In politics it's called the Balance of Power; meditation experts consider it to be a blending of mental and physical traits, but whatever you call it balance is tricky business.  It can be affected by a thousand different things but a balance disturbance can be devastating.  It's often difficult to determine exactly what is causing a balance problem and your doctor may suggest several different methods to decide what's causing your particular problem.  The greatest fear associated with imbalance is falling.  We have all fallen at some time but recurrent falls may lead to a vicious cycle of fear, being overly cautious, becoming less active, getting weaker and weaker and ultimately increasing our risk of falls!  Conversely, some people with balance and falling problems never gain insight into their risks and continue to plunge head first into the world of the horizontal.    

Balance is innate.  Comedians and stunt doubles actually have to teach themselves how to fall because it's so contrary to our natural instincts.  All the elements that combine to keep us upright are like an internal symphony.  We are born with "righting reflexes" and postural reflexes that tell us where we are in space and, in the case of a fall, try to align our body so that we land feet first and chest first.  This requires that our eyes, inner ear, nervous system, muscles, bones and joints are all working properly.  Any sour notes in the symphony affect the harmony of the whole piece.

One of my favorite poets, Shel Silverstein (of blessed memory) wrote this little poem which sums up the disorientation brought on by falls.  It's called Falling Up:

            I tripped on my shoelace
            And I fell up--
            Up to the roof tops,
            Up over the town,
            Up past the tree tops,
            Up over the mountains,
            Up where the colors
            Blend into the sounds.
            But it got me so dizzy
            When I looked around,
            I got sick to my stomach
            And I threw down.

Balance can be disrupted by unexpected things like stepping in a hole or missing a chair.  Typically we arrange our personal environment so that it is as predictable as possible, visually and in terms of the placement of furniture, etc.  But in unfamiliar surroundings we may encounter situations that "throw us off balance".   The list of factors that can lead to balance disturbances is long.  Among others there are medications, dietary deficiencies, vision problems, impaired muscle tone and strength and neurological diseases affecting the balance centers in the brain.  Heart and blood vessel problems often lead to dizziness and light headedness, ultimately resulting in a fall.  Some examples include heart rhythm problems that interfere with the blood flow to the heart and brain and blood pressure medications that make us dizzy when we first stand up.  Vitamin and iron deficiencies can cause anemia resulting in fatigue and weakness and once again, medications can deplete the body of essential electrolytes such as potassium and sodium.  Memory loss can also play a role in loss of balance.  Alzheimer's disease causes us to lose developmental milestones that we gained as children making the simplest things like walking seem complex.  Anything that requires a series of steps that we once took for granted can be challenging.  Toileting oneself is such an activity and untold numbers of falls and fractures can be traced to bathroom accidents such as slipping in urine.  Strokes, Parkinson's disease and other degenerative neurologic diseases can affect vision, muscle strength and coordination, and the motivation and capability to overcome the disabilities that result.  Of course, one can't discount the prevalence osteoporosis as a major cause falls and fractures. Sometimes a fall will cause a hip fracture, but often the hip or vertebrae fracture first, leading to a sudden loss of balance and a fall.  Even serious emotional and mental problems such as depression and anxiety can cause distraction, loss of interest in physical activity and an overall decline in our functional ability.

Fortunately there is good news about being able to develop and maintain balance and prevent falls and fractures.  The fundamentals of a good, well balanced diet can't be overemphasized to maintain strength and a sense of well-being.  Restful sleep is also important to keep up our energy level and routine exercise invigorates us.  It's also important to have regular medical care and keep in touch with your doctor if you are worried about medications affecting your balance.  If balance problems develop despite our best efforts, a thorough check up is in order including a physical therapy evaluation.  There are many techniques physical therapists can use to help us regain the power of balance.

Jean Root, D.O.