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Walking out of Tune

Sarah Mundell, DPT

In one of the most memorable episodes of The Andy Griffith Show ever, Deputy Barney Fife accepts a well-meaning invitation to join the Mayberry choir. There’s just one tiny problem: he can’t sing. And it isn’t long before the whole town knows it. He’s loudly, disastrously out of tune.

Your balance system is much like a choir: a combination of vision, proprioception (your sense of where your limbs are in space) and the vestibular system (information from the inner ear). Information from your eyes, your brain, and your vestibular system integrates to keep you upright. This helps you navigate through your environment, gauging how far you are from objects and preventing you from falling down. When one part is out of tune, the others can usually compensate (just like the other choir members tried to out-sing Barney). But sometimes the vestibular system—like the Mayberry choir—just doesn’t operate with optimum efficiency. 

 As we get older, our vision often gets weaker, and we need to be aware of how to compensate for the decrease in information from our eyes. The first thing we can do is make sure we have sufficient light available to be able to see hazards in our environment. While energy efficiency is certainly on everyone’s mind, we should make sure that rooms are bright enough that we can see where we’re moving, especially near thresholds. We can also minimize tripping hazards by removing throw rugs, low tables, and other objects from our pathways. Be mindful of the location of pets, especially small ones. As the information we get from our eyes changes with age, we need to adjust our habits to make our environments safer.

 We also receive information from sensors in our joints and muscles. Proprioception is how you know how high you need to lift your foot to clear the floor with each step. Most of us have seen firsthand the clumsiness teenagers experience. What their muscles and joints told them yesterday does not work today because they grew a ½ inch. We can re-train our proprioception through stretching and exercise, which restores proper length-tension relationships in our limbs. Common problems are tight hip muscles that tend to pull us off balance in a forward direction or tight calf muscles that tend to push us back.  Either one can result in a fall.

 The Vestibular system is a little more complicated but can be just as easily corrected.  Vestibular Dysfunction is fairly common and may be the reason for poor balance.  Very small crystals in the ear tell your brain which way is up regardless of position.  Sometimes these crystals become displaced, provide faulty information and often results in vertigo.  Vestibular Dysfunction may also be caused by decreased input from the nerves of the inner ear.  In either case, a faulty vestibular system may distort a sense of uprightness resulting in a higher risk for falls. Simple tests performed by your physician or physical therapist can tell you right away if your vestibular system is working properly. Treatment may consist of specific exercises to retrain the inner ear, balance and proprioception training, and treatments designed to relocate displaced crystrals (otocona).

It’s important to consult your physician or physical therapist to determine the root of any balance problem.  So if you’re having problems keeping your balance or know someone who is, get it checked out and treated. Don’t keep on trying to out-sing Barney; you want your whole choir of senses and systems to be singing in harmony.       

 Sarah Mundell is a physical therapist specializing in Vestibular and balance disorders.  She has helped many people since FCR initiated the program in early 2009