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The Choreography of Balance, Part 1

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It takes a lot of coordination to stand upright.

Your alarm clock rings and awakens you from sleep. You stretch your arms and legs, kick off the bedcovers and sit up onto the side of your bed. You stretch your limbs again, rub your eyes, then get up and walk out of your bedroom down the hall to the bathroom. You proceed to urinate, wash your hands and face, then wander to the kitchen to make a pot of coffee.


Every single movement you just made from sitting at the side of the bed, to walking down the hall, sitting down on the toilet, standing up from the toilet and bending over to wash your face requires a complex interaction between your brain, eyes, ears, muscles and joints. These interactions allow you to maintain balance in all these activities.


Without these interactions, you would stumble and fall, become dizzy and disoriented. Even crawling to the kitchen would be difficult.


Let’s explore these interactions that allow humans to remain upright and stable as they move about their lives. Let’s explore the choreography of balance.


Photo courtesy of Unsplash

What is balance?

As defined, balance is “to place or keep something in a position where it remains steady and does not tip over”1. Another definition is “the ability to distribute your weight in a way that lets you stand or move with falling or recover if you trip” (2). Balance is a complex interaction between your brain, ears, eyes, muscles and joints.  




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Your ears are for more than hearing

Inside your inner ears is a system of structures which detect movement and changes in position of the head and body. These structures are called the vestibular system. The vestibular system is composed of semicircular canals and otolith organs. (3)


The semicircular canals sense movements of rotation, like when you turn your head or body. The otolith organs detect when your body is moving in a forward/backward motion and also detects the consequences of gravity – like when you fall or stumble.


These structures contain tiny hairs bathed in fluid. When you move your head, the fluid shifts causing the hairs to move. This movement generates an electrical impulse which travels to the brain. The brain is then able to detect what kind of motion is taking place and which direction the body is being placed in. The term for this detection of movement by the brain is proprioception. (3)




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Ears and eyes work together to keep the human body vertical  

The vestibular system also works closely with the eyes to help maintain balance. This coordinated effort consists of two reflexes: the vestibulo-ocular reflex (VOR) and the vestibulo-spinal reflex (VSR). (3)


The VOR helps to steady vision while you move your head by keeping your eyes focused on an item in your environment. (3) Think of how a ballerina’s head and gaze are fixed as she pirouettes across a stage.


The VSR sends signals to your muscles helping you to keep your balance when your head moves. This feedback system alerts your muscles to make quick modifications to prevent falls. (3)


Our eyes play a key role in balance. The eyes provide input to the brain about our surroundings and about our physical location in space. If the ground we are standing on is unstable, the eyes provide signals to the brain as to which direction is up and which direction is down. (3)




The role of stretch in balance

The skin, muscles and joints provide information to the brain regarding posture, limb placement and joint movement. Stretching and movement of muscles, joints and skin send signals to the brain which, in turn, helps the brain determine where our body is in space. (2)

 



The brain’s role in balance

Many areas of the brain are engaged in helping us keep our balance: the cerebellum, the brainstem, the parietal cortex and the frontal cortex and the basal ganglia. (3)


  • The cerebellum coordinates input from your ears, eyes and muscles to sustain coordinated movement. It acts rapidly to correct balance when your environment changes without warning.

  • The brainstem acts as a relay system and sends signals from the cerebellum and vestibular system to other parts of the body to maintain posture. The brainstem acts automatically so there is no need for you to consciously make adjustments.

  • The parietal cortex integrates information from your body, ears, eyes and muscles to construct a full understanding of where your body is situated in your environment.

  • The frontal cortex is involved in anticipatory movement and voluntary movement. 

  • The basal ganglia works with the cerebellum to make movements smooth and coordinated.


A steep and long set of stone stairs imbedded in a grassy hill
A steep and long set of stone stairs imbedded in a grassy hill

Difficulties in the diagnosis and treatment of imbalance

Because of the physiological complexities of maintaining balance, it may be difficult to diagnose and treat the underlying causes of imbalance. Anything that disrupts the individual components of balance may lead to struggles with a person’s sense of balance. Things which interfere with balance may include (2, 4):

  • Prescription medication

  • Over-the-counter medication

  • Changes in eyesight

  • Development of vertigo/inner ear disturbances

  • Stiffness and weakness of muscles and joints

  • Prior injuries

  • Prior surgeries

  • Brain conditions such as Parkinson’s disease, normal pressure hydrocephalus, and stroke

  • Traumatic brain injuries


Acute and chronic imbalance issues may lead to depression, anxiety, falls with and without injury, difficulty ambulating, decreased socialization, isolation and loneliness.(5) Interventions available to prevent and improve balance issues. These interventions will be discussed in an upcoming article, The Choreography of Balance, Part 2. 



References


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