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We maintain balance through a complex system involving multiple sensory inputs and specialized structures throughout our body. These systems all have to work together in unison to maintain our balance at every moment. Whenever someone is having trouble with their balance, an examination by a physical therapist is important to help determine which structures are affected and the best treatment options to improve balance.

It’s important to note, that balance CAN be improved at ANY age. Too many people believe that losing balance is just a process of aging, but it is not inevitable!

Here’s an overview of how our body keeps balance.

The Main Body Systems Used to Balance

  • Vestibular System
  • Vision
  • Proprioception
  • Somatosensation
  • Central Nervous System (CNS)
  • Cerebellum
  • Reflexes

Our vestibular system, proprioception, and vision work together constantly to give our body information about where we are in space. Impairments in one or all of these systems can really affect the ability of someone to maintain balance in their environment.

Vestibular System

The inner ear contains the vestibular system, which plays a crucial role in balance. It consists of three semicircular canals and two otolith organs—the utricle and saccule. These structures detect changes in head position, angular movements, and linear acceleration.


Our visual system provides visual cues that contribute to our sense of balance. It helps us perceive the position of objects and detect changes in the environment, enabling us to make necessary adjustments to maintain balance. The visual system assists in stabilizing our gaze, allowing us to maintain a clear and steady view of our environment even when our head or body is in motion. This stabilization helps minimize visual disturbances and contributes to our overall balance.

Vision is a large contributor to our balance. Have you ever closed your eyes and felt yourself sway? Or tried to walk around in the dark? We rely heavily on our visual system day in and day out to constantly give us information about where our body is in space. It’s important to address visual changes as they occur to help avoid balance problems.


Proprioceptors are specialized sensory receptors located in muscles, tendons, joints, and other connective tissues. These receptors detect changes in muscle length, muscle tension, joint angle, and the direction and speed of movement. They send signals to the central nervous system, particularly the brain and spinal cord, providing constant feedback about the position and movement of the body.

The brain processes the information received from proprioceptors and uses it to control and adjust muscle contractions, coordination, and posture. This feedback loop between the sensory receptors and the central nervous system allows us to perform complex movements with precision and adapt to changes in our environment.

Proprioception plays a crucial role in various activities, such as walking, running, reaching for objects, and maintaining balance. It is also essential for activities that require fine motor skills, such as playing musical instruments or typing on a keyboard. Impairments in proprioception can lead to difficulties in motor control, coordination, and balance.


Somatosensation and proprioception both give information to our brain regarding our body in the environment. Sensory receptors in our skin provide information about pressure, vibration, and touch. This input, along with information from proprioceptors, helps us understand the position and movement of our body in relation to the environment.

For instance, when we stand or walk, sensory receptors in our feet provide constant feedback to the brain about the pressure distribution and any changes in the surface beneath our feet. This information helps us make adjustments in our posture and control the distribution of our body weight, ensuring stability and balance.

Central Nervous System (CNS)

The brain and spinal cord process and integrate information from the vestibular system, proprioception, vision, and somatosensation.

Once the CNS has processed the sensory information related to balance, it coordinates the appropriate motor responses to maintain stability. This involves activating the correct muscles and adjusting their contraction levels to counteract any disturbances or changes in body position. The CNS sends signals through the spinal cord and peripheral nerves to initiate muscular adjustments that help restore balance.

The CNS is responsible for maintaining postural control, which involves regulating the position and alignment of various body parts to maintain balance. It continuously monitors the position and movement of different body segments, adjusting muscle tone and coordinating muscular contractions to maintain an upright posture and prevent falls. The CNS can activate muscles in a coordinated manner to stabilize joints, shift body weight, and counteract external forces that might disrupt balance.

The CNS also has the capacity to learn and adapt to different balance demands, improving balance control over time.


The cerebellum, located at the back of the brain, plays a crucial role in balance and coordination. It receives sensory input from various sources and uses this information to fine-tune motor movements, ensuring smooth and coordinated actions.

The cerebellum is involved in sensorimotor integration, error detection and correction, coordination of muscle activity, motor learning, and feedforward control, all of which contribute to maintaining balance. It processes sensory inputs, compares them with desired motor outputs, and generates precise motor commands to adjust posture, coordination, and muscle activity, ultimately enhancing balance control.


Rapid reflexes are an essential part of maintaining balance. For example, when we lose our balance, we instinctively extend our arms or take a step to prevent falling. These reflexes are controlled by the spinal cord and occur automatically without conscious thought.

The interaction of these systems allows us to maintain balance and adjust our body position in response to changes in the environment. When any of these systems are compromised, such as due to inner ear disorders or neurological conditions, it can result in balance disturbances or disorders.

How Physical Therapy Can Help With Balance

When balance is compromised, physical therapists play a critical role in addressing impairments and helping individuals regain stability and confidence in their movement.

Physical therapy is effective in improving balance. Check out this article here.

Comprehensive Assessment

Physical therapists conduct thorough assessments to identify the underlying factors contributing to balance deficits. They evaluate strength, flexibility, joint range of motion, sensory input, gait patterns, and overall functional mobility.

Individualized Treatment Planning

Based on the assessment findings, physical therapists develop personalized treatment plans tailored to each individual’s specific needs, goals, and functional limitations. These plans may include a combination of exercises, manual therapy techniques, and specialized interventions.

Strength and Stability Training

Physical therapists prescribe exercises to strengthen muscles, particularly those in the core, legs, and ankles, which are essential for maintaining stability and preventing falls.

Proprioception and Balance Training

Physical therapists incorporate exercises that challenge proprioception and balance, such as standing on one leg or performing balance activities on unstable surfaces. These exercises improve neuromuscular control and coordination.

Vestibular Rehabilitation

For individuals with vestibular disorders affecting balance and spatial orientation, physical therapists employ specific vestibular rehabilitation techniques to improve vestibular function and reduce symptoms of dizziness and vertigo.

Gait and Mobility Training

Physical therapists work on improving walking patterns, stride length, and step symmetry for individuals with gait disturbances or difficulty walking.

Fall Risk Assessment and Prevention

Physical therapists assess fall risk factors and implement fall prevention strategies tailored to each individual’s needs. They educate patients and caregivers on environmental modifications, assistive devices, and safe movement techniques to minimize the risk of falls and injuries.

Progressive Goal-Oriented Treatment

Physical therapists use a goal-oriented approach to treatment, working collaboratively with patients to set realistic goals and track progress over time. They gradually progress the intensity and complexity of interventions as the patient’s balance improves, ensuring continued gains in functional mobility and independence.