Balance problems affect over 90 million Americans. 5 million people see a doctor yearly for this sometimes debilitating condition. 10% of those afflicted actually become disabled. One third of people over the age of 65 fall each year and 2.5 million are treated in emergency rooms each year after a fall. In 2013, 734,000 of these patients were hospitalized. Among older adults, falls are the leading cause of both fatal and non-fatal injuries. Every hour a senior dies from fall related injuries. The medical costs of falls is estimated to be over 34 billion dollars per year.
Identifying the Problem
What affects balance? There are several causes of balance problems but what they all have in common is they affect Cranial Nerve 8 or our vestibular system. The vestibular system is the sensory system that provides our sense of balance and spatial orientation and helps us coordinate our movement with balance.
Basically, there are three categories that influence balance.
1. Visual Horizon
We need to understand where we are in relation to our visual horizon in order to feel stable. Sea sickness is a good example of our visual horizon wavering and having an effect on our balance. If you can’t tell where exactly you are in your environment, you move gingerly and insecurely. Have you ever put on a pair of sunglasses that altered the visual horizon from where it really is? I have and I would always take them off when I was walking because of the effect they had on my balance. We need to know where we are in relation to our surroundings at all times.
Proprioception is about having a constant sense of where our body is in space. We rely on receptor input, which feeds into the central nervous system and ideally gets to our brain for processing, and then nerve information is transmitted peripherally to our joints and muscles. Our nervous system receives and transmits this information. There are basically two types of proprioceptors. One type gives conscious awareness of where the body and its different parts are in relation to each other. The other lets one feel both the movement and the rate of movement of our limbs and what goes on in the joints.
After an injury or surgery where pain lasts longer than two days, “circuit breakers” become tripped just like in an electrical box and interrupt messages going to and from the damaged joint. This causes a decrease in proprioceptor input into the central nervous system which can ultimately have an effect on proper movement. This is one reason why repeat injuries to the same joint are very common. There are more proprioceptors in the ankles and upper cervical spine than anywhere else. Injuries to these areas can be particularly troubling to one’s balance because the sheer numbers of proprioceptors may become a source of erroneous input into the central nervous system. It is also possible they may have no input at all.
3. Problems with the Semi-Circular Canals of the ear.
Anything affecting our inner canals can have major ramifications on our balance. Congestion is a common occurrence. A fluid build up behind the middle ear can trigger symptoms. It is also possible for a foreign object to get in the ear and cause problems.
Dizziness is a very common symptom and balance difficulties are an automatic companion to it. It is the number one complaint of people over 70. The cause can be different for each individual but commonly adrenal gland stress is at fault. If the adrenals are exhausted, orthostatic hypotension can result. This is a form of low blood pressure that affects people when they change positions. Usually this displays as dizziness or light headedness when one goes from lying to seated, or from seated to a standing position. Testing blood pressure can give a definitive diagnosis. Normally, when one goes from lying or seated to standing the blood pressure will rise some. With orthostatic hypotension the blood pressure will not rise and, in fact, may drop. This means that blood is not being delivered to the brain adequately with dizziness being the result. If this is the case diet modifications need to be made and the adrenals supported. Eliminating stimulants, eating regularly of real food, and using whole adrenal glandular supplements can be useful. Other adrenal supports include maca, Siberian ginseng, American ginseng, and rhodiola. If the blood pressure is low, B vitamins and the herb licorice can be beneficial. If blood sugar imbalances are at fault, chromium and the herb gymnema sylvestre might be called for.
Vertigo is another symptom resulting in balance issues. With vertigo the sensation feels like the room is spinning. In severe cases, it is very debilitation. A person might hang onto something for fear of being flung into space. It is estimated that 85% of vertigo cases are inner ear related. This has been my clinical experience as well.
Additional Causes of Balance Problems Related to Dizziness
Vision feeds into the vestibular system so should be evaluated, particularly with senior citizens. An eye exam needs to be done to check vision. Beyond that however, eye position testing should be done. These are functional tests where we have the person look in different directions and see if any weaken the nervous system. For example, one could have a problem every time he or she looked in the lower right quadrant. That weak position could potentially have an effect on their balance. Fixing that weakness with some nervous system rehabilitation techniques could eliminate that dysfunction in minutes.
2. Hearing difficulties can affect balance.
One study done at John Hopkins University School of Medicine found that with only a 25-decibel hearing loss people were three times more likely to have a history of falling. Every additional 10-decibel of hearing loss increased chance of falling by 1.4 times.
Over 1000 drugs list vertigo as a possible side effect. Dizziness and confusion are also common side effects. The more drugs one takes the higher the risk of falling. Four or more drugs has been correlated with a high risk for falling compared to those taking fewer than four. Most seniors are taking at least four medications. Anti-depressants appear to be a major risk factor for falls. A 2007 study showed anti-depressants doubled the risk of fractures from falls. Approximately 10% of seniors are taking these medications along with a mix of other drugs.
