Clinically reviewed by What is balance problems
Balance is not one thing. It is three systems reporting to the brain at once: the inner ear, the eyes, and the sensation coming from the feet, ankles and joints. The brain adds up those reports and the muscles react.
In older people it is usually not one of the three that has failed. It is two or three of them working at seventy percent, plus weak legs, so nothing is left in reserve. Families describe it as tawazun kharab hona, or wobbling while walking.
This matters because it is treatable. Balance can be trained at any age, and left alone it leads to falls.
Symptoms you might have
- Feeling unsteady while standing or walking, particularly when turning
- Reaching for walls, doorframes and furniture without thinking about it
- Much worse in the dark, in the bathroom, and on uneven ground
- Walking with the feet further apart and the eyes fixed on the floor
- Near misses, or a fall that was blamed on a slipper or a step
- Light-headedness in the few seconds after standing up
- A room-spinning feeling lasting seconds to a minute when you roll over in bed or look up, which is a different problem treated differently
Why it happens
- Weak hip, thigh and ankle muscles, the most common and most fixable cause
- Inner ear problems, including BPPV and loss of inner ear function with age
- Numb feet from poorly controlled diabetes, so the brain gets nothing from the ground
- Poor vision from an uncorrected cataract or new bifocal glasses
- Knee and hip arthritis, back problems and cervical spondylosis
- Medicine side effects, especially sleeping tablets, sedatives and blood pressure medicines
- Blood pressure dropping on standing, anaemia, low vitamin B12 or D
- After a stroke, with Parkinson's disease, or after weeks in bed
When you should see a physiotherapist
Come in after the first near miss, not after the third fall. Also come if you have started avoiding going out, or holding an arm for distances you used to walk alone.
Go to a hospital immediately if unsteadiness comes on suddenly with slurred speech, a drooping face, double vision, a severe headache, or new weakness or numbness on one side. That is a stroke pattern. See a doctor the same day for sudden confusion in an older person, for blackouts rather than trips, and after any fall where the hip cannot bear weight.
If dizziness happens in the first seconds of standing, ask your doctor to check your blood pressure lying and standing, and to review your medicines. Never stop a prescribed medicine on your own.
Al-Shama Physiotherapy Clinic
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اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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یہ فارم پُر کریں؛ واٹس ایپ پر آپ کی تفصیلات کے ساتھ پیغام تیار ہو جائے گا۔Yeh form bharein, WhatsApp aap ki tafseel ke saath khul jaye ga.
How it is treated
The assessment decides everything here, because general balance exercises given to someone whose problem is inner ear crystals waste months. Testing covers standing balance, walking, chair rises, leg strength, sensation in the feet, and positional testing of the inner ear.
- Progressive balance training, the core treatment. Feet together, then staggered, then one foot, then with head turns and reaching. It must be hard enough to be genuinely wobbly, with support in reach
- Exercise therapy for leg strength, hips, thighs and ankles. You cannot balance on legs that cannot hold you
- Vestibular rehabilitation: gaze stabilisation and habituation exercises where the inner ear is the problem
- Repositioning manoeuvres where testing confirms BPPV. See the vertigo and BPPV page, and do not copy these off a video
- Gait retraining, step length, turning in a wide arc, and different surfaces
- Manual therapy for a stiff neck, hip or ankle limiting the balance reactions
- Walking aid selection and sizing, and a home hazard check with the family
There is no operation for general unsteadiness. Treating a cause sometimes needs one, for example cataract surgery or a joint replacement, and that is the relevant doctor's decision.
