Balance Has Limits


Did you ever try to stand with both feet on the ground and lean as far as you can in any direction without falling? Can you lean further one way than another? Balance is the unconscious sensation you get that keeps you upright against gravity.


It may seem elementary, but it is nonetheless important to point out, that one of the essentials to upright posture is the ability to stay within your own personal protective limits of balance.

Brain-Based Solutions for Your Balance

The Highest Incidence of Accidental Death Comes from Incidental Falls

Introduction

 

We use three main systems to balance: our eyes for visual input, our inner ears for vestibular input, and our cerebellum for joint position sense or proprioception. These three systems are calibrated to each pick up where the others may slack off, but the more problems we have, the more difficult balance becomes.


Patients most often lose their balance due to neurological timing errors. When the signals from one area do not match those signals from another area, the nervous system must manage the error. For that split second any deviation from balance can cause a person to be at risk for falling.


Our muscles are designed to resist gravity and keep us upright; they reduce the probability of a fall. If the muscles on one side of our body have more tone than those same muscles on the other side of our body, we cannot stand straight. Imbalanced muscle tone causes postural errors and gravity will tend to pull us over. In the presence of a sensory mismatch, any stumble of bump that creates further muscle imbalance can lead to a devastating functional breakdown. We may not be able to step quickly enough to stop a serious fall.

The nerves that perceive joint motion (nociceptors) are never silent. There is always some joint involvement signal going somewhere and doing something. These nerves even send signals during sleep. That allows for mixing and blending all the signals from the joints and muscles together so the brain unconsciously knows what is going on at any given moment.


Humans use three systems for balance, and two of them—the eyes and ears—are encased inside the head, which moves relative to the trunk. Any discrepancy—or mismatch—from one eye or ear to the other or amongst themselves sets up pathology that must be resolved by the individual’s nervous system. (The truth is that mismatched sensory input is more the rule than the exception.)

 

The third sensory system is outside the skull. It arises in the muscles and is the sole source of sensory input to the cerebellum, and the majority of that muscle input is relative to gravity. In general, muscles respond to gravity and perform relative to joint motion.

It would be nice if these the input from the eyes, ear and muscles were all symmetrical, but they are not. Actually, the structure of each of these systems varies from the pictures in anatomy books. Books make them look so good, but that is not how it is in real life. Because of their placements, input from one part of your body regularly differs from that input that arises from the same part on the opposite side of the body. The eyes seldom work together; the ear’s balance mechanisms never match from side to side. This mismatch generates clashes that the brain must resolve in order to maintain balance.

 


 

 

 

​​Here is the big secret about all these balance signals: Because the eyes and ears are housed inside the head, and the muscles of the neck generate the highest priority signal to the brain, the way the head sits on the neck plays a deep-seated role in the interpretation of all sensory input. Therefore, no two people who have the same symptoms can ever receive the same treatment.


Head position depends upon the signals that come from the eyes, ears, and muscles, and the head moves the neck and trunk; balance has to do with feedback. To be in balance, posture and movement have to work together. Imbalance happens when sensory and motor mismatches make the brain think something is happening other than what is really happening. From either balance or imbalance, the way the muscles work is the result of sensation.


A person is either aware of their body position in space or they are not. They may think they are, but it is a mismatch. Balance results when the brain is able to interpret all the sensory input in a way that makes sense relative to reality. But what happens when the brain interprets the sensory input relative to what it thinks is reality, but that reality does not exist? Erroneous input sets up a sensory conflict that tends to generate a motor response inconsistent with reality, increasing the probability of falling and an increased potential for injury.


This tendency to fall is most prevalent in the young; it declines in the teens, and then increases again from the mid-twenties. By age 60, one in three people will take a fall. In reality, these sensory inconsistencies can be diagnosed and treated, reducing the potential for falling and injury.


 

 

 

 

 

 

 

 

Case Study

 

John (66y) complained of right lower back pain after trimming his trees for three days and that his energy was lower than he liked. He also said the vision in his right eye had been slowly deteriorating the past 10-12 years.


Findings

 

Stroking the sole of John’s foot with a sharp object inhibited the proximal rectus femoris ipsilaterally, and the sartorius was inhibited bilaterally.


The muscles worked normally when John covered his left eye but all the original muscle problems remained when he covered his right eye, indicating that his brain was able to interpret the input from his right eye better than it did from the left eye.


Next, while his right eye was covered, John counted backward from 100 by 7’s. With his right eye covered, he hummed a new tune aloud. Now, all the muscles displayed as anticipated.


 

Treatment

We used some special goggles to stimulate the right side of John’s brain while patching his right eye. Then we looked for structural findings that would increase the functional abilities of his right brain.


After the treatment, we removed the goggles and patch. The muscles were retested with appropriate findings—his muscles all had their anticipated display.


Discussion

 

Through certain functional neurological pathways, John’s right lower back was quite possibly the result of a quieted right brain secondary to a structural problem on the left side.


Consider the bounds of stability provided by balance. John’s presentation was as if his nervous system sensed that he had swayed too far forward relative to his environment, and his muscles in his lower back tightened to keeping him from tending too far forward. The sensory mismatch teased him into subconsciously thinking that he needed to be pulled back, when, in fact, he was physically in no danger of falling forward.


Summary

 

Balance is an unconscious event perceived through the eyes, ears, and muscles, and interpreted by the cerebellum and brain. It depends upon symmetrical input and motor response, and subject to how the head sits on the neck. Any confusing sensory signal upsets the whole process and leads to erroneous subconscious posturing.


The fact that one person’s balance issues are different than another person’s demands that each be treated relative to their unique needs. Treating all people with balance issues the same way could only lead to further mismatches. Anyone with balance issues should seek out the doctor who can best address your needs and stick with them.

It appeared that the image from John’s left eye was troubling, confusing in his muscle tests. Introducing a right brain activity like humming a new tune aloud appeared to stimulate that side of his brain, making all the muscles work better, indicating that the sensory and motor systems matched and the muscles worked according to their original design.

Do not become a statistic. You may not know your potential to fall until it happens. Have a physical exam checked right away and know where you stand. Ask your family and friends about their balance and perhaps you can save an injury, better yet a life.

Muscles move joints, not the other way around.

Imbalanced sensory input always results in an asymmetrical muscle pull. It is not unusual for these signals that leave the brain and go to the muscles on one side of the body tend to have a greater influence than the ones that go to the muscles on the other side of the body. These imbalances set up vicious cycles of mismatched input to the brain. Sensory and motor signals stimulate each other with rapid exchanges.

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