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Unsteady on Your Feet? Discover the Top Reasons for Balance Issues and How to Prevent Falls with Expert Insights from MUSC Health Spine Center

Advance With MUSC Health
December 04, 2023
Person laying on the floor.

There are many reasons why people can be off-balance as they age. MUSC Health's Renée Rosati, D.O., is an interventional spine doctor in the MUSC Health Spine Center, who provides non-surgical spine care. Here, she explains why you might be having trouble with balance and ways you can prevent falls.

Frequency of Falls: Recognizing the Signs

"If you're falling once a month, that's more than you're supposed to fall; that's different from being clumsy," says Dr. Rosati, who focuses on musculoskeletal and spine conditions, including arthritis in the lower back and neck. "Falls can be detrimental to your neck and can damage your spine. It's important that you find out what's causing them and take precautions to prevent falling."

The Centers for Disease Control and Prevention (CDC) states that more than one out of four older people fall each year. Sometimes, a patient is falling often but doesn't want to admit it, says Dr. Rosati, confirming the CDC's report that less than half of patients tell their doctor they've fallen. "Talk honestly with your doctor if you're losing your balance often. Frequent falls are a sign you could have one of the conditions below."

Top Reasons for Imbalance and Fall Risks

  • Peripheral neuropathy is a condition that can prevent the nerves in your feet from "feeling" the space around them. This can cause you to be off-balance and at risk for falls. "Sometimes, lab tests are not able to find a reason for peripheral neuropathy. It can be part of the aging process," says Dr. Rosati, who performs nerve conduction studies and EMG to diagnose peripheral nerve injury.
    • Proprioception is a sensory system that gives your brain information about body movement and location. As part of the natural aging process, the proprioception system function decreases. This can mean a person's feet don't function or "feel" the ground and space as well as they used to.
    • A vitamin deficiency can impair your nerves and affect your sense of proprioception. "A deficiency in B12 has been associated with peripheral neuropathy," says Dr. Rosati. Low levels of vitamin D can lower bone strength and density, increasing imbalance and falls. To determine if a vitamin deficiency is the cause of balance issues, ask your primary care doctor (PCP) for a blood work panel.
    • Your PCP can also test for diabetes, which often causes nerve problems in the feet. You can help manage diabetes through a healthy diet, exercise, medicines and keeping track of your HgA1c regularly.
  • Vestibular balance disorder. The vestibular sensory system lives in the inner ear and any vestibular disfunction can cause vertigo. If you have a vestibular disorder, you may feel as if you're floating, or your surroundings are spinning. Like the proprioceptive system, the vestibular system is a sensory system that gradually changes with age. A physical therapist can help with movements and exercises to prevent vertigo. Some ENT doctors focus on inner ear disorders.
  • Stroke. If you have a history of a stroke, you may feel wobbly or dizzy, and this can lead to falls. A neurologist can order a brain MRI to determine if you've had a stroke.
  • Sometimes a patient can be off-balance and fall because they have a tight spinal canal in their neck, also known as central canal stenosis, which can cause cervical myelopathy, a medical term for pinching of the spinal cord. "You won't always have neck pain as a result of this condition," says Dr. Rosati, who notes that spine specialists diagnose cervical myelopathy based on a constellation of symptoms and reflexes.

    Other signs of a tight spinal canal in your neck include clumsiness with your hands and trouble using zippers, buttoning shirts or holding a toothbrush. New urinary or bowel incontinence is also sometimes a side effect. "Other medical conditions also cause incontinence, so a spine specialist can perform a physical exam and check reflexes to determine if they suspect cervical myelopathy. The next step is an MRI."

    Cervical myelopathy can happen gradually or suddenly, but only a physician can diagnose it. The treatment is surgery to allow the spinal cord more space. "This does not always reverse a patient's balance difficulties, but it can prevent the condition from progressing. The goal is to stop the condition before it progresses to the point where a patient can't walk well or loses strength in their arms or legs."

Precautions to Help Prevent Falls

"The most important thing you can do is prevent falls," says Dr. Rosati. The CDC reports that one out of five falls causes a serious injury, such as broken bones or injury to the head.

"If you feel off balance, use a four-point cane, walker or rollator," says Dr. Rosati. "Check your house for any rugs or items that might trip you on the way to the bathroom at night. Install grab bars in the shower or along steps and uneven walkways. An occupational therapist can do a home evaluation and help determine where there are fall risks in you or your loved one's home."

Growing older is a challenge and presents new obstacles to navigate, says Dr. Rosati, whose practice includes non-surgical spine care to reduce patients' pain so they can return to activities they enjoy. "I'm passionate about helping people rediscover the joy in life by recommending conservative options such as physical therapy, injections or non-narcotic medicines to manage their pain."

Connect with MUSC Spine Center

Safeguard your well-being with expert advice on fall prevention and spine care from MUSC Health Spine Center. Your journey to better balance starts here. To learn more, visit or call MUSC Health Spine Center.