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How Orthopedic Physical Therapy Can Improve Balance and Prevent Falls

Wed, 22 Apr 2026 17:16:38 GMT

Have you noticed that maintaining your balance becomes more difficult after an orthopedic injury or surgery? This is a common challenge that affects many people recovering from joint replacements, fractures, or arthritis. These conditions can interfere with your muscle strength and coordination, increasing the risk of falls.

In this article, we explore how orthopedic physical therapy in Monroeville, PA, can help improve balance and reduce the chance of falling by focusing on targeted treatments designed to rebuild strength, coordination, and proprioception.

Understanding the Link Between Orthopedic Injuries and Balance Challenges

Orthopedic injuries such as joint replacements, fractures, and arthritis can hinder your ability to stay balanced for a variety of reasons. These conditions often cause pain, stiffness, and muscle weakness that limit natural movement and make it harder for the body to respond quickly to changes in position. Additionally, orthopedic problems can reduce proprioception, which is the body’s ability to sense its own position in space, a critical factor in maintaining balance.

Because of these issues, individuals recovering from orthopedic injuries are often at a higher risk of falls. This is especially concerning for older adults, as falls can lead to serious injuries, extended recovery times, and a diminished quality of life. By understanding how orthopedic conditions affect balance, patients and caregivers can better appreciate the importance of specialized therapy in their recovery.

How Orthopedic Physical Therapy Improves Strength and Coordination

Orthopedic therapy is designed to address the specific causes of balance problems related to musculoskeletal injuries. Therapists develop customized exercise programs that strengthen the muscles weakened by injury or surgery, improve joint flexibility, and retrain coordination to promote better stability.

One important focus of therapy is proprioceptive training. This includes exercises that challenge the body’s balance and position sense, such as standing on uneven surfaces or balance boards. These activities help retrain the nervous system to react more efficiently, which reduces the risk of falling during everyday movements.

Alongside proprioceptive work, physical therapists incorporate strength training and functional mobility exercises. These help patients improve core stability and leg strength, essential components for safe walking and balance.

Personalized Balance Therapy Programs at Alliance Physical Therapy

Alliance Physical Therapy in Monroeville, PA , understands that each patient faces unique challenges following an orthopedic injury. That is why we offer customized orthopedic physical therapy programs focused specifically on improving balance. Whether you are recovering from a knee replacement, managing arthritis pain, or healing from a fracture, we develop a treatment plan tailored to your individual needs.

Our balance therapy includes a combination of strength exercises, coordination drills, and educational components about fall prevention. Throughout your therapy, we monitor your progress closely and adjust your program to ensure you gain maximum benefit.

We proudly serve the community with three convenient office locations: Ross Township , Murrysville , and Penn Hills . Each facility is equipped with the tools and technology necessary to provide safe, effective, and compassionate care.

Sport-Specific Therapy: Prevention and Performance Enhancement

The Role of Proprioception and Coordination Issues in Orthopedic Patients

Proprioception, your body’s ability to detect movement and position, is often compromised following orthopedic surgery or injury. When sensors in joints and muscles are impaired, your brain may receive delayed or incomplete information about your position, affecting your ability to maintain balance.

This can lead to compensating movements that increase the risk of falls and other injuries. Orthopedic physical therapy focuses on retraining these sensory pathways and enhancing coordination through targeted exercises, helping you regain smooth, controlled movement.

Why Fall Prevention is Vital for Quality of Life and Independence

Falls are a leading cause of injury, especially among older adults and individuals with orthopedic conditions. Beyond physical harm, falls can cause anxiety and lead to activity avoidance, which further weakens muscles and reduces balance over time.

By improving strength, coordination, and awareness, orthopedic therapy helps patients regain confidence in their movements. This is critical for maintaining independence and participating actively in daily life. Fall prevention is not just about avoiding accidents; it is about preserving your ability to live comfortably and safely.

The Importance of Early Intervention in Orthopedic Physical Therapy

Starting orthopedic therapy soon after injury or surgery can greatly improve outcomes related to balance and fall risk. Early intervention helps reduce pain and swelling, prevents muscle loss, and promotes joint mobility. It also allows therapists to begin proprioceptive and coordination training earlier, which helps patients regain stable movement faster.

