Why Balance Matters More Than You Think

One of the things Nicole often hears in the clinic is, “I just don’t feel quite right.”

Sometimes it’s someone who feels less confident walking on uneven ground. Others notice they need to hold onto the handrail when using stairs, avoid walking in the dark or feel unsteady when they turn quickly. Some people simply describe feeling “off” after a concussion, while others with persistent neck pain or chronic pain are surprised to discover that their balance has also been affected.

Interestingly, many of these people wouldn’t describe themselves as having a balance problem at all.

But balance can provide an important window into how the nervous system is functioning.

Balance is a whole-brain activity

Standing upright might look simple, but your nervous system is doing an extraordinary amount of work behind the scenes.

Your brain is constantly receiving information from three major sources: your visual system, your vestibular system in the inner ear, and sensory receptors throughout your muscles and joints that tell your brain where your body is in space.

Your brain has to integrate all of that information, decide what is important and generate the appropriate muscular response, continuously and usually without you ever being aware of it.

When one source of information becomes less reliable, or the brain isn't integrating that information efficiently, the nervous system often finds another way to keep you upright.

And that’s where things become interesting.

The body is very good at compensating

Imagine someone whose vestibular system isn't contributing as effectively as it should.

They don't necessarily fall over.

Instead, they may begin relying more heavily on their vision. They watch the ground when they walk. They feel fine during the day but much less confident at night. Uneven ground becomes uncomfortable. Walking through a busy shopping centre can be surprisingly tiring.

Another person might become stiffer through their trunk, slow their walking speed or take shorter steps. Someone else may subtly shift their weight towards one side.

These strategies can be very effective. In fact, they may work so well that the person doesn't realise they're compensating at all.

They simply know that something feels different.

What are we looking for during an assessment?

This is why assessing balance involves much more than asking someone to stand on one leg.

Nicole is looking at how the whole system behaves.

What happens when visual information is removed by closing the eyes? Does the person become significantly less stable?

What happens when the head moves and the vestibular system is challenged?

Is weight distributed evenly, or does the person consistently favour one side?

How does balance interact with eye movements, sensation, joint position awareness, gait and other findings from the neurological examination?

No single test provides all the answers. Instead, we build a picture from the pattern of findings across the assessment.

Adding objective measurement with BTrackS

We’ve recently added the BTrackS Balance System to our assessment tools at Coelevate.

BTrackS is a research-grade force plate that measures postural sway, the small movements your body makes while maintaining an upright position.

This gives us something extremely useful: a measurement.

Clinical observation remains important, but objective measurement allows us to quantify what we're seeing, establish a baseline and compare balance performance with age-matched normative data.

Importantly, though, measuring balance doesn't improve balance.

The assessment tells us where we are starting from. What we do with that information is what matters.

From assessment to rehabilitation

Once we understand how an individual's balance system is functioning, we can design rehabilitation around what they need.

For one person, that might mean progressively challenging their balance while reducing their reliance on vision.

For another, vestibular rehabilitation may be more important.

Someone else may need exercises involving eye and head movements, proprioceptive training, gait exercises or progressively more challenging balance tasks.

The goal isn't simply to make someone better at standing on a balance board.

The aim is to challenge the nervous system in a way that encourages it to process sensory information more effectively and develop better strategies for maintaining stability during real-life movement.

And because everyone presents differently, rehabilitation shouldn't look identical for everyone.

Then we measure again

This is where objective testing becomes particularly valuable.

After a period of targeted rehabilitation, we can repeat the balance assessment.

Has postural stability improved?

Does the person still rely heavily on vision?

Is there still a difference between what we're seeing clinically and what the patient is experiencing?

Do we continue the current rehabilitation, make it more challenging, or change direction?

Sometimes patients tell us they don't think they've improved very much — yet their objective results show a substantial change. That can be incredibly encouraging.

At other times, the measurements confirm that progress has slowed. That's useful too, because it tells us that it may be time to reconsider the rehabilitation strategy rather than simply continuing to do more of the same.

It's not about having “good” or “bad” balance

Ultimately, we're not interested in giving someone a balance score for the sake of having a score.

We're interested in understanding why they balance the way they do.

When objective balance measurement is combined with a detailed neurological assessment, it gives us another piece of information about how the nervous system is functioning.

We can then use that information to design targeted rehabilitation, challenge the systems that need challenging and objectively monitor how the nervous system responds.

Because sometimes “I just don't feel quite right” is actually telling us something very useful.