Balance Problems and Falls: Understanding What Causes Unsteadiness

Experiencing balance problems and feeling less steady on your feet than you used to is one of those changes people tend to keep quiet about, often for years and this can gradually erode confidence. It can be unsettling when you have had a fall and the natural response is to become more guarded and cautious and slowly over time you find yourself doing less. All this unfortunately tends to make matters worse. Unsteadiness can be a little more common as we get older but it is not something you have to accept and it is also not down to one single cause.

Balance depends on several body systems working together and when one or two of those systems fade a little then the whole interconnected system can become less reliable. The encouraging part is that most of the things that undermine balance can be improved and the evidence for reducing falls through the right kind of exercise is strong.

This page explains why and roughly what age balance tends to decline, what raises the risk of a fall and where a careful assessment and staying active fits in. Chiropractic is only a small additional supplement to that picture and a good deal of what helps most can be motivated by you.

What affects your balance

Staying upright is a surprisingly complex process that your body normally does without you noticing. Your steadiness relies on the balance organs in the inner ear, in your eyes, in the position sense coming from the joints called proprioceptors, the muscles of your legs and feet pulling all this information to you brain where it id computed and then telling your muscles and joints where they are in space and what to do often quickly, to stop you falling over.

Good leg strength and core strength then carry out these instructions. When you are young and active, this system has plenty in reserve and lots of neurological connections. With age or with inactivity, each part naturally loses a little: the inner ear changes, eyesight dims, position sense dulls, reactions slow and leg muscles weaken. Stiff hips and ankles reduce the small corrective movements that keep you upright and certain medications dull down the whole system. Feeling unsteady is your body signalling that the reserve has narrowed. It is a signal for you to take proactive action and is not a forgone conclusion of decline.

Why balance declines and what raises falls risk

Falls almost never have a single cause. They usually result from several factors interacting, most of which can be reduced or managed.[3] The common contributors are reduced leg strength, slower reactions, stiff hips and ankles, changes in vision, inner-ear changes. Also the effects of certain medicines, particularly sedatives, sleeping tablets and some blood pressure drugs may contribute to becoming a fall risk. Dizziness on standing from a drop in blood pressure, unsuitable footwear and trip hazards around the home all add to these factors.

There is also a quieter factor: “FEAR”. After a stumble or a fall, it is very natural to become cautious, move less and avoid certain activities but that loss of pursuit weakens the legs and dulls the reactions further, which raises the risk once  again.

Breaking that cycle by staying active safely is one of the best things you can do and most of the factors mentioned above are changeable. Chiropractic treatment may help.

Why addressing your balance problems matters

Around one in three people over 65 years old has had a fall each year. Beyond the immediate risk of injury a fall can dent your confidence and start a gradual slide towards inadvertently doing less. National guidance now recommends that anyone in a group deemed to be ‘at risk’ is asked about falls each year so that risks can be identified early and acted upon.[1] The point worth knowing is that falls are not an inevitable part of ageing to be endured by any means at all. “Fall Risk” can be measured, controlled and lowered.

a red wall and a man in a red top walking downhill with no balance problems because he is walking and exercising

How chiropractic care may help

Firstly and importantly, I do not treat balance disorders and I do not claim to prevent falls.

What I can do is assess the musculoskeletal parts of the picture: your leg and core strength, the mobility of your hips, knees and ankles, your posture and the way you walk and whether stiffness or weakness in any of these areas is adding to how unsteady you feel. Where I find something I can help with, such as a stiff joint or a movement pattern that can be improved, I will work on it and show you what to do to help yourself. Just as importantly, I will point you towards the things that carry the strongest medical evidence and towards your GP for a full falls assessment if that is what is needed.

The evidence says that the single most effective thing for reducing falls is exercise and a large Cochrane review found that exercise reduces the rate of falls by around a quarter, with balance and functional training the most effective type of exercise and the benefits are even larger when a health professional is involved.[2] Structured strength and balance programmes such as the Otago programme have their own good evidence behind them.[4] National guidance recommends that older adults build up to strength and balance activity on at least two days each week.[5]

My role, as a chiropractor, sits alongside all of that evidence I can help you move more comfortably and stay active so that you can actually do the exercise that works and I make sure nothing musculoskeletal is holding you back. For more practical advice and further information I suggest reading my falls prevention guide in detail.

