What to Expect from Balance Physical Therapy

Balance problems are a common reason why many older adults seek help from a healthcare provider. Others may need balance help because of a stroke or other medical issue. Fortunately, balance is a motor skill that, like any other, can often get better the more you work on it.

To help you build your strength and stability, your healthcare provider may refer you to a physical therapist for balance therapy. Improved balance can help you keep your independence and carry out daily tasks with less risk of injury.

This article explains how your body systems work together to maintain balance. It also talks about possible reasons for why you feel off-kilter. Then, it walks you through a few balance exercises that you might try during physical therapy (PT) or at home.

Young man exercise with cat on his back
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Where Does Balance Come From?

The following three systems in your body work together to keep you upright and balanced:

Anything that disrupts how these systems work, or how they connect to one another, can cause problems with your balance.

Balance exercises will create situations that challenge these systems to work together in a positive way. This helps your body's systems to adapt and change, hopefully leading to better balance and muscle control.

Visual System

Your visual system gives your brain information about where your body is as you navigate through your environment. People with impaired vision may have balance difficulty for this simple reason. They cannot see where they are or how far an object is from them.

When assessing your balance, your physical therapist (PT) may ask about your vision. They may ask if you wear glasses or contact lenses.

Treating any vision issues falls outside of a PT's scope of practice, though, so they may recommend that you visit an eye healthcare provider. This will ensure your eyes are working at their best.

Vestibular System

Your vestibular system is located in your inner ear. It works to send information to your brain about how your head is positioned.

You have two vestibular structures—one on each side of your head—which act like tiny levelers. They are both filled with fluid. As you move and turn your head, the fluid rushes to one side of the structure and activates the nerves there.

These nerves then communicate with your brain to give it information about the position of your head. Your vestibular system is very sensitive, so damaging or impairing it in any way can result in vertigo (dizziness) or other balance difficulties.

Proprioceptive System

Proprioception allows you to sense your body's position and movements in relationship to your surroundings. Some people refer to this sense as spatial awareness.

This system relies on a group of specialized nerve endings in your muscles, tendons, and joints. These nerves send messages to your brain. They tell it when and how a muscle is working to create movement and what position you are in.

Recap

Your sense of balance comes from an intricate web of connections between your brain, vision, inner ear, muscles, bones, and nerves. Balance therapy is designed to improve how well these work together.

Why You May Need Balance Training

Physical therapists are movement experts who can help you improve your strength, mobility, and balance. Your healthcare provider may refer you to a PT for balance training if:

  • You have trouble moving safely by yourself
  • You have been injured in a fall or have a history of falling
  • You have had a stroke and now have balance problems
  • You are an athlete recovering from an injury
  • You have had surgery
  • You have vertigo, often linked to inner-ear disorders such as Ménière's disease

When you meet your PT, they may check your balance first. This is to find out if any specific motion, like turning or standing from a seated position, is harder for you than others are.

From there, your therapist will work with you to develop a physical therapy routine. This is aimed at improving your balance, your safety, and your ability to carry out daily tasks on your own.

In some cases, such as if you've had a stroke, your balance exercises may be used with other treatments as part of an overall plan.

While the goal of physical therapy is to improve function as much as possible, it may not always be possible to fully restore balance and results may vary.

Recap

Anything that impairs the systems involved in creating a sense of balance, or the connections between them, can lead to balance problems. This could be an illness, injury, or surgery.

Balance Exercises in Physical Therapy

Your body can change in response to specific balance exercises. This can lead to improved balance and ability to move about your day independently and safely, also known as functional mobility.

Four simple balance exercises that your PT might prescribe are as follows.

Be honest with your physical therapist if an exercise is too easy or too challenging for you. If you have any particular goals you want to work on, don't be afraid to let them know, too. That way they can better customize your treatment.

Single Leg Stance

Physical therapist helps young patient balance

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This simple leg-lift exercise is meant to enhance your balance. It works the muscles in your thighs, buttocks, and abdominals. It can also teach you how to keep your hips squared and level even when balancing on one leg.

This is an important skill to have, especially for any kind of motion that requires you to shift weight from one leg to the other. It helps whether you are turning a corner or trying to stop yourself from falling.

To do this exercise:

  • Find something stable to hold onto, like a countertop or railing, and stand beside it.
  • Bend your knees ever so slightly so that your knees do not lock.
  • With one foot planted, lift your other foot in front of you or to the side of you.
  • Hold this position for 30 seconds, with a focus on keeping your hips level.
  • Repeat with the other foot, only lifting each foot as much as you feel stable and comfortable.

Start by doing five repetitions (reps) per leg. You can work yourself up to 10 reps per leg each day, or stick with five reps while gradually raising your leg higher as your strength and balance improve.

Tandem Walking

Doctor helps man with physical therapy

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If you have ever seen someone get pulled over for driving while intoxicated, then you may have seen the police officer test them with a tandem walking exercise. This exercise tests your balance and your gait, the pattern in which your body moves when walking.

Your PT may ask you to try tandem walking to see if your balance problems could be tied to a hip injury or possibly a neurological disorder like Parkinson's disease.

The exercise can also be used to strengthen the connection between your visual and proprioceptive systems. The exercise is simple:

  • Find a counter, railing, tabletop or something you can grab onto if you lose balance. Your PT office will likely have a walkway flanked by railings for this purpose.
  • Begin in a standing position beside the stable object.
  • Slowly walk forward by placing one foot directly in front of the other.
  • Walk forward 10 paces, slowly turn around, and walk back to your starting position the same way.

Your goal is to do this without any spaces between each foot. As you step, it's OK to watch your feet until you feel confident looking straight ahead.