For those with chronic orthopedic conditions like arthritis, consistent therapy can slow decline, improve function, and reduce the likelihood of falls long-term.

Take Control of Your Balance and Safety in Monroeville, PA

If you or a loved one is dealing with balance difficulties related to orthopedic conditions, help is available. At Alliance Physical Therapy, our expert team in Monroeville, PA, provides comprehensive orthopedic physical therapy programs focused on improving balance, promoting strength, and preventing falls.

Contact us today at 412-242-7880 or visit our contact page to schedule your consultation. With offices in Ross Township, Murrysville, and Penn Hills, we proudly support the Monroeville community by offering personalized and compassionate care. Take the first step toward improving your balance and maintaining your independence with specialized orthopedic physical therapy

Physical Therapy for Athletes: Boost Recovery & Performance

Tue, 24 Mar 2026 13:52:01 GMT

If you’re an athlete looking to recover from injury or reach your peak, Alliance Physical Therapy is ready to help you move forward. We support sports enthusiasts and competitors at all levels by providing customized recovery plans, preventative strategies, and targeted performance enhancement. Operating in Pittsburgh, Penn Hills, and Murrysville, our clinics empower athletes to return to their passions stronger than ever, using specialized care designed for the unique demands of sports.

The Nature of Athletic Injuries: Challenges and Solutions

Being active comes with risks, and sports injuries like ACL tears, rotator cuff strains, and ankle sprains are all too common among athletes. These injuries can affect your abilities, lead to lost game time, and shake your confidence. At Alliance Physical Therapy, we understand that successful recovery means more than just healing; it is a journey back to full movement, capability, and athletic enjoyment.

Our team starts by conducting a detailed assessment of your injury and movement patterns. Whether you’re dealing with a sudden sprain or a chronic overuse issue, we craft a plan that addresses your immediate pain, restores mobility, and builds a foundation for lasting improvement. ACL injuries often require a focus on regaining knee stability, while rotator cuff strains benefit from shoulder mobility exercises and resistance training. Each athlete receives a step-by-step process tailored to their sport and goals, ensuring a safe and effective transition back to playing.

Physical Therapy’s Role in Speeding Recovery

The path to recovery involves much more than letting an injury heal naturally. Our clinics use physical therapy in Pittsburgh, PA, and surrounding areas to accelerate your return and reduce the chance of setbacks. Early rehab includes gentle movement, stretching, and manual techniques, all designed to reduce pain and inflammation. As healing progresses, our therapists introduce specific strength training and sport-focused drills.

Each stage of your journey is monitored carefully, and adjustments are made based on your response and recovery speed. For instance, basketball athletes recovering from ankle sprains practice balance and agility drills to rebuild confidence and coordination before stepping onto the court again. Rotator cuff rehabilitation may start with mobility work, then advance to strengthening routines using elastic bands and weights.

By following evidence-based guidelines and ongoing communication, we help you reach key benchmarks before returning to training or competition. This structured, individualized approach minimizes risk and maximizes your success.

Sport-Specific Therapy: Prevention and Performance Enhancement

Prevention is vital. Physical therapist plans aren’t just for recovery but also for proactively reducing sports injuries. Our team customizes programs based on your athletic discipline. Runners might get hip and core stability work to avoid IT band issues, while swimmers receive shoulder stability exercises for improved endurance.

We identify and correct movement flaws, build strength where you need it most, and teach optimized warm-up routines. For football players, this can involve joint stabilization and controlled impact drills, while tennis players receive forearm and shoulder conditioning. Our sport-specific therapies help you not only recover but also perform at your highest level by improving overall biomechanics.

Education plays a big role in prevention. We help athletes understand early warning signs, proper form, and self-care strategies, giving you control over your wellness and performance. For more details about our programs, visit our physical therapy page .

Customized Rehabilitation: Team-Based and Individual Solutions

At Alliance Physical Therapy, our rehabilitation plans are never generic. Every athlete works directly with therapists to learn about their injury, set clear goals, and ensure progression from healing to conditioning. This collaborative approach includes regular feedback, performance tracking, and quality checks, so you always know where you stand.

