Balance and Coordination.
What are balance and coordination problems?
Balance and coordination issues refer to the inability to maintain a controlled body position while upright or moving. Balance is the process of maintaining one's centre of mass within their base of support over the feet. Coordination involves smoothly and efficiently executing complex movements such as walking, changing directions, turning or standing up. Clinically reduced or poor coordination is termed ataxia.
Maintaining balance is a complex, continuous process that draws on input from three sensory systems — the vestibular system (inner ear), the visual system (eyes), and the somatosensory system (proprioception from joints, muscles and skin) — integrated by the cerebellum and processed by the central nervous system. When any of these systems is impaired, the nervous system attempts to compensate using the remaining inputs, but if the deficit is significant enough, balance and coordination will be noticeably affected.
Balance problems are not just a feature of older age. They occur across the lifespan in the context of neurological conditions, vestibular disorders, musculoskeletal conditions, medication side effects, and deconditioning — and they respond well to targeted physiotherapy regardless of the underlying cause.
Why does balance matter so much?
Falls are the leading cause of injury hospitalisation in Australians over 65. One in three adults over 65 falls at least once per year, and the consequences — hip fracture, traumatic brain injury, loss of independence and confidence — are frequently life-changing. Fear of falling itself becomes a significant impairment: people who have fallen or who feel unsteady restrict their activities, which produces the deconditioning and muscle weakness that further increases fall risk. Breaking this cycle through targeted balance rehabilitation is one of the most impactful interventions in physiotherapy.
What causes balance and coordination problems?
Balance and coordination issues can stem from a range of factors including neurological conditions such as Parkinson's disease, multiple sclerosis or stroke, head injuries including concussions or traumatic brain injuries, and inner ear problems such as Menière's disease or vestibular neuritis.
Other significant causes include peripheral neuropathy — impaired proprioception from diabetic or other neuropathy — lower limb weakness from any cause, cervicogenic dizziness from upper cervical dysfunction, medications (particularly antihypertensives, sedatives and some antidepressants), osteoporosis, post-operative deconditioning, and age-related decline in all three sensory systems simultaneously — the most common pattern in older adults presenting with balance problems.
In younger people, balance and coordination issues are more commonly associated with vestibular disorders, concussion, hypermobility and its associated autonomic dysfunction (POTS), and neurological conditions.
How is it assessed?
A comprehensive assessment includes physical examination assessing walking patterns, stance and ability to perform coordinated movements, neurological examination checking reflexes, strength and sensation, and balance testing using special tests to evaluate inner ear and balance function.
Standardised clinical balance assessment tools include the Berg Balance Scale — a 14-item scale assessing static and dynamic balance in functional tasks — the Timed Up and Go (TUG) test, which measures the time taken to stand from a chair, walk three metres, turn and return, and is one of the most widely validated fall risk screening tools, the Dynamic Gait Index (DGI), and the MiniBESTest. These provide objective, measurable baseline and outcome data that track progress through rehabilitation.
The Romberg test and its variants assess the contribution of vision, proprioception and vestibular input to postural stability by systematically removing one input at a time. A positive Romberg — significant sway increase with eyes closed — suggests that the patient is relying heavily on vision to compensate for impaired proprioceptive or vestibular input.
How can physiotherapy help?
Physiotherapy offers an individualised approach to tackle balance and coordination challenges through gait and balance training with exercises and strategies to improve walking patterns and enhance stability, strength training focusing on muscles that support balanced movement, vestibular rehabilitation techniques to address inner ear issues causing dizziness or imbalance, and functional training with tailored exercises that mimic daily activities to enhance independence and safety.
The physiotherapy approach is calibrated to the underlying cause of the balance problem. Where vestibular dysfunction is the primary driver, vestibular rehabilitation therapy — including canalith repositioning for BPPV and gaze stabilisation and habituation exercises for vestibular hypofunction — is the primary intervention. See our vestibular disorders page for detail.
