Feeling unsteady can be difficult to describe. You might not feel as though the room is spinning, but perhaps you feel less confident walking, struggle when turning quickly, find uneven ground challenging, or feel uncomfortable in busy environments.
Balance problems can have many different causes. For some people, the vestibular system – the balance system within the inner ear and brain – plays an important role. Vestibular physiotherapy can assess how your balance system is working, identify factors contributing to your symptoms and develop a personalised rehabilitation programme to help you move with greater confidence.
What does “balance” actually mean?
Balance is not controlled by one part of your body. Your brain constantly combines information from several sensory systems to understand where your body is in space and how it needs to move.
These include:
- Vision, which tells you what is around you and where you are in relation to it.
- Proprioception, which provides information from your muscles and joints about the position and movement of your body.
- The vestibular system, which detects movement of your head and helps your brain understand orientation and motion.
If one system becomes less reliable, the others can often compensate. However, this compensation may be more difficult when you are tired, walking in darkness, moving your head quickly or walking over uneven ground.
What is the vestibular system?
The vestibular system is located within the inner ear and contains specialised structures that detect head movement and changes in head position. It helps maintain stable vision, upright posture, balance and awareness of movement.
One important mechanism is the vestibulo-ocular reflex (VOR). This allows your eyes to move in the opposite direction to your head, helping keep your vision stable while you move.
When vestibular function is reduced, head movement may cause blurred or “bouncy” vision, dizziness or unsteadiness, particularly when walking or moving quickly.
Why might I feel unsteady?
There are many possible causes of balance problems, and not all are vestibular.
Reduced vestibular function can occur following conditions such as vestibular neuritis, labyrinthitis or other disorders affecting the inner ear. BPPV (benign paroxysmal positional vertigo) is another common vestibular condition, typically causing brief episodes of spinning or movement-related dizziness when changing head position.
Balance can also be affected by age-related changes, reduced lower-limb strength, musculoskeletal problems, changes in vision, medication, cardiovascular or blood-pressure problems, anxiety, previous falls or injury, and reduced physical activity.
This is why a detailed assessment is important. The same symptom — “I feel unsteady” — can have very different causes.
What does vestibular physiotherapy involve?
Vestibular physiotherapy is not simply a collection of balance exercises. Your physiotherapist will first understand what you experience, when your symptoms occur and how they affect your everyday life.
They may ask about dizziness, spinning or vertigo, head movements, busy environments, walking in the dark, uneven ground, blurred or bouncing vision, falls or near-falls, and how your symptoms affect exercise, work and daily activities.
Depending on your symptoms, your assessment may include:
- Eye and head movement testing
- Gaze stability
- Balance under different sensory conditions
- Walking and turning
- Head movements while walking
- Functional tasks relevant to your goals
How can vestibular rehabilitation help?
Vestibular rehabilitation uses specific exercises to help your brain adapt to changes in vestibular information and make better use of the information available from your eyes, vestibular system and body.
Your programme may include:
Gaze stabilisation
Exercises involving head movement while maintaining visual focus on a target. These aim to improve the ability of the VOR to maintain clear vision during movement.
Balance exercises
Balance can be progressively challenged by changing your base of support, visual input, standing surface, head position or speed of movement.
Walking and movement exercises
As your balance improves, exercises can become more functional. This might include walking while moving your head, changing direction, negotiating obstacles or practising activities you want to return to.
Building confidence
Balance problems can sometimes lead people to avoid movement because they are worried about falling or triggering symptoms. A structured rehabilitation programme can gradually expose you to movements and environments you have been avoiding, while keeping the challenge appropriate to your symptoms and safety.
When should dizziness or unsteadiness be medically assessed?
Most dizziness is not caused by a serious neurological condition, but certain symptoms require urgent assessment.
Seek urgent medical attention for sudden-onset dizziness or unsteadiness accompanied by symptoms such as:
- New weakness or numbness
- New difficulty speaking
- New double vision or significant visual disturbance
- New severe difficulty walking
- New hearing loss
- Other sudden neurological symptoms
If you are unsure whether your symptoms are appropriate for physiotherapy, speak with your GP or another appropriate healthcare professional first.
What can I expect from vestibular physiotherapy?
Your first appointment will usually involve a detailed discussion followed by a targeted physical assessment. Your physiotherapist will explain what may be contributing to your symptoms and whether vestibular rehabilitation is appropriate.
Your programme may include gaze-stability exercises, balance training, walking and movement exercises, strength and conditioning, functional retraining, education and a structured home exercise programme.
The aim is not simply to become better at standing on one leg in the clinic. It is to help you feel more confident and capable doing the things that matter in your everyday life.
The takeaway
Feeling unsteady does not necessarily mean that you have a problem with your inner ear, but your vestibular system can play an important role in balance, vision and movement.
A detailed assessment can help identify what may be contributing to your symptoms and whether vestibular physiotherapy is appropriate.
If you’re ready to feel steadier, move with more confidence and understand what is contributing to your symptoms, our team is here to support you. Book an appointment or get in touch to find out how vestibular physiotherapy could help you get back to the activities you enjoy.
Written By Stuart Williams |Physiotherapist | Vestibular Physiotherapist | Running Analysis
References
Agrawal, Y., Van de Berg, R., Wuyts, F., Walther, L., Magnusson, M., Oh, E., Sharpe, M. and Strupp, M. (2019) ‘Presbyvestibulopathy: Diagnostic criteria Consensus document of the classification committee of the Bárány Society’, Journal of Vestibular Research, 29(4), pp. 161–170.
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Regauer, V., Seckler, E., Müller, M. and Bauer, P. (2020) ‘Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: A systematic review’, BMC Geriatrics, 20, 494.
Strupp, M., Kim, J.-S., Murofushi, T., Straumann, D., Jen, J.C., Rosengren, S.M., Della Santina, C.C. and Kingma, H. (2017) ‘Bilateral vestibulopathy: Diagnostic criteria. Consensus document of the Classification Committee of the Bárány Society’, Journal of Vestibular Research, 27(4), pp. 177–189.