The first phase focuses on pain reduction and restoring mobility. As you improve, we shift toward functional training, incorporating sport-specific movements and resistance exercises. ACL recovery might include proprioceptive drills and plyometrics, while rehabilitation for rotator cuff injuries features graduated strengthening and stability work. Individual sessions are matched to your pace and readiness, always prioritizing safety and comfort.

Throughout therapy, we emphasize education and communication, inviting athletes to ask questions and learn new strategies. Our clinics provide a supportive atmosphere with strict safety protocols and a clean environment, allowing you to focus on achieving your goals.

Supporting Athletic Recovery and Wellness in Pittsburgh, Penn Hills, and Murrysville

Access to care is crucial for active individuals. With locations in Pittsburgh, Penn Hills, and Murrysville, Alliance Physical Therapy makes it simple for athletes to find expert guidance close to home. Our clinics are equipped to serve both competitive athletes and weekend warriors, offering a welcoming environment and efficient support.

We understand the pressures, time constraints, and challenges athletes face. Our therapists are experienced in realistic goal-setting and personalizing therapy based on your specific abilities and sport requirements. Ongoing follow-up and support are standard, ensuring you return to activity with confidence and strength.

Start Your Recovery and Performance Journey

Ready to transform your recovery or boost your athletic performance with guidance from our specialists? Contact Alliance Physical Therapy in Penn Hills at 412-242-7880 , Murrysville at 724-387-1000 , or Pittsburgh at 412-318-4286 . You can also visit our contact page to schedule your appointment and take the next step toward a stronger, healthier future as an athlete.

Pelvic Floor Highlights

Thu, 13 Jun 2019 16:00:00 GMT

Why performing Kegels may make your incontinence worse

Organ Prolapse:

Pelvic Organ prolapse can result after vaginal delivery. Prolapse is a displacement of pelvic organs down

into the vaginal vault. The bladder, the uterus, or the rectum can sit lower in the vaginal canal, resulting

in pain, incontinence, or even constipation. These symptoms can vary, and often people report

heaviness or pressure in the vaginal area, so much so that tampons fall out. Prolapse can even cause

constipation.

Prolapse can also result from years of bad postural habits that can create downward pressure in the

abdomen. The good news is that working on posture, muscular support, and proper maintenance of

abdominal pressure can reduce symptoms of prolapse!

Addressing prolapse is particular to each person and treatments can vary based on degree of prolapse,

range of motion, and strength.

Call Alliance today to address symptoms of prolapse and regain control of your life!

Is Your Core Turned Off After Pregnancy?:

A common issue after pregnancy is lack of core strength. The core can “turn off” and become weak after

being stretched out. A weak core can cause back and pelvic dysfunction. It is important to “turn on” the

core and strengthen it the right way without causing harm to your body.

To check if your core may be turned off, place your hand on your lower belly and cough. If your belly

bulges away from your spine, it is turned off. If it tenses and pulls in, it is turned on. Your core should

activate to stabilize your spine and pelvis for all movements such as squatting, turning, and lifting your

baby.

If you think your core may be turned off, or you want to ensure you regain your core strength safely,

schedule an appointment today.

Beyond Kegels:

At Alliance Physical Therapy and Rehabilitation Services, Inc. we treat a variety of pelvic floor dysfunctions. Pelvic floor disorders are common, and can include symptoms such as urinary incontinence, painful sexual intercourse, painful sitting, and prolapse. Pelvic floor muscles are responsible for many functions including bowel and bladder regulation, postural support, and helping to maintain intra-abdominal pressure. For a variety of reasons, these muscles can become overworked and tight, and develop trigger points just like other muscles in the body. Tension of the pelvic floor can result from trauma or injury, lumbar spine or hip disorders, and chronic abdominal pain. Overacting, or non-relaxing pelvic floor muscles are incapable of preventing the loss of urine during stressful events such as coughing, sneezing, laughing, and even exercise. A tight muscle is not necessarily a strong muscle.

