Feeling unsteady on your feet can be unsettling, especially when you aren’t sure what’s causing it. Balance depends on several systems working together, including your inner ear, vision, muscles, joints, and nervous system. A problem in any one of these areas can leave you feeling dizzy, unstable, or less confident when walking.
Balance problems also aren’t limited to older adults. They can develop after an injury, illness, period of inactivity, or because of an inner ear condition. The right treatment depends on what’s behind the problem. Physical therapy can help identify factors affecting your balance and use targeted exercises and, when appropriate, vestibular rehabilitation to help you move more steadily and confidently.
Reviewed and contributions made by Casey Lee, PT, Doctor of Physical Therapy, Board-Certified Clinical Specialist in Geriatric Physical Therapy
Key Takeaways
- Balance depends on information from your inner ear, eyes, muscles, joints, and nervous system.
- Feeling unsteady doesn’t always mean you’re experiencing vertigo. Dizziness, lightheadedness, and imbalance can feel very different and may have different causes.
- Weakness, vision changes, inner ear conditions, medications, injuries, and neurological conditions can all affect balance.
- Physical therapy can improve strength, coordination, walking, confidence, and balance, while vestibular rehabilitation can help with certain causes of dizziness and imbalance.
- New or severe balance problems accompanied by certain symptoms may require prompt medical attention.
By the Numbers: Balance and Dizziness
Balance problems are more common than many people realize, and research shows they aren’t limited to one age group.
- 14.8% of U.S. adults, or an estimated 33.4 million people, reported a dizziness or a balance problem within the past year. Among those reporting problems, unsteadiness was the most identified bothersome symptom.
Source: NIH / PubMed Central: Prevalence and Impact of Bilateral Vestibular Hypofunction - Recent national data found that 36.2% of U.S. adults ages 40 to 69 reported specific balance or dizziness problems in 2021 through 2023.
Source: NIH / PubMed Central: Balance Disorders in Young and Middle-Aged Adults - An evidence-based guideline estimates that one-third of U.S. adults have vestibular dysfunction, with incidence increasing with age. The guideline also found strong evidence that vestibular physical therapy improves symptoms, stability, and function in people with vestibular hypofunction.
Source: PubMed: Vestibular Rehabilitation for Peripheral Vestibular Hypofunction
If you’ve become less steady while walking, started avoiding stairs or uneven surfaces, or feel like your balance is keeping you from activities you used to enjoy, a physical therapy evaluation can help identify what’s getting in the way.
At ATI Physical Therapy, we’ll look beyond the symptom itself. Your evaluation can help determine whether strength, mobility, coordination, walking mechanics, or the vestibular system may be contributing to your balance problems.
Why Do I Feel Unsteady?
Healthy balance is more complicated than simply having strong legs. Your brain is constantly processing information about where your body is, what’s around you, and how you need to move to stay upright.
Your eyes provide information about your surroundings. Your inner ear contains the vestibular system, which helps detect head movement and position. Sensors in your muscles and joints tell your brain where different parts of your body are. Your nervous system brings all that information together and helps your muscles respond.
When one or more parts of that system aren’t working as well as they should, you may notice symptoms such as:
- Feeling unsteady while standing or walking
- Drifting or veering while walking
- Needing to hold onto furniture or walls
- Difficulty walking in the dark or on uneven surfaces
- Feeling dizzy when you move your head
- Feeling as though you or the room is spinning
- Losing confidence on stairs
- Feeling less stable when getting up from a chair or the floor
Those symptoms can have many causes, which is why understanding what you mean by “dizzy” or “off balance” matters.
Dizziness, Vertigo, and Imbalance Aren’t the Same Thing
People often use “dizzy” to describe several very different sensations.
Dizziness is a broad term. You might use it to describe feeling lightheaded, disoriented, woozy, unstable, or as though you’re going to faint.
Vertigo is more specific. It usually describes a false sensation of movement, such as feeling like you or the room is spinning.
Imbalance often feels more like unsteadiness. You may feel fine while sitting but notice that you’re less stable when standing, walking, turning, or navigating uneven ground.
Explaining exactly what you’re feeling, when it happens, and what seems to trigger it can help your healthcare provider or physical therapist determine what may be contributing to the problem.
What Can Cause Balance Problems?
There’s no single cause of poor balance. Sometimes the problem comes from the vestibular system. In other cases, strength, mobility, vision, medications, or another medical condition may be involved. More than one factor can also contribute at the same time.
Inner Ear and Vestibular Problems
Your vestibular system is located in the inner ear and plays a major role in balance and spatial orientation. Conditions affecting this system can cause dizziness, vertigo, instability, or difficulty keeping your vision clear while your head is moving.
One common vestibular condition is benign paroxysmal positional vertigo, or BPPV. It can cause brief episodes of vertigo triggered by changes in head position, such as rolling over in bed, looking upward, or bending down.
Other vestibular conditions can produce longer-lasting dizziness or balance difficulties.
Strength and Mobility Changes
Balance also depends on your ability to react when your body begins moving outside its base of support.
