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19 Reasons Your Balance May Be Off

By Beth Jennings, PT, CHWC

Falls can happen to anyone at any age. It’s easy to compensate for minor balance difficulties when we’re younger, but it can still affect your daily mobility, responses to a misstep, or athletic performance.

As you age, missteps and falls will impact your safety and independence. One in 4 older adults falls every year, so being aware of any balance difficulty is pivotal.

Where do typical balance challenges come from? Understanding how the balance system in the body works creates greater clarity about how you can get tripped up. 

The Balance System

Sensors in the human body tell the brain when you are tilting, tripping, or starting to fall. These sensors include:

  • Eyes
  • Inner ear (vestibular system)
  • Somatosensory system (sensors in joints and muscles that detect position, pressure, or light touch) 

For example, your somatosensors might detect more pressure than normal on the heels, while your inner ear detects your head is tipping back, and your eyes are seeing more ceiling than they should. 

The brain processes this information and sends orders to your body on how to correct this imbalance.

In the example, your brain determines that you are falling backward and orders a number of muscles to activate to pull your balance forward.

This response requires:

  • Reaction time
  • Muscle strength
  • Flexibility
  • Attention/cognition 

So, a disruption or challenge in a sensor, the brain, or one of the response mechanisms could affect your balance. 

Feet and Legs:

We use sensors in the joints and muscles of our legs and feet to detect whether our balance needs to be corrected. An injury or surgery around a joint can damage these sensors or create weakness or a restriction in movement, whether permanent or temporary. Physical therapy is a great resource to “recalibrate” your balance. 

    1. Sprains/strains such as an ankle sprain, a torn ligament in the knee, or a hamstring strain

    2. Recent surgery to correct a bunion, to repair a broken bone, or to undergo a total knee replacement

    3. Foot pain and other foot conditions such plantar fasciitis, bunions, corns, or hammertoes 

    4. Neuropathy, a condition where the nerves in the extremities deteriorate and sensation is lost

    5. Weakness in the feet and legs

    6. Limited movement in ankles and legs due to braces, injuries, or surgery

Head and Neck:

The head holds our central processor for our balance, the brain, and two of the sensors, vision and the inner ear. Challenges to using any of these could impact your balance.

     1. Unclear vision such as double vision, blurred vision, visual impairment, not wearing glasses, darkness, or glare

     2. Inner ear (vestibular) conditions such as Meniere's disease, BPPV, labyrinthitis, dizziness, or a vestibular migraine

     3. Migraines with dizziness or visual impairment

     4. Whiplash and neck surgery 

     5. Brain injuries such as a concussion, stroke, brain tumor, or brain surgery

     6. Poor attention resulting from waking up in the middle of the night, experiencing sickness or high levels of pain, or living with medical conditions such as dementia or brain injury

Medical Conditions:

     1. Diabetes, particularly uncontrolled diabetes

     2. Multiple sclerosis, an autoimmune disease that affects the brain, the spinal cord, and the nerves

     3. Parkinson’s disease or other movement disorders

     4. Nerve damage that can occur with peripheral neuropathy, diabetes, lumbar disc herniation, spinal cord injury, alcoholism, trauma, nutrition deficiency, or inflammatory disease

     5. Cardiovascular conditions such as coronary artery disease, abnormal heart rhythm, or low blood pressure

     6. Illness or extreme fatigue such as with a cold, flu, migraine episode, COVID, or respiratory illness

     7. Certain medications such as sedatives, antidepressants, antihistamines, or blood-pressure medications 

Maintaining balance is essential for your overall well-being, regardless of age. Understanding the complexity of your body’s balance system and the wide range of ways it can be disrupted is the first step in improving your balance.

If you are experiencing a challenge in your balance, contact us to determine if an evaluation is appropriate for you.

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Beth Jennings, PT, MPT, CHWC is a physical therapist and owner of a health and wellness coaching business. 

Disclaimer This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.


Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Facts About Falls. August 6, 2021.