If you think you may have an overactive pelvic floor, it is most helpful to learn to relax these muscles prior to strengthening. Performing Kegels and trying to strengthen muscles that are in spasm may result in a worsening of symptoms. If you struggle with urinary incontinence and are unsure where to start, come in for an evaluation to help guide you back to a symptom free life.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498251/

Exercise: The Body's Secret Weapon.

Thu, 08 Nov 2018 16:00:00 GMT

Why does physical therapy (exercise) work?!

Our bodies have the ability to re-build after injuries and the key to unleashing this ability is exercise. I was recently talking to a student of mine and realized that the foundation of everything that I was teaching him went back to the question of, WHY?! For example; “yes, we know exercise works, but why?” This made me think that this information would be valuable for patients.

The most important thing that you need to take from this is the concept of BIOPLASTICITY. This idea sits at the core of everything a physical therapist does. Generally speaking, the term means that our tissues (aka our biology) have the capacity for change (for the good or bad) with stress (either applied or removed). Through this mechanism we can do one of three things: 1) get in better shape, 2) get out of shape, or 3) get injured. Here is how:

Let’s start with an example we can all relate to: the skin on your hands. Here is a hypothetical: you work a desk job and don’t do much heavy lifting in your regular daily life. If this is the case, then it is likely that the skin on the palms of you hand would likely be very soft and smooth. This supple skin is your body adapting to your daily life of performing light and dexterous tasks. Now, spring comes and you get a load of mulch for your yard. You have two options here: 1) spread a bit each day for the next week or two, or 2) spread it all on Saturday, no matter what. If you go with option one, over the course of the week, you will start to notice callous formation on the palms of your hands. This skin will become rough and more thick. This is an adaption to your new activity to allow you to withstand the new stress of shoveling. We will touch on option two later.

This same adaption happens in every tissue of your body. In your connective tissues (muscles, tendons, ligaments, skin, bone) it is called Machanocoupling (British Journal of Sports Medicine Article). Specific to bone, this is called Wolf’s Law, which means that the more load makes a bone stronger. This is an incredible tool! This means that if we have an injury in the muscle then the solution is NOT rest, it is action. (An important note is that relative rest during the initial few days of inflammation is indicated, but limited to only a few (1-5) days.) Once we are out of the inflammatory period we will start to progressively load the injured tissue and continue to load it in a number of different ways until it is ready to return to whatever activity injured it.

Before those with osteoporosis jump up and go for a run, let’s talk about option two from above. This process MUST be slow and progressive loading . I am taking big risk telling people this, but I would not have a job if everyone abided by the idea that too much load too fast leads to tissue break-down and injury. So, if you shoveled all 10 yards of mulch in one day then instead of a nice strong callous you would have some painful, nasty blisters (aka tissue breakdown). The same thing happens to all of your connective tissues. So take your time and build slow.

We can apply some similar ‘stress’ principles to the brain. In the brain this is called neuroplasticity, and this idea is most evident with stroke patients. When a patient has a stroke and has a loss of control over an extremity, the best way to improve their control over it is to force them to use it. Here we are relying on the body’s ability to develop new pathways through the brain. This applies to the healthy brain and our ability to learn new tasks. We move through our life by setting off neurologic patterns of movement that run like a program through our brain. As I sit here and type this, I am not thinking about every single letter that I type, my brain is operating on a program of movement that I have developed over the last number of years. If (for some terrible reason) someone completely re-organized my keyboard, then It would take me about three weeks of work to write a new program. This is because it takes about three weeks for the brain to re-write itself. It would take longer to perfect the program, but that is the difference between competence and excellence. Where competence can take three weeks, excellence takes 10,000 hours.

These progressive training ideas also apply to the vestibular system (inner ear, responsible for balance). This system helps our brain understand where our head is in space and there are times when it can start to function at a lower level than ideal. This is called vestibular Hypofunction. This occurs as a result of injury to the system (ie. head injury) but can also happen as a (somewhat) normal result of aging. Regardless of the cause of the hypofunction we can work to improve the function by stressing the system. This process is called Habituation. In physical therapy we can do exercises that force the vestibular system to work which results in adaptations in the system that improves the function of it over time.

