Meghan Murphy, M.D.
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Problems that affect balance can make you feel dizzy or as if the room is spinning and you're going to fall. At times, you may feel unsure or unsteady on your feet, as if your brain and legs are disconnected.
Many body systems, including your brain, nerves, muscles, bones, joints, eyes, inner ear and blood vessels, must work together to maintain normal balance. When any of these systems aren't functioning well, you can experience balance problems. Occasionally, balance concerns are caused by issues with your central nervous system, including your brain, spinal cord and peripheral nerves.
Determine when your balance issues started
Many people dismiss balance issues as a normal part of aging. While this is true to an extent, any noticeable change in your balance is important to bring to the attention of your health care team. A rapid deterioration versus a gradual decline in balance is important information to determine the urgency needed to be evaluated by a health care provider.
If you notice gradual changes, such as needing to hold the stair rail or grab the counter occasionally, you should contact your primary care provider. He or she can evaluate you for signs of more concerning symptoms. In some cases, it could be something simple, such as dehydration, or benign paroxysmal positional vertigo, which can be treated in a few therapy sessions.
If your symptoms are severe and dramatic ― for example, the inability to keep your balance suddenly with no previous concerns ― you could have a serious medical condition, such as a stroke or concussion. While rare, other primary brain problems leading to balance changes include tumors. These conditions require prompt medical attention and evaluation.
Nerve conditions that can affect balance
Many medical conditions can cause issues with balance, and several nerve conditions could be linked to balance concerns. Your nervous system sends information from your brain and spinal cord to the rest of your body. If a part of this system is damaged, the signals can't be transmitted effectively, which leads to balance issues and falling.
A traumatic injury, such as a concussion or stroke, could cause you to feel off balance. A stroke or "mini stroke," also known as a transient ischemic attack, or TIA, can lead to an abrupt loss of balance, weakness on one side or speech problems. A brain tumor also can interfere with the connection between your brain and the nerves in your legs and feet, causing you to feel unsteady or weak.
- Cervical and thoracic spine
Arthritis in your neck, upper and mid spine, also known as your cervical or thoracic spine, can compress your spinal cord. This is called spinal stenosis. When this occurs, the nerve signals don't travel efficiently from the brain to your feet and cause you to lose your balance. This spinal cord disease is called myelopathy, and it interferes with the signals between the brain and feet. Myelopathy can lead to hand weakness, and dexterity and balance issues. Often, people with this disease notice that they lose their balance if they close their eyes in the shower or cannot walk heel to toe in a straight line. They also can have clumsy hands, numbness and tingling, and sensation of shocks in their arms and legs.
- Lumbar spine
Degeneration of your lumbar, or lower back, vertebrae can compress your nerve roots, which can cause significant pain, numbness, tingling, weakness or difficulty lifting the front part of your foot. These symptoms can lead to balance issues and a potential fall.
- Peripheral nerves
The nerves outside of your brain and spinal cord can become damaged, which is called peripheral neuropathy. Weakness, numbness, pain and balance issues can be caused by peripheral neuropathy because it makes it difficult to determine where your body is relative to other objects or the ground.
Typically, spinal stenosis or degeneration occurs slowly over time. However, your symptoms could progress quickly and affect your activities if you have a traumatic event like a fall or automobile accident.
Also, people are busy and often learn to compensate for small changes in symptoms. Your body may continually compensate for months or even years until a fall or other event significantly affects your balance.
Treatment options for balance issues
If you are experiencing balance concerns, the No. 1 goal of treatment is to prevent you from falling. In many cases, your health care team will first look to conservative treatment measures. Such measures could include physical therapy or the use of a walking aid device. During this time, it's essential that you communicate to your health care team if you've had a fall, or experience new numbness, tingling, weakness or worsening symptoms.
If your spinal cord is injured and you develop symptoms suddenly, the goal is to seek care immediately before you lose function. This could include spinal decompression surgery. If a tumor is causing your balance issues, you may require surgery, radiation or chemotherapy.
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