Dr. Guiteras wrote a medical advice column for the Chapel Hill Herald from 1980 to 2000. He is now reviving the column for the CHFM website. The opinions expressed herein are those of the author, not necessarily those of the management of CHFM; even so, you can trust what you read here. If you have a question that you would like to have considered for this monthly column, send it to askgpg@yahoo.com. We will consider it for reply and reserve the right to edit the question to suit our needs. Please do not use this email address for any other purpose. Question: I’ve noticed that my balance is going bad. I feel unsteady when I walk down stairs and I feel like a toddler when walking in the dark. My golf swing has gone to pot – I’m easy prey for guys I used to mop the floor with. I can’t quite figure it out. Is it just my age? I’m 70 and in pretty good health. What’s going on? Answer: Balance problems are common among older people. The list of causes is long. It could be the depredations of age. After all, you can’t run as fast or jump as high as you could when you were 20, can you? Unfortunately, but not surprisingly, your balance may falter. But what causes this deterioration? Let’s start at the bottom and work our way up. We take our lowly feet for granted but they are what connect us to Mother Earth. If they hurt, you won’t connect to Mama so well. Old feet are like the guy who sang Old Man River: you can almost hear Right say to Left, “You and me, we sweat and strain, body all achin’ and wracked with pain.” If they hurt too much, they won’t cooperate when you want to walk a straight line or tiptoe through the tulips. The fibrofatty pad that cushions the foot gives way and the metatarsals complain; bunions grow, toes bunch up, pretty soon you’ve got uncooperative feet. Another thing can go wrong in the feet. The nerves give out. Way down here, the poor little spindly things just can’t make it forever; after decades of sending signals at lightspeed up to your brain, telling the body exactly where it is and how it is oriented in space, the peripheral nerve may run out of steam. Consider your knees and hips for a moment. Are they a little cranky? Do you want to give one a break during your walk? Think about it – when humans walk, they spend only a brief time on two feet. Most of the time we are bearing weight on one leg only. So if one side is gimpy, well, you’ve got an unstable situation. If you lurch to one side when walking, think of the problems this causes for maintaining balance. If you think these things are complicated, you ain’t seen nothing yet. We’ve still got the eyes, inner ear and the brain to deal with. Your eyesight plays a role in balance. If things look fuzzy, you might find it difficult to navigate uneven terrain, or even the hallway to the bathroom, in the dark. The semicircular canals of the inner ear are one of Nature’s triumphs. When you study their anatomy and physiology, you can scarcely believe such a structure exists, much less actually works. Its works are more than we can get into with detail but you should know that this structure consists of three small tubes arrayed in different planes, each bearing tiny stones suspended in fluid. These stones move in relation to the orientation of the head, fall against nerve endings which then send signals to the brain, telling it (and you) where you are in space, all this data being correlated instantaneously with signals coming from your eyes, your feet, your cerebellum, your cerebrum and who knows where else. Then we’ve got the cerebellum, that unpretentious lump of tissue at the back of the brain. It is the yeoman of the central nervous system, an humble poor relation of the haughty cerebrum. All it does is control balance. If it is grossly damaged, it’s almost impossible to function (though persons born without one may never miss it). You fall, you lurch, you stumble around. Imagine what happens if it just gets old. You may not fall, lurch or stumble but you won’t be nimble or quick. You won’t become a prima ballerina, a point guard or a high wire performer. What can we do about these insults to our balance, to say nothing of our self esteem as we hop about the bedroom like a drunken Great Blue Heron, trying desperately to pull on our Ralph Lauren briefs before crashing headlong into the Heppelwhite chest of drawers, much to the amusement of our spouse? Are we lost in physical ineptitude, decrepitude and uselessness? No, no, I say. We can fight back, take control (or, at least, lose control more slowly), even improve our balance. How do we do this? Well, it’s not easy and it will take time. Good nutrition, less alcohol and more sleep will help – as these measures improve any body function. More specifically, if your feet hurt, get good shoes that support and cushion. If store bought shoes don’t meet the need, see a podiatrist. Maybe orthotics will help. Exercise is the cornerstone. You need to strengthen your arms, your legs, your spinal and abdominal muscles. Lifting weights will help a great deal. You need to do this regularly, avoiding overuse and acute injury. Don’t overdo. Balance, flexibility and coordination exercise such as tai chi, yoga or dance are excellent defenses against a crumbling balance apparatus. You could try martial arts training. Whatever you do, take your time with it. Get good instruction. Avoid excess. Practice. Practice. Practice. You will feel better, look better and – who knows? – maybe even look dignified in those Ralph Laurens mini-briefs. Remember the usual caveat of medical columnists: see your doctor. Get things checked out. Make sure it’s “only” Old Age working on you, not something else. Want more? 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