Human Performance and Rehabilitation Centers, Inc.

Balance Issues? Your Appointment Explained.

Many times, doctors will send a patient to physical therapy if he/she has experienced a fall, been ill, or just felt unsteady while walking. There are several different components to increasing and maintaining balance and mobility.

When you arrive for your appointment, there will be paperwork to complete, most importantly a past medical history form, including a list of your medications. This information is needed to see if you have any conditions or take any medication that could contribute to your symptoms.

During the evaluation, the therapist will test the muscle strength in your legs and assess your balance. These tests are done in an effort to determine which system of balance needs to be addressed. There are three primary systems of balance: vestibular, visual, and proprioceptive. The vestibular system is located in your inner ear and is sensitive to head movements and can create dizziness if there is a dysfunction. The visual system plays a role in your balance by interpreting what you see and making adjustments to obstacles that are ahead, such as a curb. Proprioception is the feedback that you receive from your feet being in contact with a surface. This is important if you are walking on an unstable surface, such as grass or gravel. These three systems help maintain your balance, and your legs have to be strong enough to help hold you up!

The PT will analyze how you walk and determine if you need an assistive device, such as a cane or walker, for safety. Your balance may be tested by performing tasks such as balancing on one leg and standing with your eyes closed and by performing tasks that involve putting your feet close together or in front of each other. Some of these tests may seem silly, but they give the therapist information about your ability to perform daily activities safely.

Often, your therapist will want to see you once or twice a week to work on increasing strength and balance. One thing to remember with balance is that repetition helps the body re-learn the correct way to perform daily activities. More than likely, the PT will send you home with exercises to perform on your own. Performing these exercises will help maintain your mobility and strength between PT visits. Working on balance is a time-consuming process; you will need to be patient with yourself as your symptoms improve. Most importantly, therapists want patients to remain safe with their mobility and prevent future falls. By improving strength and balance, you will be on the right track to stay injury free!

As the World Turns: Using Therapy to Resolve Vertigo


The sensation of spinning, or vertigo, can be a common problem especially among older adults. Vertigo is usually a condition called Benign Paroxysmal Positional Vertigo, (BPPV), an inner ear malfunction treated in a therapy setting. Vertigo is not detected in an MRI.

BPPV, the most common form of vertigo, is a mechanical failure of the inner ear. Calcium carbonate crystals (otoconia) that are embedded in a part of the ear called the utricle dislodge and float to places where they cause problems. When enough of these crystals settle in the fluid of the ear canals, they trick the brain into thinking the head is moving when it isn’t. That’s where the sensation of spinning comes from.

Treating Vertigo

Our first step is to determine if a patient has BPPV. We do this by performing a Dix-Hallpike Test in which we ask the patient to lie in a supine position while we carefully roll the head until it triggers vertigo. If a patient has BPPV, a bout of vertigo will create a detectable “error message” in the eye movement. Both eyes will turn rapidly in a torsional fashion which also intensifies the sensation of spinning.

Ultimately, the eye movements are the key to a BPPV diagnosis and helps us pinpoint exactly where the crystals have migrated. Our next step is to gently maneuver the head using specific protocols. Your therapist should be well-trained in this intervention, which uses gravity to naturally guide the crystals from their offending location back to the utricle. The most common type of maneuver is called an Epley Maneuver, and it can take less than five minutes to perform. Many patients will feel instant relief, and others will see progress in a day or two.

Patients who suffer from BPPV have often spent months or years trying to get a clear diagnosis. Seeing a therapist first can bring an end to both frustration and discomfort.