Why balance matters
Balance is something most people take for granted — until it starts to decline. Your ability to stand, walk, and move confidently depends on the coordinated input of three sensory systems: your vestibular system (inner ear), your visual system, and your proprioceptive system (sensors in your muscles and joints). When any of these systems is compromised, your balance suffers — and your risk of falling increases significantly.
Falls are the leading cause of injury-related hospitalisations among older Canadians, and they are responsible for the vast majority of hip fractures, head injuries, and loss of independence in adults over 65. But balance problems are not an inevitable consequence of aging. With the right assessment and rehabilitation, most people can improve their stability, regain confidence, and dramatically reduce their fall risk.
Common causes of balance problems
Balance disorders can arise from a range of underlying issues. Understanding the cause is the first step toward effective treatment.
Vestibular dysfunction
The inner ear is central to your sense of balance. Conditions such as BPPV, vestibular neuritis, Meniere's disease, and age-related vestibular decline can all reduce the accuracy of signals your brain receives about head position and movement. This leads to dizziness, unsteadiness, and difficulty with activities like walking in the dark or on uneven surfaces.
Age-related changes
As we age, the vestibular organs gradually lose hair cells and nerve fibres, proprioceptive feedback from the feet and ankles diminishes, and reaction times slow. These changes happen gradually, so many people do not notice their balance declining until a near-fall or actual fall occurs.
Medication effects
Many commonly prescribed medications — including blood pressure drugs, sedatives, antidepressants, and antihistamines — can cause dizziness, lightheadedness, or drowsiness as side effects. When multiple medications interact, the impact on balance can be compounded. If you suspect your medications are affecting your balance, speak with your physician or pharmacist.
Peripheral neuropathy
Damage to the peripheral nerves — often caused by diabetes, chemotherapy, or other medical conditions — reduces sensation in the feet and lower legs. Without accurate feedback about the surface beneath you, your brain has difficulty making the rapid postural corrections needed to keep you upright.
Risk factors for falls
Certain factors place individuals at higher risk for falls. These include:
- Previous falls — a history of falling is the single strongest predictor of future falls
- Balance and gait impairments — unsteadiness, shuffling, or difficulty turning
- Muscle weakness — particularly in the legs and core
- Visual impairment — reduced depth perception, contrast sensitivity, or peripheral vision
- Vestibular disorders — inner ear conditions causing dizziness or spatial disorientation
- Polypharmacy — taking four or more medications simultaneously
- Fear of falling — which paradoxically restricts activity and leads to further deconditioning
- Environmental hazards — loose rugs, poor lighting, cluttered walkways, lack of handrails
If two or more of these factors apply to you or a family member, a balance assessment is strongly recommended.
How we assess balance
At Burlington Vestibular Therapy, your physiotherapist will conduct a thorough assessment to identify the specific causes of your balance difficulties. This typically includes:
- Health and medication history — identifying medical conditions, medications, and previous falls
- Vestibular examination — testing inner ear function using positional tests and observation of eye movements (nystagmus)
- Balance testing — standardised clinical measures such as the Berg Balance Scale, Timed Up and Go (TUG), and the Dynamic Gait Index
- Strength and range of motion assessment — evaluating lower limb and core strength
- Functional mobility assessment — observing your gait pattern, turning ability, and ability to manage stairs or uneven terrain
- Sensory assessment — checking proprioception and sensation in the feet and ankles
This comprehensive evaluation allows us to determine which systems are contributing to your balance problem and to design a targeted rehabilitation programme.
How vestibular rehabilitation helps
Vestibular therapy is an evidence-based approach to improving balance and reducing fall risk. Your treatment plan will be tailored to your specific assessment findings, but it typically includes one or more of the following components.
Balance retraining exercises
Progressive exercises that challenge your balance in a safe, controlled setting. These may involve standing on different surfaces (firm, foam, uneven), reducing your base of support, practising weight shifts, and performing tasks while balancing — gradually building your ability to maintain stability in real-world conditions.
Gaze stabilisation
If your vestibular system is impaired, your brain may struggle to keep your vision clear during head movement. Gaze stabilisation exercises train the vestibulo-ocular reflex (VOR) to improve visual clarity during walking and head turns, reducing dizziness and improving confidence with daily activities.
Strength and coordination training
Targeted exercises to build lower limb and core strength, improve joint stability, and enhance coordination. Stronger muscles and faster neuromuscular responses give your body more capacity to recover from unexpected perturbations — such as tripping on a curb or being bumped in a crowd.
Home safety and movement strategies
Your therapist will discuss practical strategies for reducing fall risk at home, including advice on footwear, lighting, bathroom modifications, and safe movement techniques for getting in and out of bed, using stairs, and navigating slippery or uneven surfaces. A home exercise programme will be provided so you can continue making progress between appointments.
Who benefits from balance rehabilitation
Balance and falls prevention physiotherapy is appropriate for a wide range of individuals, including:
- Older adults who have experienced a fall or near-fall
- People diagnosed with vestibular disorders such as BPPV or vestibular neuritis
- Individuals with peripheral neuropathy or reduced sensation in their feet
- People experiencing dizziness or unsteadiness from any cause
- Those recovering from concussion, stroke, or neurological conditions affecting balance
- Anyone who has noticed a gradual decline in their confidence with walking or daily activities
You do not need a physician referral to see a vestibular physiotherapist in Ontario.
When to seek help
Do not wait for a fall to take action. If you are experiencing any of the following, a balance assessment can help:
- Feeling unsteady when walking, especially on uneven surfaces or in the dark
- Dizziness or lightheadedness with position changes or head movements
- Holding onto furniture or walls for support at home
- Avoiding activities you once enjoyed due to fear of falling
- A recent fall or near-fall
Early intervention is key. Research consistently shows that vestibular rehabilitation and balance training can reduce fall risk by 30 to 50 per cent in at-risk individuals.
Book your vestibular assessment at Burlington Vestibular Therapy and take the first step toward steadier, more confident movement.
The information on this page is for educational purposes and does not replace individualised medical advice. If you are experiencing a medical emergency, call 911. Learn more about vestibular therapy and the full range of conditions we treat.