Walking With Different Head Motions

Woman practices walking with physical therapist

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This exercise strengthens the connection between all three balance systems at once. It trains them to communicate quickly when your focus or attention abruptly changes.

This is an especially important skill to have for those times when your attention is being pulled in several different directions. Regular practice can help you feel more stable and confident when you are in a crowded place or when you are busy moving about your workplace.

First, make sure you are not too close to any objects—like counters, tables, or walls—that you could accidentally bump your head into.

Then:

  • Start by standing with your eyes facing forward.
  • Walk 10 paces while slowly turning your head left and right, and scanning the room with your eyes.
  • Try different variations with this exercise; for example, instead of turning your head left to right, you can try nodding your head up and down.

You may be trying this exercise at home and feel like you still need to hold onto something. If so, ask someone you trust to walk next to you just in case you lose balance. Some people may also find it helpful to use a walking cane.

Walking with Different Visual Field

Learning to walk in physical therapy

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This exercise is a key to building the connection between your inner-ear and proprioceptive systems, and keeping you stable if you become wobbly or dizzy.

Regular practice also strengthens your proprioceptive system to keep you balanced even when your surroundings may be disorienting.

To do this exercise:

  • Print out a checkerboard design, a spiral, or any other design pattern that seems to change or shift when you look at it.
  • Tape this design to the wall so that it is level with your eyes.
  • From three or more yards away, stand and slowly walk forward toward the design while staring directly at it.
  • If you feel ready, you can then try walking backward while keeping your eyes on the design.

Your PT also may challenge you to walk while watching a video. This trains your visual system to quickly adapt to changing imagery and builds its connection to your inner-ear and proprioceptive systems.

This exercise may be harder for some people who are prone to motion sickness. If the exercise strains your eyes or makes you feel queasy, let your PT know.

When to Stop

If you experience symptoms including chest pain, shortness of breath, or dizziness while doing balance exercise, you should stop immediately. Be sure to make your PT aware of the problem, or call for medical assistance.

Balance Equipment

Your physical therapist may use special pieces of exercise equipment to help challenge your balance. These may include a BAPS board, yoga blocks, or similar items.

BAPS Board

Child uses balance board in physical therapy

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The Biomechanical Ankle Platform System, or more simply the BAPS board, is a type of wobble board. It is commonly used in physical therapy to improve balance, range of motion, ankle strength, and proprioception.

The board looks like a flat disc with a round piece on the bottom. It can be adjusted to change how much the board wobbles when you balance on top of it.

To use it, your PT will have you hold onto something stable while standing on the board. You will then be asked to use your lower body to swivel the board in different directions without falling off.

Your goal is to touch the edge of the board to the ground then return it to a level position while maintaining your balance. Take your time as you move on the BAPS board. Moving too fast won't help you build muscle or balance faster—it will only put you at risk of falling.

Yoga Blocks

Woman stretches using yoga block

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Yoga blocks are a type of foam block that are commonly used in yoga and Pilates classes. They can be used in physical therapy to lift a certain body part off the ground while the rest of the body stays in a stable position.

For example, your PT may ask you to perform squats using the blocks. For this exercise, you would place two yoga blocks on the ground side by side. Then, you stand with your heels on the blocks and your toes on the ground.

To keep yourself from falling as you squat, you will need to focus on keeping your body weight distributed equally across your hips and buttocks so that you don't tip forward.

To prevent falls, only perform balance exercises that are safe for you to do. Work closely with your physical therapist to ensure you are challenged enough, but not too much, and follow their directions carefully so that you stay safe.

Getting Started With Balance PT

If you have fallen or feel like your balance is impaired, you should contact your healthcare provider to be checked out.

While the reason for how you are feeling may not be serious, feeling off-balance can be a sign of something more urgent.

For example, loss of balance accompanied by blurry vision, lightheadedness, weakness, or confusion can indicate a life-threatening condition like a stroke. Your provider can best consider your balance concerns in the context of your overall health. They can also determine if you need additional treatments.

Ask them to refer you to a physical therapist for a complete balance evaluation. You may also be able to visit your physical therapist via direct access. This means that no healthcare provider referral is needed.

While seeing a doctor first is still generally advised, this may be appropriate in cases where an obvious injury, like a sprained ankle, is the only reason for your visit.

Length of Balance Therapy

How often you will need to see your therapist (and for how long) will depend on the cause of your balance problems.

In general, physical therapy programs last a few weeks to a few months, with sessions at least once or twice per week.

For example, vertigo tends to improve within two to six weeks with physical therapy. For someone who has had a life-changing injury or severe brain trauma, physical therapy may be needed indefinitely.

Keep in mind that physical therapy takes time and consistency in order to see results, so don't expect your balance to improve overnight.

Recap

It's always best to consult with a healthcare provider before starting balance therapy. They can help determine the cause of your issue, which may require treatment beyond physical therapy.

Summary

Age, injury, illness, and surgery can leave you feeling off-balance. It's best to see your doctor for an evaluation.

They may refer you to a physical therapist for balance training, which involves a series of exercises to improve your strength and your balance. More specifically, these exercises are aimed at challenging the three systems your body employs to keep you balanced.

A physical therapist will consider any health diagnoses you have been given and any specific motions that are challenging for you when creating your plan. The duration of this therapy and the results it yields will vary depending on the cause of your balance issues and your overall health.

A Word From Verywell

To improve your results, your PT may give you exercises to do at home. Be sure to exercise in an area that is free of anything you might knock into or trip over. Have something that you can grab onto for support if needed nearby as well.

Make sure to complete your "homework" consistently. Doing so can help you regain your sense of independence and get back to your normal everyday activities more quickly.

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