But us mere mortals have a certain base level of balance that lets us go about our daily activities without falling over or getting sick. Otherwise we’d all be wobbling around like toddlers figuring out the whole walking thing for the first time.
Some people, though, have worse balance than others. Having bad balance is pretty common, and tends to get worse as we age, says Helen Bronte-Stewart, M.D., M.S., a movement disorders specialist at Stanford Medicine. There are a few ways to tell if you have a potential balance problem (and that you’re not just a huge klutz).
“The most concerning outcome is falling, but if you have trouble putting on long pants when you have to balance on one leg, that suggests you may have balance problems,” Bronte-Stewart tells SELF. Other red flags: “If you cannot walk in a straight line, bump into things, or if you have trouble standing with your feet together and eyes closed.”
But what can cause it? Here are the most likely causes of bad balance.
1. A disorder affecting your inner ear
The vestibular system is the part of the inner ear involved in balance. It gathers information relating to motion, equilibrium, and spatial orientation, and send signals to the brain, according to the Vestibular Disorders Association.
When the vestibular organs on both sides of the head are functioning properly, they send symmetrical impulses. If they don’t work properly, there can be issues with sensory input and relaying that input to the brain.
A vestibular disorder, or vestibulopathy, can cause issues with orientation. The most common vestibular disorder is benign paroxysmal positional vertigo (BPPV). It’s triggered by certain head movements that cause particles in the inner ear to bang around, causing other effects such as dizziness, spinning (vertigo), lightheadedness, and nausea.
It’s rarely serious, and sometimes goes away on its own within a few weeks or months. “Others may need therapy to help the brain recalibrate the two sides of the body,” Bronte-Stewart says. It’s usually effective with just one or two treatments, according to the Mayo Clinic.
Some vestibular disorders are caused by other factors, such as a benign growth affecting a nerve, which would require surgery to fix, Bronte-Stewart notes. Some are caused by infection, and can be fixed with a round of meds. “Some disorders are less easy to treat, but many of them can be at least improved with good vestibular therapy,” she reassures.
2. Detraining or poor core strength
Sometimes, balance issues can be caused by simple deterioration in physical fitness. This is most common as we age and our muscle mass deteriorates. But it can affect people at any age. If you’re fairly young, having a desk job shouldn’t make an impact, as long as you’re up and about when you’re not working and you exercise regularly, Bronte-Stewart says.
But if you really don’t move much—you’re a classic couch potato—you can lose the strength in your core and glutes needed to reorient your body.
If you find you can’t balance during physical activity that involves putting one leg in front of the other (like walking over rocks through a stream on a hike) or balancing on one leg or something that isn’t stable, “it could be because you don’t challenge [these muscles] that often with exercise,” Bronte-Stewart says. “There’s an absolute rule that applies to muscles and the brain: If you don’t use it, you lose it,” she explains.
3. Poor eyesight
Vision helps keep the vestibular system functioning correctly—it’s a major player in gathering spatial signals. If you can’t maintain a steady focus on the things around you, especially when you’re moving, it can throw you off a bit.
It could be as easy as getting corrective lenses—maybe you never realized before your vision wasn’t perfect. If you have balance issues and also notice other signs of deteriorating vision, like not being able to read road signs you used to be able to, or getting a headache from reading, consider visiting an optometrist for an eye exam.
4. Neurological disorders
If you feel off balance and also see the room spinning or feel lightheaded, that’s not a core-strength problem. Vertigo that causes imbalance can be a sign of a stroke—if it’s sudden and paired with other stroke symptoms like numbness, weakness, speech problems, or vision problems, see a doctor immediately.
Dementia is also a common cause of balance problems. The condition makes it difficult for people to remember where they’re going, causing a disconnect between sensory signals and spatial awareness. Parkinson’s disease can also upset the body’s balance for a variety of reasons, mostly due to interruptions in processing in the brain.
“Someone with Parkinson’s may have difficulty with how their body is positioned in space—they feel upright when really backwards or leaning to the side. They may fall over if they trip.” The illness also makes it difficult to adapt to sensory feedback, making something like a moving escalator a hazard.
5. Nerve damage
Peripheral neuropathy, a result of damage to the nerves that send information from your brain and spinal cord to the rest of your body, can also throw off balance, especially if the damage is done to the legs. “You’re not getting the right input from a part of the body,” Bronte-Stewart explains.
So, for example, “you’re not sure where your feet are in space, so the body isn’t processing the sensory information it needs to move forward.” One of the most common causes of peripheral neuropathy is diabetes, but certain medications (like chemo), some autoimmune diseases, infection, trauma, nutrient deficiencies, and alcoholism can all cause neuropathy.
Loss of balance and orientation is also one of the first symptoms of multiple sclerosis, which impacts the central nervous system. It’s usually paired with other symptoms like blurred vision and numbness on one side of the body.