Our post-pandemic society has us questioning our choices, making life changes, and striving for improved happiness and health. With that questioning comes the ongoing discussion of finding “balance” in our lives. The phrase “work-life balance” is often used, as many of us seek that elusive optimal balance.  One definition of “balance,” however, often escapes discussion. It is the most fundamental kind: the balance that holds us upright.

Balance is a valuable, yet under-appreciated, function that our body performs. With unwavering consistency, there isn’t a task a human performs without activating some part of their balance system. Walking, picking up a child, climbing stairs, and even standing still, none of these daily actions can be completed without the basic ability to balance.

It’s when balance becomes unbalanced – through changes in our musculoskeletal system, central nervous system, and sensory system – that we see injuries becoming a larger issue.

How often have you considered the mechanisms that keep you upright? And as we age, problems with balance become more noticeable and are often detrimental to our health. 

Statistics report that 35 percent of U.S. adults older than 65 suffer a fall each year, with 50 percent of them requiring hospitalization for the injuries sustained. And three out of five adults older than 80 suffer from a balance disorder.1

What is balance? What is our balance system?

Balance is the ability to maintain a center of mass within the stability limits of support. Balance has three properties: steadiness, symmetry, and dynamic stability.

Balance in practice is extremely complex. The coordination of skeletal muscle combined with the tendons, joints, and the spine impacts biomechanical parameters like body sway, stride length, frequency, and symmetry. The central nervous system controls the motor signals from the brain to the body.

The sensory system involves the body’s orientation and stabilization, so you know where your body is and how it relates to its surroundings. Think of this system as the body’s GPS – it has three main sensory inputs: vision, the vestibular system (the inner ear), and proprioception.

Proprioception is a crucial component of the complex balance system that informs us of how and where our body is positioned in space. Our bodies can sense movement, location, and actions. It results from sensory signals, including neurotransmitters and more, in your nervous system, while most of the receptors are located in the muscles, joints, and tendons. It is closely tied to controlling movement and it combines with other senses and body processes to locate external objects relative to the body. This is the system that is largely affected by certain medications taken by older populations and accounts for many falling events.2

Proprioception is intertwined with the balance system and plays a critical role in athletic performance. Better proprioception improves balance, reaction time, coordination, and agility, and even reduces the risk of injury. A 6-year study of European basketball players observed an 81-percent decrease in ankle sprains and a 75.5-percent decrease in missed games and practices as a result of participating in a proprioceptive training program.3

These three systems – vestibular, vision, and proprioception – synergistically signal to the brain where it integrates sensory information and transmits the signals back to the skeletal system, the muscles of the trunk and legs, tendons, and joints ‒ all for maintaining balance.

The biggest disruptors of balance

An injury, such as a blow to the head or an inner ear infection, can disorient these systems and adversely affect balance almost instantaneously. However, physiological changes that affect balance due to aging tend to be a slower, more methodical progression through the body’s different systems.

The largest age-related physiological changes that affect standing balance and most often cause falls are decreased muscle thickness, specifically in the thigh, peripheral nerve loss in the feet, and autonomic neuropathies – all of which can cause ataxia, otherwise known as loss of muscle control or coordination.  

Glaucoma, cataracts, and other vision changes with or without significant changes in the vestibular system, like hearing loss, tinnitus, or vertigo, account for a large proportion of falls in older populations.1 Chronic health conditions, like diabetes, heart disease, and changes in blood vessel health, thyroid, and nerves can adversely impact balance in a variety of ways. 

How can you test your balance?

Determining if your balance is adequate can be done through a few simple tests. 

The single-leg balance test, for example, is exactly as it sounds. Stand upright with both arms by your sides, but not touching your legs. Slowly lift one leg and hold it slightly away from your center of balance. Hold this for as long as possible without falling. The average person (young to middle-age) should be able to hold this for a minimum of 30 seconds.

For an extra challenge, close your eyes to test the vestibular and proprioceptive systems, without your vision helping. If you cannot hold that position for longer than 10 seconds, then it is likely your balance needs improving.

You can also try the Functional Reach Test, which measures your maximum reaching distance while maintaining a stable base. Read more here for a detailed walkthrough on how to perform this test.       

Although maintaining balance is multifactorial and involves multiple body organs and systems, it is possible to minimize the risk of balance-related health complications with a few simple exercises a day. And while many of us make time for cardio or strength training, we forget about the vital role balance plays in physical health.

Good balance takes work, and is a measure to test, track, and optimize throughout your health span ‒ starting in your younger years to minimize risk for the common injuries with age. If you want to work on your balance, read tips from Thorne and the Mayo Clinic on improving flexibility, mobility, and balance.

Having good balance, while often neglected, is incredibly important for healthy aging, particularly in mitigating the risk of falls and injury. For these reasons, balance is one of the many elements of health tested in the innovative Thorne Lab experience.

Vitamin D and balance

Numerous studies have examined the effect of vitamin D on balance and risk of falls in older populations – with mixed results. One study of 370 geriatric participants found that supplementing vitamin D to severely deficient participants resulted in significant improvements in gait and balance after 12 months.4 Because vitamin D is also essential for bone and muscle strength, testing vitamin D levels in older patients is recommended.

This article was contributed by Natalie Sinsheimer, an intern for Thorne HealthTech.

References

  1. Xing L, Bao Y, Wang B, et al. Falls caused by balance disorders in the elderly with multiple systems involved: Pathogenic mechanisms and treatment strategies. Front Neurol 2023;14:1128092.
  2. Gaspar AGM, Lapão LV. eHealth for addressing balance disorders in the elderly: systematic review. J Med Internet Res 2021;23(4):e22215.
  3. Riva D, Bianchi R, Rocca F, Mamo C. Proprioceptive training and injury prevention in a professional men’s basketball team: a six-year prospective study. J Strength Cond Res 2016;30(2):461-475.
  4. Sahin Alak ZY, Ates Bulut E, Dokuzlar O, et al. Long-term effects of vitamin D deficiency on gait and balance in the older adults. Clin Nutr 2020;39(12):3756-3762. doi: 10.1016/j.clnu.2020.04.003.