If you’ve spent any time searching for how to improve your balance, you’ve probably found a lot of lists: “5 exercises to prevent falls,” “10 balance moves for seniors,” things like that. As a physical therapist who has a love of working with older adults, I want to let you in on something: those lists aren’t wrong, exactly, but they’re not really the answer either.
Balance isn’t one thing. It’s the output of several systems working together. Your strength, your vision, your inner ear (vestibular system), the sensors in your joints and feet that tell your brain where your body is in space, your reaction time, and even your confidence and fear of falling all play into what your balance is like. When any one of those pieces is off, your balance suffers, but the exercise that helps depends entirely on which piece is off.
That’s why I don’t hand every patient the same home exercise program. The first thing I’m doing in an evaluation isn’t picking exercises, it’s figuring out what’s actually driving the instability. Two people can walk in both saying “my balance is bad,” and leave with completely different plans, because the root cause is different!
The Same Exercise, Modified Many Ways
Take single-leg stance, standing on one foot. It shows up on almost every generic balance list and it can be useful. But “useful” doesn’t mean “one-size-fits-all.” Depending on what someone needs, that same exercise might look like:
- Standing on one foot with eyes open, holding a counter, for someone just getting reacquainted with balance work
- The same stance with eyes closed, to challenge the vestibular and joint-position systems more directly
- Standing on a folded towel or foam pad, to reduce the reliable input from the feet and force the brain to rely more on other systems
- Adding a head turn or a mental task (like counting backward), to train balance the way it’s actually challenged in daily life — while your attention is on something else
- Practicing it as part of a functional movement, like reaching to a shelf or turning to check for traffic
None of these variations require different equipment or a different “exercise.” What changes is how we load the specific system that needs work. That’s the difference between a generic list and an individualized plan.
Why This Matters More As We Age
This individualized approach matters even more with geriatric patients, because the reasons balance declines are so varied. It might be:
- A strength deficit from disuse or a recent illness or surgery
- A vestibular issue that hasn’t been formally diagnosed
- Sensory loss in the feet, sometimes related to diabetes or neuropathy
- Vision changes
- Fear of falling that’s become its own limiting factor, separate from the physical impairment that started it
- A combination of several of these at once
Treating all of these with the same exercise list means some patients get exercises that don’t address their actual problem, and others get exercises that are either too easy to create change or too advanced to be safe.
If you’re working on your balance, generic lists aren’t harmful, and they’re a reasonable starting point if you have no other guidance. But if you’ve had a fall, a near-fall, or you just don’t feel steady anymore, the most valuable thing isn’t a new exercise, it’s an evaluation that identifies what’s actually driving the problem so your time and effort go toward the thing that will actually move the needle.
That’s the work I do every day with older adults, and it’s honestly my favorite part of the job: not handing someone a printout, but figuring out their specific picture and building a plan around it.
If that sounds like what you need, I’d love to see you for an evaluation.
Dr. Rachel Atufunwa, PT, DPT