Headshot of Leslie Budzynski DC, BCA registered Bournemouth Chiropractor at Bournemouth Chiropractic

Related guides

These pages cover the areas most closely connected to staying steady and independent:

If you feel unsteady and your balance issues are getting in the way of things you would rather be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

Book a free consultation

Or call for a chat on 01202 937568

Red flags: When to see a doctor about balance problems

Some unsteadiness and some falls need medical assessment rather than hands-on treatment and a few need it urgently. If a fall involved fainting, a blackout or any loss of consciousness needs prompt medical attention to check other systems such as the heart and circulation, because it may not be a balance problem at all.

Sudden unsteadiness that comes on with slurred speech, facial drooping, weakness down one side or a severe headache is a medical emergency and you should call 999 without delay. Dizziness where the room spins or dizziness that comes on when you stand up, should be checked by your GP. If you have had repeated falls without an obvious explanation, please ask your GP for a falls assessment, which looks systematically at all the contributing factors together.[1]

Your first visit to Bournemouth Chiropractic

Your first appointment starts with a full history, including any falls, dizziness and the medicines you have been prescribed or any injuries you may have incurred as the result of a fall or otherwise. This is followed by an examination of your strength, joint mobility, posture and the way you move. Then I can give you an honest view of what is contributing to your feelings of unsteadiness and offer you a clear plan, including where to turn for the parts of your presenting issue that sit outside chiropractic too. You can read more about what to expect at your first visit before you come in.

Frequently Asked Questions about Balance Problems

A chiropractor can assess the musculoskeletal contributors to unsteadiness, such as leg strength, joint stiffness and the way you walk, offer advice and signpost you to the approaches available with the best evidence. I do not treat balance disorders or prevent the falls themselves. The strongest evidence for reducing falls is exercise, so much of my role is helping you stay active enough in order to do that.

Usually several things at once rather than one cause unsteadiness as we age. Reduced leg strength, stiff joints, slower reactions, changes in vision and the inner ear and the effects of some medicines all combine. Because the causes are multiple, the most useful step is often a proper assessment that looks at all of them together.

The evidence points clearly to strength and balance exercise as a falls prevention measure. Build it up to at least twice a week, ideally as part of a structured programme. If you have had repeated or unexplained falls and are experiencing balance problems, ask your GP for a falls assessment as well, since some contributors, such as medication or blood pressure sit outside exercise.

Not quite, there is a difference between feeling dizzy and feeling unsteady on your feet. Dizziness, especially a spinning sensation or feeling faint on standing, points towards the inner ear, circulation or medication and should be checked by your GP rather than assumed to be ordinary unsteadiness. Dizziness could also be caused by an issue in your neck. Getting the cause right is the first step to dealing with it.

Try not to reduce activity because you are frightened of falling. Cutting back on activity weakens the legs and dulls the reactions that keep you upright, which raises the risk over time. The safer path is to stay active in a way that suits you, building strength and balance gradually, rather than winding down will help with balance problems.

Concerned about your balance?

If you have started to feel less steady and want to understand why, come and talk it through. If you would like to ask questions before committing to anything, I offer a free 15-minute consultation. This is a short, no-obligation chat to talk through what is going on and whether I am the right person to help. It is not an examination or treatment. A first appointment is different: it includes a full history, a physical examination and treatment. Whichever you choose, you will leave knowing more than when you arrived. You do not need a GP referral to see me as a chiropractor.

References

[1] National Institute for Health and Care Excellence. Falls: assessment and prevention in older people and people 50 and over at higher risk. NICE guideline NG249, 2025. Available at: nice.org.uk/guidance/ng249

[2] Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;1:CD012424. doi:10.1002/14651858.CD012424.pub2

[3] Ganz DA, Latham NK. Prevention of falls in community-dwelling older adults. New England Journal of Medicine. 2020;382(8):734-743. doi:10.1056/NEJMcp1903252

[4] Thomas S, Mackintosh S, Halbert J. Does the “Otago exercise programme” reduce mortality and falls in older adults? A systematic review and meta-analysis. Age and Ageing. 2010;39(6):681-687. doi:10.1093/ageing/afq102

[5] UK Chief Medical Officers. UK Chief Medical Officers’ Physical Activity Guidelines, 2019. Available at: gov.uk (search “UK Chief Medical Officers physical activity guidelines”)

Medical Disclaimer

The information on this website is for general informational purposes only and does not constitute medical advice, nor is it a substitute for diagnosis, treatment, or guidance from a qualified healthcare practitioner. If you have any health concern, please consult your GP or another appropriately qualified clinician. Chiropractic treatment isn’t suitable for everyone. Suitability is assessed at your initial consultation, with referral to another healthcare professional made where appropriate. Treatment outcomes vary between individuals, and no guarantee of results is made or implied.

Practitioner: Leslie Budzynski D.C. | Doctor of Chiropractic | GCC registration: 00043 | BCA membership number: 0072

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