Weakness in the hips, legs, ankles, or core can make those reactions slower or less effective. Limited joint mobility can also make activities like stepping over an obstacle, climbing stairs, or recovering from a stumble more difficult. Even more concerning is the fact that weakness and mobility problems, when left unmanaged, perpetuate a vicious cycle of self-limiting behaviors which further increase risks for falls and injuries.
This can become especially noticeable after an injury, surgery, illness, or an extended period of inactivity.
Vision Changes
Vision provides your brain with important information about your environment and your position within it.
Vision changes can make balance more difficult, particularly in unfamiliar environments or when navigating stairs and uneven surfaces. If you notice you’re significantly less steady in dim lighting or when your eyes are closed, that information can also be help during an evaluation.
Medications and Medical Conditions
Some medications can cause dizziness, drowsiness, or blood pressure changes that affect steadiness. Neurological conditions and other medical issues can also influence balance.
If symptoms began after starting or changing a medication, talk with your healthcare provider. Don’t stop taking a prescribed medication without medical guidance.
How Physical Therapy Can Help With Balance Problems
Physical therapy for balance problems starts by identifying where you’re having difficulty rather than giving everyone the same set of balance exercises.
Your physical therapist may look at how you stand, walk, turn, get up from a chair, navigate obstacles, or maintain your balance under different conditions. They may also assess strength, flexibility, coordination, and your ability to respond when your balance is challenged.
Treatment is then built around what the evaluation finds.
For someone with lower-body weakness, that might mean progressive strengthening and functional exercises. Someone who has difficulty walking or changing direction may work on gait, coordination, and dynamic balance. If the symptoms point to a vestibular problem, specialized vestibular rehabilitation may be appropriate.
What Is Vestibular Rehabilitation?
Vestibular rehabilitation is a specialized form of physical therapy for certain conditions affecting the vestibular system.
Treatment is individualized, but depending on the condition, it may include exercises that help your brain adapt to movement, improve gaze stability, reduce sensitivity to movements that trigger dizziness, and improve balance while standing and walking.
For some vestibular conditions, treatment may look different. BPPV, for example, is often treated with specific repositioning maneuvers rather than a traditional strengthening program.
Research supports vestibular rehabilitation for appropriate patients. An updated clinical practice guideline from the Academy of Neurologic Physical Therapy found strong evidence that vestibular physical therapy can reduce symptoms and improve gaze stability, postural stability, and function in people with peripheral vestibular hypofunction.
When Balance Problems Need Medical Attention
Not every episode of dizziness or unsteadiness requires physical therapy. New balance problems can sometimes be related to conditions that need medical evaluation.
Seek emergency medical care for sudden dizziness or loss of balance accompanied by symptoms such as facial drooping, weakness or numbness on one side of the body, difficulty speaking, sudden severe headache, new vision changes, chest pain, fainting, or an inability to walk safely.
You should also talk with a healthcare professional if balance problems are new, worsening, causing falls, or interfering with everyday activities.
When to See a Physical Therapist for Balance Problems
If you’ve become less steady while walking, started avoiding stairs or uneven surfaces, or feel like your balance is keeping you from activities you used to enjoy, a physical therapy evaluation can help identify what’s getting in the way.
At ATI Physical Therapy, we’ll look beyond the symptom itself. Your evaluation can help determine whether strength, mobility, coordination, walking mechanics, or the vestibular system may be contributing to your balance problems.
From there, we’ll build a treatment plan around your needs and goals. That may include strengthening, balance training, gait training, functional exercises, or vestibular rehabilitation when appropriate.
The goal isn’t simply to perform better on a balance test. It’s to help you feel steadier and more confident doing the things that matter in everyday life.
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Frequently Asked Questions
Why do I suddenly feel unsteady when walking?
Unsteady walking can have many causes, including vestibular problems, muscle weakness, vision changes, medications, neurological conditions, or other medical issues. Sudden or severe changes in balance should be medically evaluated, particularly when accompanied by other new symptoms.
Can physical therapy improve balance?
Yes. When balance problems are related to issues physical therapy can address, treatment may improve strength, coordination, walking, postural control, and confidence. Vestibular rehabilitation can also help people with certain inner ear and vestibular conditions.
Does an inner ear problem always cause dizziness?
No. Inner ear conditions are one possible cause, but dizziness can also be associated with medications, blood pressure changes, neurological conditions, and other health issues. An evaluation can help determine the appropriate next step.
What is vestibular physical therapy?
Vestibular physical therapy is specialized rehabilitation designed for certain disorders affecting balance and the vestibular system. Depending on the diagnosis, treatment may include gaze-stability exercises, balance training, habituation exercises, walking activities, or repositioning maneuvers.
Should I use a cane if I feel unsteady?
A cane or other assistive device can improve safety for some people, but the right device and fit depend on your individual needs. A physical therapist can assess your walking and recommend and fit an appropriate device if needed. The more important question to ask is, “Why do you feel like you need the cane?” A physical therapist can help find the answers and solutions.