The idea of bioplasticity is a powerful tool and it is at the core of all of what we do in physical therapy, exercise, learning and life. We need to make sure we are STRESSING our bodies the enough to stimulate improvement and not too much to cause injury. To strike this balance consultation with a professional is often needed. This is where we your local physical therapist comes into play, so give him/her a call!

The Dollars and "Sense" of Healthcare in Pittsburgh

Thu, 06 Sep 2018 16:00:00 GMT

A market in turmoil and who is benefitting?

We find in our practice on an increasing and daily basis a request by our patients to have us attempt to explain and/or resolve their healthcare insurance issues. Years ago, when there were less insurance products available, we as clinicians felt like we had a level of working experience with these products and could sufficiently answer our patient's questions. And, remembering that we are clinicians and not insurance specialists, we often could then and still do, defer and point them in the right direction with their particular product resource. There has been an evolution in the healthcare arena since the 70's that began with physician providers having tremendous earning power. That scenario changed with the advent of managed care and providers earnings dropping to 40 or 50 cents on the dollar. The next generation of big earners was the pharmaceutical industry trying to recover the funds they spent on years of research and development, particularly on products that did not prove to be especially beneficial. And that brings us to the latest player in the healthcare earnings market...the insurance companies.

The insurance industry is of particular interest to the patients of Pittsburgh in that we have a unique situation in our area of hybrid entities that are both the clinical body and the insurance carrier. By this time, everyone has to be aware of the negative advertising campaigns we have seen and heard on television, the radio and in print between UPMC and the Highmark/Allegheny Health giants. While we heard a daily onslaught of why the public should be afraid for their future ability to get good care and why one system was better than another many individuals were just too confused and opted for third party insurers that would allow them freedom of choice. They chose not to be bullied by entities making millions of dollars and limiting the patient to go to clinics only in their system or they would not be covered or by directing the patient to selected clinics under their umbrella and applying different levels of deductibles, co-insurance and co-pays to influence your right to choose through the application of financial hardships. Some insurances make a distinction between "in-network" and "out-of-network" clinics and only cover your care when you go to an in-network provider. Even when you go to an in-network provider, there are often multiple levels of coverage, which typically confuse the patients and providers, allowing the insurance companies to pass off much of the cost to the patient. In many areas of the country, clinicians have opted out of these cumbersome insurance products and provide care for their patients on a "cash" basis. This means that the patient is treated, they pay the provider out of their own pocket, and then they turn the charges in to their insurance company on their own to get their payments re-imbursed. Often times, the clinic will provide the patient the necessary paperwork and lend some guidance but the service that was once done as part of your healthcare visit is now passed on to the client. This extra consumer burden has been born out of the complexities of the current insurance environment. The reality is that at this point clinicians are getting paid less (or the same) and need to staff more people to decipher the billing polices required by the insurance carriers.

The facts are that your caregivers in the Pittsburgh healthcare market are not charging more and are not earning more per patient or office visit. We are all playing by the same rules when we enter into an insurance agreement with a given company to see our patients. We agree to follow a usual and customary fee schedule that the industry has established. We all tend to think of our health insurance card as something that must certainly cover all of our healthcare expenses when the circumstances justify the need but that is simply not the case. No matter how you spin it, your health insurance premiums are rising, and you are not getting more services for the costs. Even when your premium seems to have stabilized or taken a small dip in a given year, what is commonly reflected is that your clinician is being asked to take some form of discount and the patient is being asked to make up the difference by a cash payment on their visits. Another side effect of the strangulating insurance issues in Pittsburgh is that many of our young and talented healthcare professionals are choosing to train here and leave the area for greener pastures and many of our homegrown clinicians take their expertise elsewhere. I have experienced this first-hand by watching two of my sons graduate from one of our Eastern suburb high schools and go on to medical school training at a Pennsylvania institution only to make the career choice to practice out-of-state when they completed their anesthesia residencies. So, are we getting the best care available in Pittsburgh or just the best care the insurance industry is willing to cover?

