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Your 3 Balance Systems Explained

Life's all about balance.

I had the pleasure recently of providing balance screens at a boxing gym, which turned out to be quite the eye-opening experience for many of the athletes and coaches. Even the best boxers were shocked at how difficult the simple test of standing in various positions with their eyes closed was. Exasperated, they would ask me, "What's wrong with me? What can I do to fix this?", etc.

My response was:

  1. There's nothing "wrong" with you- just some things you need to work on!

  2. Most people (even the super athletic) neglect balance training.

  3. Let's talk about what your balance system actually does!

Because balance training is perceived as something only for older adults, ballerinas, and flamingos, you'll rarely see someone at the local gym working on it in between sets at the squat rack.

However, balance is CRUCIAL to train- especially as we age or recover from an injury, whether it be an ankle sprain, concussion, or stroke.

Here are some scary facts from the CDC:

  • Falls are the leading cause of traumatic brain injuries.

  • 800,000+ patients are hospitalized annually due to a fall-related injury.

  • The most common injuries from falls are head injuries and hip fractures.

  • Current death rates due to falls are steadily on the rise in the US.

If you throw in a bit of balance training to your regular workout routine now, your future self will be thanking you.


Let's discuss the 3 major players of the balance system and how you can tune them up to pursue your career of acrobat (or human flamingo).

1. Vision

Everyone's BFF when it comes to staying upright- our eyeballs. This aspect of balance is typically pretty sharp and we tend to over-rely on it. This is why when I asked the boxers to close their eyes while standing in various positions, they ended up doing a weird breakdance to keep themselves from falling over. Almost everyone I screened that day said "This is so hard with your eyes closed!". It sure is- that's why we test it that way.

Hints you need a tune up:

  • You tend to stumble or feel off-balance in low-light environments, like walking around the house at night

  • Closing your eyes while standing on either leg is really challenging

  • You feel less confident moving around if you can't see what's in front of you- ex. people who hike or walk outside while always looking down at the ground

The fix:

  • If you already have an exercise routine, try closing your eyes during some of the movements (as long as it's safe to do so). Ex: squats or lunges with eyes closed or trying a yoga pose with eyes closed

2. Proprioception (Sensory Input)

Also known as kinesthesia, proprioception is your muscles' and joints' ability to sense where they are in space. For example, if you close your eyes and move your elbow, your elbow joint communicates to your brain whether your arm is bending or straightening. Another example is sensing what type of surface you're walking on; typically you can tell if you're walking on sand vs. pavement without looking down.

Proprioception can be damaged in a variety of ways. People with chronic ankle sprains may have difficulty sensing what their feet and ankles are doing, while someone who's had a stroke can have an entire side of their body that struggles to communicate where it is in space.

Hints you need a tune up:

  • You're one of those people who frequently rolls their ankles when walking on uneven surfaces.

  • You generally don't feel like the most coordinated human-being- doing two things at once is a struggle.

  • Looking at your body part while you move it helps your coordination and/or balance (ex. watching your leg kick a ball vs. looking up at the goal).

The fix:

  • Challenge your proprioception with uneven surfaces: I like to have people work on basic movements, like standing still, squats, reaches, etc. while standing on a foam pad or BOSU ball.

  • When walking or being active outside, trying looking down at the ground less often to break your reliance on the visual system (see above!)

  • Practice activities in single leg stance.

3. The Vestibular System (Inner Ear)

My personal favorite, and least understood: the vestibular system. Without getting too complex, your inner ear is a dime-sized system behind your eardrum that communicates to the brain what position your body is in. Are you upside down? Are you spinning? Did you turn your head to the left or right?

Your vestibular system works quickly and smoothly to maintain a sense of equilibrium during movement. If you've ever had dizziness, motion sickness, or vertigo, you've experienced the vestibular system trying to make sense of your spatial orientation when it's overloaded.

Hints you need a tune up:

  • You experience the above-mentioned symptoms during regular, daily tasks like driving, chores, walking, turning your head, etc. or even at rest.

  • You generally experience motion-sickness, like as the passenger in a car or on amusement park rides.

  • It feels like the world is just a bit off-kilter or you tend to veer off in one direction or the other.

The fix:

  • The vestibular system can be really complex, so if you're experiencing dizziness or other related symptoms that are impacting your daily life, it's best to see a physical therapist or other healthcare provider to thoroughly assess you and provide tailored exercises to fit your needs.


Don't wait until you're already injured or experiencing falls- start working on your balance now to keep your body in top shape and be able to fully enjoy the human experience.

Talk to your physical therapist about incorporating fall prevention and balance training into your plan of care and remember to always use a spotter (or a wall or chair) when starting balance exercises.

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Mar 23, 2023
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