How To Improve Your Balance • • • • Anatomical Causes, Common Disorders, Treatment Options, and Advice For Improving Balance & Preventing Falls Dr. Eric Oltmanns D.C. Dr. Eric Oltmanns D.C.  Crossroads Chiropractic Clinic  Located inside the St. Cloud Medical Group Across From Hennen’s Furniture  Access to Over 50 MD’s and Urgent Care  Access To Digital X-ray, MRI, and advance imaging  Access to Physical Therapy HOW MANY OF YOU HAVE FALLEN OR LOST YOUR BALANCE RECENTLY?  30-40% of adults over 65 years old fall each year  Less than half talk to their doctor about their balance issues or recent falls  This group has a higher rate of hip fractures, head injuries, lacerations, and other fractures. Our Balance System  Our Nervous system, Eyes, Inner ear, Muscles, Joints, and Bones all play major roles in our balance  These structures function together to ensure that we remain upright and prepared in our environment NERVOUS SYSTEM  Our nervous system receives information from our vision, Proprioception (Touch), and Vestibular System (motion, equilibrium, and spatial orientation)  Our Brain Interprets the sensory input, and creates a motor response such as muscle control to maintain balance. Eyes (Visual Cues)  Visual cues provide our balance system with important information such as depth perception, spatial awareness, and a general sense of the objects you come into contact with. Inner Ear  Our inner ears contain 3 semicircular canals that contain a fluid called endolymph that functions to provide information on the position of our head and its movement in space in relation to gravity. This occurs when Ca+ crystals within the endolymph strike micro sized hairs within the canals. MUSCLES AND JOINTS  Sensory organs located in our muscles and joints help provide information to our brain. When we lean forward, pressure is detected on the front part of the soles of the feet detecting the change in movement sending a signal to the brain.  Muscles also help us regain balance when it is lost by using the interpreted signal from the brain to contract the necessary muscles that bring us back into balance. • If one of the areas of our balance system are not functioning optimally, we will be at higher risk for loosing balance and falling. Knowing these anatomical structures gives us clues on what to work on to improve our balance. Dizziness  General term for describing everything from feeling light-headed, weak, or unsteady.  Many Causes are possible for the general term “dizziness” TEST YOURSELF 1. Stand next to your chair or table. 2. Hold your hands above the table surface incase you need support. 3. Close your eyes and lift one foot of f the ground. 4. Balance on your other foot. 5. Count to yourself the number of seconds you can hold this position without loosing balance or opening your eyes. RESULTS  The shorter your balance time, the older your equilibrium is.  If you balanced for…  22 seconds = Balance of a 20 year old  15 seconds = Balance of a 30 year old  7 seconds = Balance of a 40 year old  3.5 second = Balance of a 50 year old  If you tipped right away, you are 60+ in Balance years Common Disorders That Cause Dizziness  Vertigo  BPPV  Menieres Disease  Acute vestibular neuritits (Inflammation of the inner ear)  Vestibular Migraine  Other VERTIGO a sensation of whirling and loss of balance, associated particularly with looking down from a great height, or caused by disease affecting the inner ear or the vestibular nerve. There are different causes of vertigo but primarily stem from the inner ear BPPV (Benign Paroxysmal Positional Vertigo)  Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo  The sudden sensation that you're spinning or that the inside of your head is spinning when changing positions such as getting out of bed, or standing up from a sitting position BPPV Continued….  The problem is in the inner ear where Ca+ Crystals are getting stuck in the semicircular canals  This causes the sensation of spinning along with other possible symptoms BPPV continued…  Usually lasts 20 seconds but no longer than one minute  Sensation  Slightly  Loss can cause nausea or vomiting Blurred vision of balance The Epley Technique This technique is used to reposition the crystals in the inner ear and is initially done at the doctor’s office to ensure that you are doing it correctly. You can do this once per day to lessen your symptoms http://www.youtube.c om/watch?v=ZqokxZRb Jfw Meniere’s Disease  involves the excessive buildup of fluid in your inner ear. It's characterized by sudden intense episodes of vertigo lasting as long as several hours, accompanied by fluctuating hearing loss, ringing in the ear and a feeling of fullness in the affected ear. Acute Vestibular Neuritis (Inflammation of the inner ear)  Signs and symptoms of inflammation of your inner ear (acute vestibular neuritis) include the sudden onset of intense, constant vertigo that may persist for several days, along with nausea, vomiting and trouble with