Visit the ANPT Education Center

Consumer Information: Vestibular Disorders & Dizziness

How Does the Balance System Work

Shannon L.G. Hoffman, PT, DPT

Your sense of balance comes from many different systems working together to create stability of your body and your vision. Good balance depends on correct sensory information, proper use of that information by the brain, and the right response from the muscles. The sensory information that is needed comes from your visual, somatosensory, and vestibular systems:

  • Visual system: Your vision provides important information to the brain about your environment, specifically where your body is in relation to the horizon while still or moving.
  • Somatosensory system: You have special sensors sensitive to stretch, pressure, vibration, and touch in your muscles, tendons, joints, and skin that help your brain to know how your body is positioned.
  • Vestibular system: Balance organs in the inner ear tell the brain about the movements and position of your head. This system senses head movement and keeps your eyes focused. It can also tell the brain when your head is moving in a straight line (like when you are riding in a car or going up or down in an elevator) and sense the position of your head even when it is still (if it is upright or tilted).

Putting it All Together

Information about your current state from all of these systems travels to the brain stem. The brain stem also gets information from other parts of the brain, mostly about previous experiences that affect your sense of balance. Your brain can control balance by using the information that is most important for a particular situation.

For example, in the dark, when the information from your eyes is reduced or might not be accurate, your brain will use more information from your legs and your inner ear. If you are walking on a sandy beach during the day, the information coming from your legs and feet will be less reliable and your brain will use information from your visual and vestibular systems more.

Once your brain stem sorts out all of this information, it sends messages to the eyes and other parts of your body to move in a way that will help you keep your balance and have clear vision while you are moving.

How a Physical Therapist Can Help

If you feel dizzy, off balance, or have fallen, a physical therapist can help to determine how well you are using these systems (or not) to keep your balance. The physical therapist may instruct you in specific exercises that address the problem and improve how your body uses all these systems together.

What can a Physical Therapist do for People who have Dizziness and Falls

Falls and dizziness are common among people over 65 years of age. However, falling should not be thought of as a normal thing that happens as we age. A physical therapist is trained to look at problems with walking and balance and conduct a fall risk assessment. Sometimes the problem may be related to easily treated problems in the inner ear such as Positional Vertigo, a spinning dizziness that comes on with changing positions of your head. Often there is more than one reason for dizziness and falls in the same person.

How does a Physical Therapist Treat People with Dizziness and Falls

The physical therapy evaluation will identify problem areas. Taking your personal goals into account, the therapist will develop a treatment plan that targets these problems. Your physical therapist will be able to tailor your plan to meet your goals and address your specific problem areas. The therapist may do a home safety assessment to assess the environmental challenges you face every day in
your home. In addition, your physical therapist may recommend that you see a doctor for further testing.

Where can I find a Physical Therapist that sees People with Dizziness and Falls Problems

All physical therapists receive baseline education on how to treat people with balance and vestibular problems. Some physical therapists, however, have advanced skills and knowledge in the area of vestibular rehabilitation. These talented therapists can be found in specialty outpatient clinics, in orthopedic outpatient practice, and within inpatient facilities. Advanced training differentiates these clinicians from their peers. Vestibular physical therapists often attend competency-based coursework to advance their knowledge. In addition, many have
taken a standardized national examination to recognize their advanced skills in neurology, including the knowledge of balance and vestibular dysfunction. Those who have successfully passed the American Board of Physical Therapy Specialties exam in neurology use the designation "Neurologic Clinical Specialist" (NCS) after their name.

The American Physical Therapy Association, Academy of Neurologic Physical Therapy has a list of providers  The map is designed to assist in identifying vestibular therapists across the country who work with those with vestibular disorders. Clicking HERE will open the map in new window where you can select a state to identify providers that might be in your area.

Want to Learn more about Vestibular Problems, Dizziness and Balance and Falls

Aging and Dizziness

Acoustic Neuroma

BPPV- Why Me?

Common Vestibular Testing


Dizziness and Falls

Migraine Associated Dizziness

Vestibular Problems in Children

Trauma and Inner Ear Problems

What is BPPV?

What is Vertigo?

Why See a PT for Dizziness

Need More Information or Looking for a Support Group

Vestibular Disorders Association. The Vestibular Disorders Association (VEDA) serves people with vestibular disorders by providing information, offering a support network, and elevating awareness of the challenges associated with these disorders.

Client Logo
Client Logo
Client Logo
Client Logo
Client Logo
Client Logo
Client Logo
Client Logo