Other causes of balance problems include:
Both food and environmental allergies can affect the brain and nervous system directly and also have a congesting affect. Congestion can cause fluid and pressure in the ears to build up, which the affects balance. A gluten or milk allergy are common causes of congestion. Obviously avoiding the offending food item(s) makes sense. Pollen allergies are tough to avoid, but the herb nettles and the flavonoid quercetin are very helpful for allergy symptom relief.
Infections affect so many systems of the body as energy is focused on defeating whatever the infection is. There is usually accompanying fatigue, disorientation, and congestion. The type of infection needs to be determined. Is it viral or bacterial? The treatment needs to fit the problem. There are some excellent natural remedies to treat both. For example, if the infection is bacterial, berberine or echinacea might be helpful. If viral, the herbs elderberry and isatis could be beneficial.
3. Kidney problems
In Chinese medicine the ears are on the kidney circuit. For example, ringing in the ears is often a reflection of kidney stress. Again, the ears affect balance in a big way. Good foods for the kidneys include spinach, parsley, asparagus, aduki and mung beans.
4. Heart and Circulation issues
Circulation issues can affect the ears but also the ability of the body to function normally. For example, if one doesn’t get good circulation in the legs the chance of falling increases. If we don’t get good circulation to the brain, it’s possible to experience dizziness. Hawthorn is an excellent heart and circulation herb. Other good aids for the vascular system include grape seed extract, pycnogenol, flavonoids, and fish oil.
5. Lymphatic congestion
All of the above mentioned items can contribute to lymphatic congestion which could affect the ears. Another major cause of this congestion is undigested fats. Undigested fat can also clog the lymphatics. The enzyme lipase, which digests fat, taken away from food, will help clear the lymphatics. Taken with food it will help digest fat. Other remedies to aid the lymph system include the herbs red root, burdock, and cats claw. If there is infection in the lymph arabinogalactin (from the Larch tree) may help.
6. Muscle weakness
This is a major problem especially with seniors. Many do not exercise and often have weak legs. Exercise is not an option. It is a necessity. Some weight training is good at any age, but for improved balance, tai chi has been shown to be excellent. In my experience, it is extremely important for one to have the strength to get up from a seated position and to sit back down slowly with ease. The inability to do that affects balance hugely, particularly side to side balance. Not all muscle problems are due to lack of exercise. Often, there are neurological issues preventing the muscles from responding appropriately when used. This is not a strength problem but a glitch between the brain and the muscle. This “wiring” needs to be re-set and can usually be done very quickly using neurological rehabilitation techniques.
7. Vitamin B12 Deficiency
Vitamin B12 should be tested on every senior and everybody with balance problems. 40% of seniors are B12 deficient. Why is this important? Simply, B12 affects the nerves. A myriad of symptoms may manifest with a deficiency, like numbness, tingling, burning, etc. but a lack of good balance and falls are at the top of the list of possible symptoms. Position sense may be affected, or weakness in the muscles, clumsiness, or vision problems may be at fault, all because of a B12 deficiency.
B12 testing is rarely done and when it is the normal ranges used are inadequate. Currently, the normal range (depending on the lab) is 200pf/ml-1100pg/ml. This is ridiculous considering neurological symptoms can manifest at levels below 450pg/ml. Seems it would be wise to supplement if one’s levels fell below that level or if their homocysteine levels were high, regardless of the B12 number. Low B12 is one reason for high homocysteine, which can have negative cardiovascular effects.
The importance of testing for a B12 deficiency cannot be stressed enough, especially since dementia is also a possible consequence of low levels. B12 deficiency is epidemic for three main reasons. The first is it is simply not in the food anymore. Beef used to be a good source. Testing in the early 1990’s showed no B12 could be found in the samples. Secondly, so many people are on medications that deplete B12, like antacids, proton pump inhibitors, metformin, antibiotics, birth control pills, etc. Thirdly, certain medical conditions can decrease B12 in the body. Those include Crohn’s disease, celiac disease, and atrophic gastritis. Too many lives are at stake not to be testing Vitamin B12 levels on all patients.
It is not uncommon for multiple causes to fill one’s cup to the point that symptoms start manifesting. Once the systemic issues have been identified and treatment starts to negate those stressors, the specific muscle and joint weaknesses as well as specific positions that affect the vestibular system need to be identified. Re-setting these neurological circuit breakers will usually make fast, positive changes. For example, symptoms may be triggered with the head in a certain position. The treatment involves making the correction in the same position. Often, turning to one side will bring on symptoms. Using a challenge test where the person is seated in a swivel chair, I can turn the person and see where their nervous system starts to break down. Sometimes it is only a quarter of a turn before symptoms begin. Employing many of these functional tests and using Quantum Neurology corrections, the person can start improving toward normal functioning again. This is physical therapy for the vestibular system and can improve one’s quality of life tremendously. It is also great prevention for falling, a leading cause of injury and death.
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