Exercises, and what to avoid
What helps
- Standing at a counter: feet together thirty seconds, then one foot half a step ahead, then heel to toe, fingertips resting on the counter
- Sit to stand from a dining chair without using the hands, ten times twice a day
- Heel raises and toe raises holding the counter, fifteen of each
- Walking heel to toe along a line on the floor, and side stepping along the counter
What to avoid
- Practising balance work alone with nothing solid within arm's reach
- Standing on cushions, folded quilts or soft mattresses in the early weeks
- Stopping going out because of fear. Nothing destroys balance faster than three months of sitting
- Standing up quickly from bed, and climbing on stools to reach a high shelf
What you can do at home
Get up in three stages: sit on the edge of the bed and count to thirty, stand holding something solid and count to ten, then walk. Most morning dizziness is handled by this alone.
Light the route to the bathroom. A night light, or a charged torch beside the bed for when the power goes.
Non-slip rubber mat in the bathing area, and wipe the floor after every use. A wet bathroom floor is where most of these falls happen.
Wear closed shoes with a back strap and a firm sole indoors. Loose chappals take away the information your feet give your brain.
Take your medicine list to your doctor and ask which ones cause dizziness. Get your eyes tested too.
How long it takes
Balance training works, and reasonably fast. Most people notice a difference in six to eight weeks of two or three sessions a week, with measurable change in standing time and chair rises by twelve weeks.
If testing shows BPPV, that is a much shorter story. Most cases clear in one to three treatment sessions with the right repositioning manoeuvre.
Leg strength takes eight to twelve weeks to build and is the part that holds the improvement.
Where the cause is a stroke, Parkinson's disease or diabetic neuropathy, balance work becomes ongoing rather than a course of treatment. Gains fade within a few months of stopping, in everyone.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
توازن تین چیزوں پر چلتا ہے: کان کا اندرونی حصہ، آنکھیں، اور پیروں سے آنے والا احساس۔ بزرگوں میں اکثر تینوں تھوڑا تھوڑا کمزور ہو جاتے ہیں، اور ٹانگوں کی طاقت بھی کم ہو جاتی ہے۔
لڑکھڑانا عمر کا حصہ نہیں، یہ علاج ہونے والی چیز ہے۔ طاقت اور توازن کی ورزش سے چھ سے آٹھ ہفتے میں صاف فرق آتا ہے، چاہے عمر ستر اسی سے اوپر ہو۔
ایک فرق سمجھ لیں: اگر کروٹ بدلتے یا اوپر دیکھتے وقت کچھ سیکنڈ کمرہ گھومتا محسوس ہو، تو وہ بی پی پی وی ہے، اور اس کا علاج الگ ہے، اکثر ایک دو سیشن کا۔
اٹھتے وقت بستر پر بیٹھ کر ٹیس تک گنیں، پھر پکڑ کر کھڑے ہوں، پھر چلیں۔ غسل خانے میں ربڑ میٹ رکھیں اور بند جوتا پہنیں۔
Roman Urdu
Tawazun teen cheezon par chalta hai: kaan ka andaruni hissa, aankhen, aur pairon se aane wala ehsas. Buzurgon mein aksar teenon thora thora kamzor ho jate hain, aur taangon ki taqat bhi kam ho jati hai.
Ladkhadana umar ka hissa nahi, ye ilaj hone wali cheez hai. Taqat aur tawazun ki warzish se chhe se aath hafte mein saaf farq aata hai, chahe umar sattar assi se oopar ho.
Ek farq samajh len: agar karwat badalte ya oopar dekhte waqt kuch second kamra ghoomta mehsoos ho, to wo BPPV hai, aur uska ilaj alag hai, aksar ek do session ka.
Uthte waqt bistar par baith kar tees tak ginen, phir pakar kar khare hon, phir chalen. Ghusalkhane mein rubber mat rakhen aur band joota pehnen.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Why do I feel unsteady when I walk but I am not dizzy?
Is my dizziness vertigo or a balance problem?
Can balance be improved at seventy five or eighty?
How many sessions will it take?
Should my mother use a stick if she feels unsteady?
Related conditions
- Parkinson's disease physiotherapy
- Osteoporosis and weak bones
- Bed sores, prevention and care
- Falls and fall prevention
- Difficulty walking