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Balance Problems and Fall Prevention: Physical Therapy in Brooklyn and Staten Island

By Dr. Jack Engelberg, PT, DPT · · 4 min read

Falls are not a normal part of aging, even though many people assume they are. Whether you've had a fall, a few near misses on the subway stairs, or you've just started holding onto furniture as you walk through the house, feeling unsteady is worth addressing. Balance can improve with the right training at almost any age, and physical therapy is one of the most effective ways to lower your risk of falling.

Why Do Balance Problems Happen?

Balance depends on several systems working together:

  • Vision — telling you where you are in space
  • The inner ear (vestibular system) — sensing head movement and position
  • Sensation in your feet and joints — feeling the ground beneath you
  • Muscle strength and reaction time — catching yourself when you trip
  • The brain — processing all of this information quickly

When any of these systems is affected, balance can suffer. Common contributors include:

  • Leg weakness, especially in the hips and ankles
  • Inner ear conditions, like BPPV
  • Neuropathy (reduced sensation in the feet), often from diabetes
  • Vision changes
  • Neurological conditions like Parkinson's disease or stroke
  • Joint pain or arthritis, such as knee arthritis
  • Certain medications, or multiple medications
  • Low blood pressure when standing
  • Reduced activity, which leads to loss of strength and confidence
  • Fear of falling, which can itself lead to less activity and more weakness

Warning Signs

  • Feeling unsteady when walking or turning
  • Holding onto walls or furniture
  • Difficulty getting up from a chair without using your arms
  • Slower walking or shuffling
  • Tripping or near falls
  • Worry about falling that keeps you from going out
  • Dizziness when standing up or turning your head

How Physical Therapy Helps

Exercise programs that include balance and strength training have been shown to reduce falls in older adults.

Evaluation

Your therapist will review your fall history, medical conditions and medications, then use standardized tests of balance, walking speed, strength and mobility. These measures identify specific risk factors and give you a baseline to track progress.

Treatment May Include

  • Balance training — standing with feet closer together, on one leg, on softer surfaces, with eyes closed, and during movement
  • Strength training — especially the legs and hips, to improve your ability to recover from a stumble
  • Gait training — walking speed, step length and turning
  • Vestibular rehabilitation — if an inner ear problem contributes to dizziness or imbalance
  • Assistive device training — choosing and correctly using a cane or walker if needed
  • Floor recovery — practicing how to get up safely after a fall
  • Home safety recommendations
  • Dual-task training — walking while talking or carrying something, as in real life

What You Can Do at Home

  • Stay active. Walking, tai chi and supervised strength training are all helpful.
  • Practice safe balance exercises next to a sturdy counter, such as standing with feet together or heel-to-toe.
  • Remove trip hazards like loose rugs, cords and clutter.
  • Improve lighting, including night-lights in the hallway and bathroom.
  • Install grab bars by the toilet and in the shower, and use non-slip mats.
  • Wear supportive shoes with good grip, rather than loose slippers.
  • Stand up slowly, especially after lying down or sitting for a long time.
  • Review medications with your physician or pharmacist.
  • Get your vision checked regularly.

When to See a Physical Therapist

Consider an evaluation if:

  • You've fallen in the past year
  • You feel unsteady or are afraid of falling
  • You're limiting activities because of balance concerns
  • You've recently been in the hospital or had surgery
  • A family member has noticed changes in your walking

Seek medical care right away after a fall with a head injury, new pain or inability to bear weight, or if dizziness comes with chest pain, fainting, slurred speech, facial drooping or sudden weakness.

Frequently Asked Questions

Can balance really improve?

Yes. Balance is a skill that responds to practice, and strength can be built at any age.

Should I use a cane?

A cane or walker can be very helpful for some people, but it needs to be the right type and height and used correctly. Your therapist can guide you.

What should I do if I fall?

Stay calm, check for injury, and if you're able, roll onto your side, get onto hands and knees, and use a sturdy chair to help you stand. If you're hurt or can't get up, call for help. A therapist can practice this with you.

Ready to get started? Call the Refuah office nearest you

Schedule an evaluation by phone, or book online at refuahpt.com.

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About the author. Dr. Jack Engelberg, PT, DPT is a Doctor of Physical Therapy and owner of Refuah Physical & Occupational Therapy, with offices in Midwood and Boro Park, Brooklyn, and on Staten Island.

Medical disclaimer: This article is for general education only and is not medical advice, diagnosis or treatment. Everyone’s situation is different. Talk with your physician or a licensed physical therapist about your symptoms. If you think you have a medical emergency, call 911.

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