Silverstein Institute
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How to Get Your Balance Back

Written by Silverstein Institute
Published: 22 Mar 2017

DizzinessAnyone who has ever suffered from dizziness and/or that wobbly feeling of being unsteady on your feet knows how miserable it can be. Literally hundreds of conditions can cause dizziness and related balance problems. This topsy-turvy feeling usually doesn’t last more than a week or two and can generally be treated with medication or simply waited out-but not always.

Related Blog: Do I Have to Live with Vertigo?

Good News: For the estimated 10 million Americans who suffer from chronic dizziness and/or balance problems, many therapies can help.

What Goes Wrong: Most people with long-term dizziness and balance problems have some sort of damage to the vestibular system, a complex structure of nerves and fluid-filled tubes and chambers in the inner ear that detect motion and send signals to the brain to help maintain equilibrium.

As we grow older, the number of vestibular nerve cells naturally decreases and blood circulation declines, including to the inner ear. These changes-along with conditions such as diabetes (blood vessels in the body may narrow, impeding blood circulation)…viral infections of the vestibular nerve…benign tumors (such as acoustic neuromas, which grow on the nerve leading from the inner ear to the brain)…or Meniere’s disease (fluid buildup in the inner ear)-can cause a permanent dizzy and/or unsteady feeling.

Where to start: If you have suffered from dizziness and/or a balance problem, specifically a spinning sensation, see an ENT (ear, nose and throat specialist), who can determine if your vestibular system may be affected. Some problems can be treated with a simple head maneuver in a doctor’s office, while others may require further testing, medications or even the help of a physical therapist trained in vestibular rehabilitation.

This form of therapy, which involves gait training, head movements and positioning exercises, will strengthen the vestibular system, reduce symptoms and improve your sense of balance. To find a local therapist, consult the Vestibular Disorders Association website, Most insurers cover this therapy if an ENT orders it.

How to help yourself: In addition to working with a physical therapist, self-care approaches can be a tremendous help…

Secret #1: Try tai chi and/or yoga. Both tai chi and yoga can improve gait, posture and other measures of physical performance in people with vestibular disorders. If you feel a little unsteady, these gentle workouts tend to be more enjoyable-and safer-than most other forms of exercise. Either exercise can be done weekly or even daily for an hour at a time.

Caution: For certain vestibular disorders, such as a treatable inner ear problem known as benign positional vertigo, your vertigo may worsen with these exercises, so see an ENT first. If your dizziness/balance problem is due to some other condition, your symptoms may also initially worsen because the exercises are stressing a system that’s somewhat damaged. The dizziness/balance problems should start to improve within a few weeks.

Secret #2: Take off your shoes. Your feet are more than just a platform for standing. They’re part of the proprioceptive system, which integrates nerve signals from the feet, ankles, eyes and other parts of the body to provide spatial orientation. Walking barefoot makes it easier to “feel” that you’re in the right space. Try walking barefoot when you’re active at home or doing exercises such as tai chi or yoga. Then it’s not practical to take off your shoes, wear shoes with thin soles or thick, protective, slip-proof socks if you’re worried about foot injuries in the house. Most people feel steadier-and less dizzy-when their feet can feel what’s under them.

Helpful : Practice standing and walking on various floor surfaces-such a s a hard floor, a thin carpet and a thick rug-to improve your dizziness/balance problems. Doing this can challenge and “re-educate” the proprioceptive system.

Secret #3: Cope with “busy” spaces. Our balance largely depends on our vision to identify points of reference (such as an object in the distance) that tell us if we are moving in a straight line or heading off course. In places with a lot of activity and “clutter,” such as shopping malls and supermarkets, it’s hard to get a visual fix.

Helpful: Keep your eyes focused on what’s right in front of you. Don’t let your eyes wander until you need to look at something new-for example, when you’re reaching for a product on a shelf.

Secret #4: Learn your visual weaknesses. Some people with dizziness/balance problems avoid escalators because they can’t handle the movement of the steps…or feel unsteady when they walk, say, on checkered tiles. Even though you’re working to retrain the vestibular system and be comfortable in the world, you may simply need to avoid certain environments, such as busy restaurants, sporting events, and crowded shopping malls.

Secret #5: Change positions slowly. Orthostatic hypotension is a common trigger for dizziness and balance problems. It’s caused by low blood pressure that usually occurs when you’re changing positions-when you get out of bed, for example, or when you stand up from a seated position. You probably don’t need treatment if it’s mild-and your doctor has ruled out a more serious problem, such as heart disease or hypoglycemia. But you must be careful!

Our advice: Take your time when changing positions. In the morning, sit up in bed for a minute or two so that your blood pressure can stabilize before you stand up. Then carefully stand up. Stand still for a moment, then walk when you’re sure that you’re steady.

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