balance. These symptoms may be so severe that you have to stay in bed. When associated with sudden hearing loss, this condition is called labyrinthitis. Fortunately, vestibular neuritis generally subsides and clears up on its own. But, early medical treatment and vestibular rehabilitation therapy can be helpful in speeding recovery. Inflammation of the inner ear continued… Vestibular Migraine  Migraine is more than a headache disorder. Just as some people experience a visual "aura" with their migraines, others can get vertigo episodes and have other types of dizziness due to migraine even when they're not having a severe headache. Such vertigo episodes can last hours to days and may be associated with headache as well as light and noise sensitivity. Other Disorders  Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke, brain hemorrhage or multiple sclerosis. In such cases, other neurological symptoms are usually present, such as double vision, slurred speech, facial weakness or numbness, limb coordination, or severe balance problems.  If you experience any of these more severe symptoms, call 911 right away to rule out Stroke Other Causes of Dizziness, Balance loss, and Falls  Medications  Low blood pressure (hypotension)  Heart conditions  Muscle weakness/Joint Instability Medications  Loss of balance can be a side effect of certain medications, such as anti-seizure drugs, sedatives and tranquilizers.  Always ask your Doctor or Pharmacist about drug interactions when starting or stopping a medication. Low Blood Pressure A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly. Heart Conditions  Inadequate output of blood from the heart. Certain conditions such as any of the various diseases of the heart muscle (cardiomyopathy), an abnormal heart rhythm (arrhythmia) or a decrease in blood volume may cause inadequate blood flow from your heart. Muscle & Joint Weakness and Instability  Muscle weakness and osteoarthritis — the type of arthritis that involves wear and tear of your joints — can contribute to loss of balance when it involves your weightbearing joints such as hips, knees, lumbar (low back) spine What Can I Do To Improve My Balance?  Strengthen Lower Extremities and core  Join an exercise class  Practice balancing throughout your day during your down time  Remove clutter from your environment  Avoid quick movements while getting out of bed, or standing up.  Regular eye exams/yearly physicals  Regular medication reviews with your Doctor Exercises for Strength and Balance Stork        1. Stand with your feet slightly apart and raise one leg off the ground while keeping your arms to the sides and your shoulders relaxed (photo). 2. Try to balance for 30 seconds. Repeat two times, then switch legs. Try to work up to two minutes. 3. If you have difficulty balancing with no hands, try placing your fingertips or one fingertip on a hard surface until you are able to balance with no hands. You can make this exercise more difficult by closing your eyes while you balance. Here are some other variations on the stork: • Once you have mastered standing still as a stork, try swinging your arms as if you are running in place. • When this is easy, hold water bottles or light weights in your hands and swing them. • To make the stork even more challenging, fold up a bath towel so that it is several inches thick, and do the stork while standing on it. Be careful not to cheat by gripping the floor or the towel with your toes. Side Leg Raise     1. Stand next to a sturdy surface like a chair. If you need to use your fingertips for balance, do so. 2. Raise one leg off the floor to the side, and hold it 6 to 12 inches off the floor, then lower it (photo). 3. Do not bend forward at the waist (engage your core). Repeat 10 to 15 times per leg. 4. Make this more difficult by removing your fingertips from the chair (if you are using it) and even more difficult by closing your eyes. Somatosensory Training  1. Stand with arms crossed and eyes closed   First with feet sided by side, then with one foot slightly infront of the other, hold balance. Attempt to avoid swaying in any direction. Add a backwards head tilt as if looking at the ceiling. Next, begin leaning as far forwards, backwards, and sided to side without loosing balance. Attempt to hold the position for a few seconds before changing the direction of leaning. Somatosensory Training  2. Walk a strait line with eyes closed as if you are on a tightrope.  After completing this open your eyes and walk the same line while turning your head sided to side and up and down Stability trainer Resistance band exercises  Refer to the handout provided  Different colors for different tensions Chiropractic and Acupuncture  Adjustments improve the efficiency of your nervous system  Reduces the pressure on nerves and in turn increases the function of those nerves.  Neck adjustments increase blood flow to the brain  Acupuncture treatments works well for our patients with balance disorders