Strengthening Your Balance

Featuring: Florence Tse
Balance issues become more common with age. Florence Tse, Senior Physical Therapist at Eisenhower Health, discusses how to work through these balance issues.


Florence Tse has been a physical therapist for more 30 years. She joined Eisenhower Health 21 years ago and she is the senior therapist in the physical therapy department and the leading therapist in the Balance Institute. She holds a Doctor of Science Degree from Loma Linda University and a Master of Science degree from Boston University. She is certified in vestibular rehabilitation. Florence specializes in treating patients with balance disorders and issues with dizziness.


Bill Klaproth (Host):   As people age, balance issues become more common. So what are the common conditions that effect people's balance as they age? Let's find out with Florence Tse, senior physical therapist at Eisenhower Health. Florence, thank you for your time. So we often hear about balance issues in relation to aging. We know Eisenhower Health cares for people of all ages, but especially those older than 65 due to the retirement population of our area. So what are the common issues that affect people's balance as they age?

Florence Tse, PT, DSc (Guest):    Well, thanks Bill for having me. There are lots of normal physiological changes throughout our body when we age. It happens to our brain, muscles, soft tissues, bones, blood vessels, heart, and lungs. We lose our muscle strength, flexibility, and endurance as we age. Muscle mass decreases 3 to 5% every decade after 30 years of age, and that rate increases over the age of 60. We lose our strength when we have problem maintaining or regaining balance when we fall. As we lose our endurance, we will have increased chances of falling as we fatigue and get tired easily. We also lose bone density as we age. This increases the chance of breaking the bones when we fall. Cartilage in the joint may start to wear and tear as we age. We may have osteoarthritis at the hips, knees, and feet. Notice this at the spine as well. All of this will cause pain and stiffness during walking or standing. So some people will avoid those activities. With less activities, people will lose more strength and endurance therefore increase the chance of falling. We also see changes in the vision. Conditions such as far sightedness, degenerations, cataracts, and glaucoma. All this will cause blurry visions, even blindness, and effects the perceptions of where we are in space causing poor depth perceptions or even unable to see the obstacles when we walk.

In our cardiovascular system, the most common changes when we age is stiffening of the blood vessels and arteries. The heart muscles adjust by increasing the workload. A lot of elderly will have difficulty in physical activity such as walking long distance or walking uphill. As they avoid those activities, they will become deconditioned and lose their strength and endurance therefore increase the chance of falling. Another condition that's related to cardiovascular system is the postural hypotension. What it is is a drop of blood pressures when we stand up from sitting or lying down. It may make you dizzy or light headedness or even faint, and this will increase the chance of falling.

Now elderly also have increased chance of getting balance related conditions such as stroke, Parkinson's disease, concussions from car accidents or previous falls, traumatic brain injury or neuropathy. All these conditions effect how well the body perceive the balance signals, how well the brain process those signals, and how well the body executes those actions to maintain balance.

Host:   So as we age, there's a lot of things that effect balance. Thank you for that very comprehensive list. So what about people of all ages? What are some other conditions that might lead to balance issues?

Florence:   Well the other conditions that will affect your balance is the vestibular disorder. What it is is in any conditions that involve the inner ear. We have balance sensors in the inner ear on both sides. It sends signals to the brain and pulls various information about the movement on the head and it's position in respect to gravity. Any disorder in the inner ear will interfere with the signals the brain receives causing vertigo, dizziness, and poor balance. Some of the examples of the inner ear disorders are vestibular neuritis, which is inflammation of the nerves that sends signals from the inner ear to the brain about balance. Meniere's disease, which is fluid buildup in the inner ear. And BPPV, it's a short name for benign paroxysmal positional vertigo, which is the dislodge of the inner ear crystal. Another area that may affect the balance is your neck. The loss of mechanical receptors at the upper neck area. It connects to the vision and the vestibular systems that help with balance and head and eye movement control. Any pain or spasm at the neck may cause blurry visions, dizziness, poor neck and eye movement control, and postural stability.