Where lower limb weakness and deconditioning are primary contributors — as in post-surgical patients, older adults with sarcopenia, or patients following stroke — progressive lower limb strengthening and gait retraining are prioritised alongside the balance training.
Where proprioceptive deficit is the driver — peripheral neuropathy, post-ankle sprain, after lower limb surgery — sensory retraining and progressive balance challenges on unstable surfaces restore the proprioceptive feedback that the nervous system needs for postural control.
Task-specific balance training — practising the exact functional activities that are difficult and dangerous — produces the most direct functional improvement. Sit-to-stand practice, step negotiation, outdoor walking, and dual-task activities (walking while talking or carrying something) all translate directly to real-world safety and confidence.
Environmental modification and assistive device assessment — walking aids, grab rails, shower chairs, adequate lighting, non-slip mats — are important parallel interventions that reduce fall risk while rehabilitation progressively improves underlying balance capacity.
Clinical Pilates provides an excellent controlled environment for balance and coordination rehabilitation — the emphasis on body awareness, precise movement control and progressive challenge is directly aligned with balance rehabilitation goals. The reformer, balance boards and unstable surface work provide graded proprioceptive challenges in a safe, supported environment.
Our Balance and Bones exercise classes are specifically designed for older adults managing falls risk, osteoporosis and age-related balance decline — combining the resistance training stimulus needed for bone health with progressive balance and coordination challenges in a monitored small-group environment. See our Balance and Bones page for more detail.
For NDIS participants with balance and coordination impairments, physiotherapy for falls prevention and balance rehabilitation is claimable under therapeutic supports. See our NDIS physiotherapy page.
Prognosis varies based on the underlying cause. While age-related changes are irreversible, training and physiotherapy can help manage symptoms, slow down the progression of balance loss and improve quality of life. For conditions like vestibular neuritis, most individuals recover with treatment. Ongoing physiotherapy plays a vital role in improving and maintaining balance and coordination regardless of the cause.
Our physiotherapists Yulia Khasyanova, Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in balance and coordination rehabilitation and falls prevention and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Balance and coordination issues refer to the inability to maintain a controlled body position while upright or moving. Balance is the process of maintaining one's centre of mass within their base of support over the feet. Coordination involves smoothly and efficiently executing complex movements such as walking, changing directions, turning or standing up. Clinically reduced or poor coordination is termed ataxia.
Maintaining balance is a complex, continuous process that draws on input from three sensory systems — the vestibular system (inner ear), the visual system (eyes), and the somatosensory system (proprioception from joints, muscles and skin) — integrated by the cerebellum and processed by the central nervous system. When any of these systems is impaired, the nervous system attempts to compensate using the remaining inputs, but if the deficit is significant enough, balance and coordination will be noticeably affected.
Balance problems are not just a feature of older age. They occur across the lifespan in the context of neurological conditions, vestibular disorders, musculoskeletal conditions, medication side effects, and deconditioning — and they respond well to targeted physiotherapy regardless of the underlying cause.
Why does balance matter so much?
Falls are the leading cause of injury hospitalisation in Australians over 65. One in three adults over 65 falls at least once per year, and the consequences — hip fracture, traumatic brain injury, loss of independence and confidence — are frequently life-changing. Fear of falling itself becomes a significant impairment: people who have fallen or who feel unsteady restrict their activities, which produces the deconditioning and muscle weakness that further increases fall risk. Breaking this cycle through targeted balance rehabilitation is one of the most impactful interventions in physiotherapy.
What causes balance and coordination problems?
Balance and coordination issues can stem from a range of factors including neurological conditions such as Parkinson's disease, multiple sclerosis or stroke, head injuries including concussions or traumatic brain injuries, and inner ear problems such as Menière's disease or vestibular neuritis.
Other significant causes include peripheral neuropathy — impaired proprioception from diabetic or other neuropathy — lower limb weakness from any cause, cervicogenic dizziness from upper cervical dysfunction, medications (particularly antihypertensives, sedatives and some antidepressants), osteoporosis, post-operative deconditioning, and age-related decline in all three sensory systems simultaneously — the most common pattern in older adults presenting with balance problems.
