What causes balance problems?

Balance problems can have many causes.Vision, the vestibular system, sensation, strength, neurological conditions, medications, blood pressure, pain, and other medical or environmental factors can all contribute. Several factors may be present at the same time.A physical therapy evaluation helps identify which factors appear most relevant and whether additional medical evaluation is appropriate.

NEUROLOGICAL & BALANCE REHABILITATION · STAFFORD & FREDERICKSBURG, VA

Falls Are Not An Inevitable Part Of Getting Older

Falls become more common with age, but that does not mean they should simply be accepted.

Balance, strength, walking ability, and functional mobility can be assessed and trained throughout adulthood. Fall risk can also be influenced by medications, vision, health conditions, previous falls, the home environment, and other factors.

At Divine Physical Therapy, in-home balance and fall prevention physical therapy focuses on identifying the factors that may be contributing to your risk — then building a plan around what can be changed. Care is provided through one-on-one physical therapy in Stafford County, Fredericksburg, and surrounding Virginia communities. Adult children and caregivers arranging care for a parent or family member are welcome to make the first call.

Physical therapist assisting patient with stair exercises.

THE MYTH

Are Falls Just Part Of Getting Older?

No.

Age can increase fall risk, but falls are usually influenced by multiple factors rather than age alone. These may include:

The advantage of identifying these factors is that many can be addressed, managed, or accommodated. The first step is determining which factors are most relevant to you.

Reduced leg strength

Changes in balance or walking

Vision changes

Vestibular or inner-ear problems

Changes in sensation

Certain medications

Blood pressure changes

Neurological conditions

Previous falls

Fear of falling

Environmental hazards within the home

Why Does Balance Change?

Balance depends on several systems working together.

Your brain receives information from your vision, vestibular system of the inner ear, and sensory information from your feet, joints, and body. Your nervous system integrates that information, while your muscles generate the movement needed to keep you upright and respond when your balance is challenged.

Changes anywhere within that system can affect stability. Strength, reaction time, medications, blood pressure, neurological conditions, vision, pain, and the environment can also influence fall risk.

That is why a good balance evaluation does not stop with one test or one explanation.

Before I test anything, I listen for the pattern.

Someone who describes the room spinning when rolling over in bed needs a different examination than someone who feels unsteady primarily in the dark. Lightheadedness when standing requires another line of questioning altogether.

People often use the phrase ‘balance problem’ to describe very different experiences. My first job is to understand what you mean by it — and determine whether physical therapy is the right place to start.”

Dr. Thea Paige, PT, DPT, CMTPT, PCES

Physical therapist assisting woman with balance exercise

THE MYTH

How Is Balance And Fall Risk Tested?

Balance assessment uses your history, clinical examination, and standardized measures to build a more complete picture of your mobility and fall risk. Depending on your needs, testing may include:

Berg Balance Scale

Timed Up and Go (TUG)

Five Times Sit to Stand

Gait speed

Strength testing

Walking and transfer assessment

Sensory and balance testing

Home Mobility Observation

These tests provide objective information that can be repeated over time to track change. However, no single balance test can determine whether someone will or will not fall.

Fall risk is multifactorial. Test results are interpreted alongside previous falls, health history, medications, vision, neurological status, confidence, home environment, and other relevant factors. The number is useful. The clinical picture matters more.

WHAT THE EVIDENCE SUPPORTS

What Actually Helps Reduce Fall Risk?

Exercise is one of the strongest tools available for fall prevention in community-dwelling older adults.

Research supports programs that appropriately challenge balance and include functional and strengthening exercise. The program should be individualized to the person’s abilities and progressed as those abilities improve.

Depending on the individual, fall-prevention planning may also include:

Sherrington C, et al. Exercise for Preventing Falls in Older People Living in the Community. Cochrane Database of Systematic Reviews. 2019.

Medication Review With Your Provider

Vision assessment

Appropriate footwear

Home-safety modifications

Assistive-device assessment and training

Management of relevant medical conditions

Education for family members or caregivers

Fall prevention works best when the plan addresses the individual’s actual risk factors rather than relying on one intervention.

TRAINING

Why Does Balance Training Need To Be Challenging?

Balance improves when the balance system is appropriately challenged. That challenge must also be safe and matched to the person’s current abilities.

For one person, that may mean practicing standing with a narrower base of support. For another, it may mean turning while walking, stepping over obstacles, navigating stairs, changing surfaces, or responding to movement while carrying something. As ability improves, the challenge progresses.

The goal is not to make someone feel unsafe. It is to provide enough challenge for the nervous system and body to adapt while maintaining appropriate guarding and support.

Physical therapist assisting a man in parallel bars.

AT HOME

Why Does In-Home Balance Therapy Matter?

A clinic can measure balance.

Your home shows how you actually use it.

An in-home evaluation allows Dr. Paige to observe the environment where everyday mobility occurs, including your stairs, bathroom, bedroom, furniture, lighting, walking paths, and the route you take through the house at night.

Treatment can then incorporate the specific movements and environments that matter to you. Instead of practicing only on clinic equipment, you may practice getting out of your own chair, navigating your own stairs, turning in your hallway, or safely moving through the areas where you feel least confident. That makes the environment part of both the assessment and the treatment plan.

CONFIDENCE

Fear Of Falling Matters Too

Fear or concern about falling can change the way someone moves and participates in everyday life. Someone who becomes afraid of falling may begin avoiding stairs, walking outside, exercise, social activities, or other movements that previously felt routine.