I think it is time for the healthcare consumer in Pittsburgh to "step up" and become better informed about their care. It is the patient's responsibility to understand their insurance purchase and what it allows. Your clinician's office can provide support to help you get through some of the confusion but we all need to be more proactive with our insurance carriers, our legislators and the Pennsylvania Insurance Commission. At Alliance Physical Therapy, we pledge to work with our patients to do our best to avoid putting them in a position that compromises their healthcare because of insurance/financial constraints. As a small player in a large game, our goal is to take the high road and work to do that which is right for the patient. You have a right to choose where you get your care...so make sure you ask all the right questions and consider Alliance for your rehabilitation needs.

Weekend Warriors, Couch Potatoes and Sports Medicine

Wed, 22 Aug 2018 16:00:00 GMT

Where will you get the best care for YOU??

Have you ever heard someone wonder out loud, “How does the quarterback from the Steelers have knee surgery and get back on the field in a couple of weeks?” or “I had shoulder surgery and I can’t even think of throwing a ball like that pitcher for the Pirates!” We need only to remember that these individuals are blessed with natural athletic gifts and work full-time to maintain a level of conditioning that most of the general population can only dream about. So, their recovery from an injury starts at a better point along the path than those of us who are working more and working out less! The weekend warrior is someone who engages in strenuous physical activity part-time or on weekends. The Center for Disease Control research estimates that only 1-3% of the population even engages in that level of activity and that 80% of that group are lumping activities such as household tasks like gardening into their regime. We are a statistically sedentary nation and yet we wonder why we get injured and why we don’t recover quickly!

Couch potatoes are the baby boomers who can’t play like we did when we were in high school and who are more concerned with home weight loss programs than in cardiovascular fitness. We face increased injuries when we try to exercise without the proper preparation due to fatigue, heavy physical demands, prolonged bouts beyond our tolerance and/or inexperience in the chosen sport/activity. A basic premise to consider if we are limited to a couple of days a week to exercise is to spread the days out to avoid deconditioning rather than doing both days on the weekend and to always involve a warm up and cool down period. Don’t be afraid to try an activity…. you might find you actually like it and it will become a healthy habit! If it makes you happy you are likely to stay motivated.

Our advice is to consult a knowledgeable health care professional to safely get started. But avoid the mentality that you need to go to a “Sports Medicine Clinic” because that is where the professional athletes go and “if it’s good enough for them, then it is good enough for me”. Sports medicine is a marketing term to attract clients and not a medical specialty. Someone working in sports medicine can be in internal medicine, emergency medicine, family practice, orthopedics, physical therapy, athletic training or nutrition, to name some examples, and should have additional training and experience in physical fitness and performance and the treatment and prevention of injuries associated with sports and exercise. A true sports medicine facility should coordinate research, education and practical applications with the idea of taking that knowledge and being of help to all people, not just elite athletes. The information that is generated at a facility like that is readily available to all clinicians and it is their responsibility to evaluate and treat their clients with the best evidence-based protocols in practice at the time.

So, find something you think you might like to try, consider talking to a specialist in movement and exercise like a physical therapist to help get you prepared to safely start, and go out and have some fun developing life-long healthy habits! And remember, weekend warrior or couch potato, you deserve and should expect the same care and attention that the professional quarterback or baseball pitcher gets!

Aging With Grace By Colin Gundling, PT, DPT, MTC, OCS

Mon, 23 Jul 2018 16:00:00 GMT

The Science of Balance

By Colin Gundling, PT, DPT, MTC, OCS

The biggest fear of many older adults is that of falling. This fear comes with good reason, as falls and the subsequent injuries have been shown to be associated with increased disability and even mortality soon afterwards! Now, I am sure you have some questions about all this, so I am going to take a stab at a few:

You may be thinking; how do we avoid falls?

There are many ways to avoid falls, but I will tell you that the answer is certainly not completely avoiding activities. So many older adults that I treat are surprised when we perform a balance test (ie, standing on one leg) and they can barely even start the test before losing balance. If this is the case for you, this tells me a couple of things: 1) your balance stinks. 2) your hip strength probably also stinks. 3) you have not challenged your balance recently, so you were not aware of how bad it is! The reality is that we live in a world that we do not have 100% control over. This means that we need to be prepared for changes in our environment; not just avoid anything and everything that could be dangerous because that will just lead to more disability and deconditioning.