In younger people, balance and coordination issues are more commonly associated with vestibular disorders, concussion, hypermobility and its associated autonomic dysfunction (POTS), and neurological conditions.
How is it assessed?
A comprehensive assessment includes physical examination assessing walking patterns, stance and ability to perform coordinated movements, neurological examination checking reflexes, strength and sensation, and balance testing using special tests to evaluate inner ear and balance function.
Standardised clinical balance assessment tools include the Berg Balance Scale — a 14-item scale assessing static and dynamic balance in functional tasks — the Timed Up and Go (TUG) test, which measures the time taken to stand from a chair, walk three metres, turn and return, and is one of the most widely validated fall risk screening tools, the Dynamic Gait Index (DGI), and the MiniBESTest. These provide objective, measurable baseline and outcome data that track progress through rehabilitation.
The Romberg test and its variants assess the contribution of vision, proprioception and vestibular input to postural stability by systematically removing one input at a time. A positive Romberg — significant sway increase with eyes closed — suggests that the patient is relying heavily on vision to compensate for impaired proprioceptive or vestibular input.
How can physiotherapy help?
Physiotherapy offers an individualised approach to tackle balance and coordination challenges through gait and balance training with exercises and strategies to improve walking patterns and enhance stability, strength training focusing on muscles that support balanced movement, vestibular rehabilitation techniques to address inner ear issues causing dizziness or imbalance, and functional training with tailored exercises that mimic daily activities to enhance independence and safety.
The physiotherapy approach is calibrated to the underlying cause of the balance problem. Where vestibular dysfunction is the primary driver, vestibular rehabilitation therapy — including canalith repositioning for BPPV and gaze stabilisation and habituation exercises for vestibular hypofunction — is the primary intervention. See our vestibular disorders page for detail.
Where lower limb weakness and deconditioning are primary contributors — as in post-surgical patients, older adults with sarcopenia, or patients following stroke — progressive lower limb strengthening and gait retraining are prioritised alongside the balance training.
Where proprioceptive deficit is the driver — peripheral neuropathy, post-ankle sprain, after lower limb surgery — sensory retraining and progressive balance challenges on unstable surfaces restore the proprioceptive feedback that the nervous system needs for postural control.
Task-specific balance training — practising the exact functional activities that are difficult and dangerous — produces the most direct functional improvement. Sit-to-stand practice, step negotiation, outdoor walking, and dual-task activities (walking while talking or carrying something) all translate directly to real-world safety and confidence.
Environmental modification and assistive device assessment — walking aids, grab rails, shower chairs, adequate lighting, non-slip mats — are important parallel interventions that reduce fall risk while rehabilitation progressively improves underlying balance capacity.
Clinical Pilates provides an excellent controlled environment for balance and coordination rehabilitation — the emphasis on body awareness, precise movement control and progressive challenge is directly aligned with balance rehabilitation goals. The reformer, balance boards and unstable surface work provide graded proprioceptive challenges in a safe, supported environment.
Our Balance and Bones exercise classes are specifically designed for older adults managing falls risk, osteoporosis and age-related balance decline — combining the resistance training stimulus needed for bone health with progressive balance and coordination challenges in a monitored small-group environment. See our Balance and Bones page for more detail.
For NDIS participants with balance and coordination impairments, physiotherapy for falls prevention and balance rehabilitation is claimable under therapeutic supports. See our NDIS physiotherapy page.
Prognosis varies based on the underlying cause. While age-related changes are irreversible, training and physiotherapy can help manage symptoms, slow down the progression of balance loss and improve quality of life. For conditions like vestibular neuritis, most individuals recover with treatment. Ongoing physiotherapy plays a vital role in improving and maintaining balance and coordination regardless of the cause.
Our physiotherapists Yulia Khasyanova, Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in balance and coordination rehabilitation and falls prevention and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