Over time, reduced activity can contribute to decreased strength, endurance, mobility, and confidence. Physical therapy can address this through appropriately graded and supervised practice — helping someone rebuild physical capacity while also becoming more confident using it.

The goal is not reckless independence. It is safe independence supported by measurable ability.

EARLY SIGNALS

Catching Changes Before The First Fall

You do not have to wait for a fall to assess balance. Changes in walking speed, strength, transfers, balance, confidence, or activity can provide useful information before a major event occurs. A baseline assessment can be especially useful for someone who.

For clients interested in proactively monitoring mobility, balance and functional testing may also be incorporated into an Annual Movement Physical.

Has noticed increasing unsteadiness

Has experienced a near-fall

Avoids stairs or uneven surfaces

Has recently become less active

Has a neurological condition affecting mobility

Has begun holding furniture or walls while walking

Has recently returned home after hospitalization or rehabilitation

Has family members noticing changes in walking or balance

WHAT DOES A FALL-PREVENTION PLAN LOOK LIKE?

Five Moves From Worried To Measured.

01. Measure:

Assess balance, strength, walking, transfers, functional mobility, and other relevant factors using standardized measures when appropriate.

02. Identify the contributors:

Determine which factors may be influencing your balance or fall risk — including strength, sensory changes, neurological factors, medications, vision, confidence, or the home environment.

03. Address the environment:

Look at how you actually move through your home and identify practical changes that may improve safety and independence.

04. Train:

Progressively challenge balance, strength, walking, transfers, and the specific activities that matter to you.

05. Retest:

Repeat relevant measures to track progress, adjust the plan, and determine what still needs attention.

Sherrington C, et al. Exercise for Preventing Falls in Older People Living in the Community. Cochrane Database of Systematic Reviews. 2019. Lusardi MM, et al. Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability. Journal of Geriatric Physical Therapy. 2017.

KEEP READING

Where To Go Next

Neurological & Balance Rehabilitation

Explore one-on-one neurological rehabilitation, balance training, and fall-prevention care at home.

The Transition Home After Rehabilitation

Support mobility, safety, and independence after returning home from inpatient rehabilitation.

Stroke Recovery at Home

Continue working on walking, balance, mobility, and everyday function in your own environment.

YOUR QUESTIONS, ANSWERED

Frequently Asked

Physical therapists can use standardized measures such as the Berg Balance Scale, Timed Up and Go, Five Times Sit to Stand, and gait speed along with strength, walking, sensory, and functional testing.These measures provide objective information that can be tracked over time. No single test perfectly predicts whether someone will fall, so results should be interpreted as part of a broader fall-risk assessment.Source: Lusardi MM, et al. Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability. Journal of Geriatric Physical Therapy. 2017.

Yes.Older adults retain the ability to improve strength, balance, and physical function with appropriately prescribed exercise. Research also shows that exercise programs can reduce falls among community-dwelling older adults, particularly when balance and functional exercise are important components of the program.Age influences the starting point, health considerations, and rate of progression — but it does not eliminate the ability to train.Source: Sherrington C, et al. Exercise for Preventing Falls in Older People Living in the Community. Cochrane Database of Systematic Reviews. 2019.

Yes.Concern about falling can lead people to restrict activity, which may contribute to reduced strength, endurance, mobility, and participation. It should therefore be considered alongside physical and environmental factors when evaluating someone with balance concerns.The goal is not simply to tell someone to “be careful.” It is to identify what they can safely do and progressively rebuild their ability and confidence.

Useful changes depend on the individual and the home. Common areas to assess include:Lighting, particularly between the bedroom and bathroomLoose rugs and clutter in walking pathsBathroom surfaces and available supportsStairways and handrailsFrequently used furnitureFootwearPlacement of commonly used itemsEntryways and outdoor walking surfacesAn in-home physical therapy evaluation allows recommendations to be based on how you actually move through your space rather than a generic checklist.

Maybe.An assistive device should provide the level of support you need while allowing you to move as safely and independently as possible. The appropriate device depends on your balance, strength, walking pattern, endurance, environment, medical condition, and goals.Fit matters too. A cane or walker that is the wrong height or used incorrectly may not provide the intended benefit. Physical therapy can help determine whether a device is appropriate, fit it correctly, and teach you how to use it safely.Your needs may also change as your mobility improves or your medical status changes, so assistive devices should be reassessed over time.

If you may be injured, struck your head, cannot safely get up, have new neurological symptoms, or have another urgent medical concern, seek appropriate medical attention.After the immediate issue is addressed, it is worth looking at why the fall happened, particularly if the cause is unclear or falls are recurring. Evaluation may include reviewing:What you were doing immediately before the fallPrevious falls or near-fallsBalance and walkingStrengthMedicationsVisionBlood pressure or dizzinessFootwearEnvironmental factorsA previous fall is an important part of assessing future fall risk, but it should be considered alongside the person’s other risk factors rather than used as a stand-alone prediction.

Smiling woman in a blue shirt in a fitness studio.

BEGIN WITH A DISCOVERY CALL

Worried About Your Balance Or Someone You Love?

You do not have to wait for a fall to find out where things stand.

Start with a complimentary 15-minute Discovery Consultation with Dr. Paige. We can discuss what has changed, whether physical therapy is an appropriate next step, and what an in-home balance evaluation may involve. Adult children and caregivers are welcome to initiate the conversation for a family member.