The balance system in the body is called the vestibular system. It is a series of specialized nerve cells or receptors in the inner ear that connect to the brainstem. One of its main functions is to tell the brain where the head and body are in space at any given time. This very intricate system is always working because gravity is always at work on the body and the brain always needs to know where your head is in space.

For example, if you walked into an elevator and closed your eyes, you would know whether it was going up or down. If your eyes were closed and you were in a car, you would know whether or not it was moving AND if it was going forward or in reverse. These vestibular receptors are able to detect even the slightest movements.

So, the vestibular system is connected directly to the brain and it is connected to your muscular system (it tells your arms to extend to break a fall). It is also connected directly to your eyes. It tells your eyes to move in an equal and opposite direction and speed when you are looking at something while moving. Additionally, it is involved in blood flow to the brain as well as the autonomic nervous system.

Because of how sensitive this extensive neurological system is, it is vulnerable to infection and injury. Anything that interferes with how it works will create symptoms for one of two reasons; either the brain can’t understand where the head and body are, or the brain perceives movement that really isn’t happening. We describe these symptoms as vertigo, imbalance and dizziness. They are all slightly different but many people use the terms interchangeably.

When you have a vestibular problem, life can become very uncomfortable. The feeling of not knowing where you are in space, or spinning, or the world around you moving, or not being able to walk without falling to one side, or feeling faint when going from a seated to a standing position, or getting an intense vestibular migraine are all potentially life altering issues.

Unfortunately, this system declines with age (probably because adults don’t spend too much time on swings or doing tumbling or spinning activities to maintain a high level of function). That makes riding rollercoasters not nearly as fun at 60 years old as they were at 15 years old. This decline in function leads to increased risk of falls in the elderly as well.

Understanding the functionality of this system is critical to knowing how to handle a patient dealing with these issues. Of course many things can create these symptoms, but for the most part it is a functional problem that responds very well to an integrative rehabilitation approach.