Another thought may be: But, can balance really get better?

Yes. Progress may seem slow, but it will improve if you work on it. Don’t lose hope!

When should we start working on balance?

Now. I don’t care what age you are- it’s never too early OR late to start working on your balance. The group that I often see the most surprise in when we assess their balance is that 50-65 year-olds. From this group, I often hear “I had no idea my balance was this bad!” One thing that I have observed in my career is that our bodies are amazing at adapting to stress. If we stress the body in a slow, graded manner then our systems and tissues will adapt to that challenge and improve.

How do I know if I have balance issues?

That is a loaded question, because there are different levels of issues with balance. I would say that the best way to figure out if you have balance issues is to empower you with a better understanding behind the Science of balance.

There are three body systems that help you stay on your feet: 1) Visual, 2) Vestibular (inner ear), 3) Proprioceptive (the position of your joints and muscles). These three systems work in concert to send information to your brain about what your body is doing. An issue with one system will result in increased reliance on the others. So, in order to have an influence on your balance we need to identify which system is the FAULTIEST, and why. Once we do that we can determine a plan to intervene on that system. To test each system, we need to dampen the information coming to your brain from the other two systems. This way your brain will be primarily relying on the non-dampened system.

The other important thing to consider in your ability to balance is the size of your Base of support. The larger your base of support is, the easier it is to stay balanced. Your body knows this and will increase the support base in situations where it predicts that you may become off-balance. This is obvious in children who are learning to walk and have a very wide base of support. So, when you are testing your balance you need to be aware of the progression of your base of support to increase the balance challenge. The image Below demonstrates the progression of support from easiest to hardest.

When your balance is challenged and you start to become off balance you will use different body parts to stay on your feet, this is called your balance strategy. The balance strategy is the sequence of body movements that you employ to stay balanced once you start to become unsteady. This is your first line of defense against hitting the floor is your Ankle Strategy. This means that the first part of your body that moves when to keep your balance is your foot. An example of this is that you lift your toes when you start to lose your balance backwards. If that is not enough to keep you balanced, then you will use your Hip Strategy next. This means you will hinge/move at your hips to stay upright. If that fails, then you will likely take a step or put your foot down (if you’re standing on one leg), which is called your Step Strategy. This is important to be aware of because in cases of injuries to the hip or ankle/foot we may skip that strategy and go too quickly to the next one. This makes you less steady and increases your risk for falls.

If I didn’t lose you during that ramble then you would probably say: Well, that’s great, but how do I know if I am having issues?

Test for each system:

1) General Balance Test- A good overall test that will indicate that you have a significant risk for falling is standing on one leg with eyes open, head level, and on a stable surface. If you are unable to maintain this position for >5 seconds, then you are at risk of falling and causing serious injury.

2) Visual System Test- Stand barefoot on a pillow and look up towards the ceiling with your eyes open. Start with your feet shoulder-width and move through the base of support progression from Image 1. If you are able to make it all the way to single leg stance and hold for >30 seconds without touching down, then the visual is likely not the limiting factor to your balance.

3) Vestibular System Test- Stand barefoot on a pillow with your head at level and close your eyes. Start with your feet shoulder-width and move through the base of support progression from Image 1. If you are able to make it all the way to single leg stance and hold for >30 seconds without touching down, then the vestibular system is likely not the limiting factor to your balance.

4) Proprioceptive System Test- Stand barefoot on a solid surface and look up towards the ceiling, then close your eyes. Start with your feet shoulder-width and move through the base of support progression from Image 1. If you are able to make it all the way to single leg stance and hold for >30 seconds without touching down, then the proprioceptive system is likely not the limiting factor to your balance.

Test(s) failed. What do I do now?!

If you do have issues with these tests, then the best thing that you can do is to talk to your doctor or physical therapist about what you can do to address this. A full evaluation of balance in physical therapy will shed more light on the specifics of your balance issue, which will allow your physical therapist to create a more specific balance program for you. Obviously, your vision is not something that can be addressed in physical therapy and your primary care physician can help you with that. Otherwise, there are some great things that can be done to help you become more steady on your feet!

Remember, It takes an Alliance to meet your goals!