Host:   So many things effect balance that I didn't know about. The neck, as you were talking about, that's fascinating to me. So I'm sure some people learn about Eisenhower's balance institute through their primary care doctor, but how would someone know if they can benefit from the balance institute?

Florence:   Yes. You may benefit from balance institute if you experience dizziness, lightheadedness, motion sensitivities, or vertigo with spinning sensations. Of course, you have to be cleared by the doctors for any major medical or neurological conditions. Or you may just have history of falling or lack of confidence when you walk during your daily activities. For example, you become a furniture walker. That means you have to hold on to the furniture to walk due to fear of falling. Or you become hesitant to walk on slopes, uneven surfaces, curbs, bending over to pick up objects on the floor, getting dressed and standing, or closing your eyes to wash your face in the shower. Or you maybe just want to be proactive to learn some balance exercise to prevent falling.

Host:   Gotcha, okay. So balance, as we're talking about, is obviously important. We want to prevent falls and further injury. How do you work with older people who have had or have balance issues?

Florence:   Well, it's very important to have comprehensive evaluations to understand the reasons causing people's imbalance and dizziness. The balance we would test how well they can keep their balance in standing or when they move around. Besides testing the strength, postural, flexibility, and sensations, we would use the state of the art EquiTest balance master to evaluate how well they can maintain the balance under different conditions. We use that to identify which sensory systems they have problem in using to maintain their balance, and also to identify if there is any problem in executing the postural control.

For dizziness, we will test how well they can maintain the visual acuity. That means see clearly during active head and body movement. If they have vertigo, we will use another state of the art video [inaudible] goggles to assess if they have any crystal dislodge in the inner ear and provide treatment accordingly. Based on the findings of the evaluations, we can individualize the program to address the specific balance problem. Studies have shown that balance training with strengthening exercise and functional training can significantly improve balance and prevent falling.

Host:   So let's stick with vertigo for a minute. Now vertigo, the definition is when the room is spinning. Is that right?

Florence:   Correct, yes.

Host:   That's different than motion sensitivity. You feel like whoa, the room is spinning. That is vertigo, right.

Florence:   Correct.

Host:   So are some people predisposed to vertigo. Can it come back? How do you treat it at the balance institute?

Florence:  Yes, it can reoccur. New episodes can develop after successful treatment as well. The rate of recurrence is about 15 to 50%. How do we treat that? To treat benign paroxysmal position vertigo we use various maneuvers to reposition the crystals that are dislodged in the inner ear and back to where it belongs. It involves a series of simple and slow head body movements. Each position is held for about a minute after any symptoms or abnormal eye movement stop. This procedure is usually effective after one or two treatments.

Host:   Hm, one or two treatments. So that's generally how many sessions people would need?

Florence:   For people with vertigo, it depends on how many crystals are dislodged in the inner ear and how well they can tolerate the treatment because they will get more dizzy when doing the treatment. So usually one to four treatments to get rid of the symptoms. For people with dizziness, motion sensitivities or imbalance, it depends on what we find out in the evaluation. If there are lots of impairments we need to address, it may take four to six weeks to improve their dizziness and imbalance. It also depends on how much they want to get better. If they do their home exercise program as prescribed, they will get well faster. Repetition is the key to motor learning. The more they practice, the faster the brain will learn and adapt.

Host:   Gotcha. Is a referral from a physician required for patients to be seen at the balance institute?

Florence:   Yes, Bill. All we need is a doctor's prescription with a diagnosis related to balance. They can fax or call or walk into the balance institute at Eisenhower Health at 760-773-2033 and we'll get you started.

Host:   Really interesting. Florence, thank you so much for your time today. This has been fascinating.

Florence:   Absolutely Bill.

Host:   That's Florence Tse, senior physical therapist at Eisenhower Health. If you want to learn more about Eisenhower Health's balance institute, just call 760-773-2033. That's 760-773-2033. Or you can also visit If you found this podcast helpful, please share it on your social channels and be sure to check the entire podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.