If you’ve been following our osteoporosis, balance, and falls series over the last 5 weeks, you might be wondering how to put all of this information together. In today’s article, I’m going to help you do just that by telling you a story about a lady we worked with recently in the clinic. For this article I will call her Susan but it’s important to note that it’s not her real name. As I go through Susan’s story, I’m going to tell you how we assessed her 3 Balance Systems as well as the other various factors that contribute to her balance. Then we’ll discuss how we used this information to design a successful treatment plan for her.
Here’s Susan’s story in a nutshell: Susan came into the clinic after she fell 6 months prior while walking to her car in a gravel parking lot. She ended up with a couple bumps and bruises, but otherwise was uninjured. However, over the next several months, she became more and more worried about having another fall, so she started limiting her activity level, and she specifically avoided things like walking on uneven surfaces (since walking on the gravel was part of why she fell). She decided to come in for physical therapy because lately she’s been feeling even more unsteady on her feet, and she’s had several near-falls where she’s had to catch herself on a piece of furniture or a wall inside her home. If you have had a few falls where you caught yourself or just a few bumps and bruises you may not realize what weaknesses may be contributing to these little mishaps! Hopefully this story will make you think about what might be contributing to your imbalances.
After talking with Susan and assessing her various balance systems, her PT came up with some key findings. When performing a special balance test, she lost her balance quickly when she closed her eyes, especially when standing on a foam pad (unstable surface). This indicated weakness in her inner ear (vestibular system). She also had limited strength in her ankles, hips and core. This is important because when you don’t have adequate strength in your ankles, legs/ hips, or core you cannot react as well if needed and you may start dragging or shuffling your feet.
She had normal sensation, with no signs of neuropathy, and no signs of vertigo (which we touched on last week!). Susan also had a sore left hip, which makes it hard to put weight on her left leg at times and caused her to shift her weight towards her right side when standing and walking. As you might be able to tell, there were several factors contributing to Susan’s poor balance which included; inner ear weakness, limited strength, altered walking (due to fear) and left hip pain. In order to design a successful treatment approach for Susan, her therapists had to take all of these factors into account. Here’s what successful treatment looked like for Susan:
1. Balance exercises in the clinic to improve her inner ear function.
2. Specific strengthening exercises for her ankles, hips, and core.
3. Hands-on treatment of her hip pain, as well as specific stretches.
4. Gait training (working on walking form with feedback from therapists).
And the result? 6 weeks later, Susan has made improvements in all areas.
Her performance with the specific balance testing was significantly better as she was able to balance in all required positions for 30 seconds. She’s also walking normally again, with longer steps and without looking at the ground. And since her hip isn’t bothering her, she’s putting weight on both legs equally, which also improves her balance (plus, if you don’t put equal weight on each leg you can end up with another problem like knee pain, back pain etc…). And most importantly, Susan has regained her confidence and is no longer afraid that she’s going to fall when doing her daily activities. She’s back to taking long walks with her friends, even if there are hills and uneven terrain at times. She knows that she’ll have to keep working hard to keep herself in top shape, but she has all the tools she needs to keep her balance sharp and her muscles strong.
I hope Susan’s story helps you understand two things. First, if you’re worried about your balance, you’re not alone. And second, it’s very likely that you don’t have to just put up with it. With the right treatment approach, it’s very likely that you can make significant improvements to your balance and get back to enjoying those activities that you’ve had to give up. Talk to you again next week!
The author, Jennifer Penrose, is a Physical Therapist and owner of Penrose Physical Therapy. If you have any questions about balance and falls, you can call on (360) 456-1444 or by email at jennifer@penrosept.com
