you stay upright with good balance. These include:

  • Your visual system
  • Your vestibular system in your inner ear
  • Your proprioceptive system in your muscles and joints

First, your visual system works to provide your brain information about where your body is in relation to your environment. People with impaired vision may have balance difficulty due to the inability to see exactly where they are. When assessing your balance, your physical therapist may ask about your vision and if you wear corrective lenses. Making changes to your vision or corrective lenses falls outside of the scope of practice for physical therapists, but your PT may recommend you visit an eye doctor to ensure that your eyes are working optimally.

Your vestibular system is located in your inner ear, and it works to provide your brain information about the position of your head. The vestibular structures (you have one on each side of your head) act like tiny levels. They are filled with fluid, and as you move and turn your head, the fluid rushes to one side of the vestibular structure and activates the nerves there. These nerves then communicate with your brain, telling it the position of your head. Damage or an impairment with your vestibular system may result in vertigo, or spinning sensations, as you move your head.

Your proprioceptive system is a group of specialized nerve endings in your muscles, tendons, and joints of your body. These nerves communicate with your brain, telling it when and how a muscle is contracting, as well as information about position sense. An injury, surgery, or a neurological condition may impair your proprioception, leading to decreased balance.

Your physical therapist can assess these three systems and determine the factors that may lead to impaired balance. Then, he or she can prescribe specific exercises to help improve your balance.

How You Can Improve Balance

Your body can change and grow in response to specific balance exercises, and this can lead to improved balance and safe functional mobility.

Four simple balance exercises that your PT might prescribe include the following. Be sure to check with your doctor before starting these, or any other exercise, for your balance:

  • Single leg stance: Find something stable to hold onto, and then lift one foot off the floor. Hold this position for 30 seconds, and then repeat with the other foot. You can increase the challenge by letting go of the stable object you are holding or by closing your eyes while standing on one foot.
  • Tandem walking with a heel-to-toe pattern: Standing upright, walk forward by placing one heel directly in front of the toes on the opposite foot. Walk forward for 10 paces. You can make this more challenging by walking backward in a toe-to-heel pattern. Be sure something stable, like your kitchen counter, is close by for safety.
  • Walking with various head motions: Walk forward for 10 paces while turning your head left and right, scanning across the room as you walk. Then, walk forward while nodding your head up and down. The changing visual field will challenge your balance and equilibrium systems.
  • Altering your visual system as you move to challenge your balance: Print out a checkerboard design or any other design that can create altered visual images. Tape this design to the wall, and walk forward toward it while staring directly at the design. Then, walk backward, keeping your eyes focused on the design. This altered visual field can challenge your equilibrium and overall balance.

Your physical therapist may use special pieces of exercise equipment to help challenge your balance as well. These may include:

  • The BAPS board
  • A wobble board
  • Spongy pieces of foam
  • Videos that challenge your visual system

The key to improving your balance is to create situations that challenge your balance. This helps your body's systems adapt and change, hopefully leading to improved balance and muscular control.

A word of caution: Creating situations that challenge your balance may lead to falls while you are doing the exercise. You should only perform balance exercises that are safe for you to do. Working closely with your physical therapist can ensure that you do the right exercises that challenge your balance while still maintaining safety.

First Steps to Improving Balance with Physical Therapy

If you have fallen or feel like your balance is impaired, you should check in with your doctor for an assessment. Ask your doctor to refer you to a physical therapist for a complete balance evaluation. Your PT can check things out and get you started on the path to improving your balance. You may also be able to visit your physical therapist via direct access; no doctor's referral is needed, so if you feel like you want to learn some new balance exercises, just call your physical therapist and explain your needs.

A Word from Verywell

Many people don't even realize their balance is impaired. Some athletes and weekend warriors have repetitive strain or overuse injuries, and one variable that may be causing the injury is impaired balance and proprioception. If you are experiencing pain and limited motion, your physical therapist can assess your balance as part of a comprehensive evaluation and prescribe balance exercises as part of your rehab.

Working to improve your balance can be an important component of your overall physical therapy exercise program. It can help improve your mobility, and it may provide an important boost to your confidence when walking so you can minimize your risk of falling and enjoy your normal everyday activities.

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Article Sources
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  1. American Physical Therapy Association. Physical therapist's guide to balance problems. Updated February 4, 2015.

  2. VeDA. The human balance system.

  3. Willis JR, Vitale SE, Agrawal Y, Ramulu PY. Visual impairment, uncorrected refractive error, and objectively measured balance in the United States. JAMA Ophthalmol. 2013;131(8):1049-56. doi:10.1001/jamaophthalmol.2013.316

  4. VeDA. What are the symptoms of a vestibular disorder?

  5. Helix Magazine. Proprioception: Your sixth sense. Updated October 27, 2014.

  6. Aging In Place. Top 10 elderly balance exercises to improve balance and coordination. Updated January 2020.

  7. Mountain Ridge Physical Therapy. Balance and proprioception: Overlooked training for runners and athletes with knee pain and other leg overuse injuries. Updated March 28, 2016.

Additional Reading
  • Lamb Sarah E, Lamb Jill E. Better balance, fewer falls  BMJ  2015;  351