Balance, the Brain and the Nervous System: Looking Beyond the Muscles

2 days ago

5 min read

Walking quickly requires the brain and nervous system to co-ordinate the movement.

When we think about balance, we often think about strong legs, good muscles and being physically fit.

But balance is much more than that.

Balance is a brain function.

Your ability to stand upright, walk across a room, change direction, negotiate uneven ground or catch yourself when you stumble depends on an extraordinary amount of information being gathered, processed and coordinated by your nervous system.

This becomes particularly important when someone develops balance problems following a neurological event such as a stroke.

And it raises an interesting question:

Could looking at the nervous system more broadly be part of supporting someone who is struggling with balance?

Balance is a conversation between the brain and the body

Every moment you are standing or moving, your brain is receiving information from several different systems.

Your eyes tell your brain where you are in relation to your surroundings.

Your inner ears provide information about movement and orientation through the vestibular system.

Your muscles and joints provide information about where different parts of your body are positioned and how they are moving. This is called proprioception.

Your brain then has to integrate all of this information and coordinate an appropriate response.

This happens largely without conscious thought.

You don't normally have to think:

"My left foot is here, my ankle is moving this way, my head is tilting slightly and I need to activate these muscles to stop myself falling."

Your nervous system simply does it.

That is why balance problems are not always simply a problem with the legs.

They can be a problem with how the brain is receiving, processing and responding to information from the body and the environment.

What happens after a stroke?

A stroke can affect different areas of the brain, so the effects can be very different from one person to another.

Some people experience weakness or changes in coordination.

Others may have difficulty with walking, vision, spatial awareness, sensation or balance.

And someone who was previously extremely fit and athletic can still experience significant balance problems after a stroke.

Being physically strong does not necessarily mean that the nervous system is able to coordinate movement in the same way it did before.

This is an important distinction.

Strength and neurological control are not the same thing.

Stroke rehabilitation therefore often involves much more than simply strengthening muscles.

Modern rehabilitation approaches may include gait training, balance training, trunk control, visual feedback, motor imagery, vestibular rehabilitation and other task-specific therapies. Current stroke recommendations emphasise coordinated care involving the different professionals involved in a person's recovery.

The vestibular system and balance

One particularly interesting part of this picture is the vestibular system.

The vestibular system is located in the inner ear and provides the brain with information about head movement and orientation.

It works together with vision and information from the muscles and joints to help us maintain our orientation and balance.

Research into stroke rehabilitation has found that vestibular rehabilitation can improve balance and gait in people following stroke. A systematic review and meta-analysis of 15 randomised controlled trials involving 769 participants found moderate-certainty evidence that vestibular rehabilitation improved balance, with benefits also seen in gait function.

More recent research has continued to support this approach, including in people living with longer-term effects of stroke.

This doesn't mean that everyone with balance problems needs vestibular rehabilitation.

It does, however, demonstrate something important:

Balance is a neurological process involving multiple sensory systems — not simply a question of muscle strength.

So where does chiropractic fit?

This is where I believe it is important to be both open-minded and realistic.

Chiropractic should not be presented as a treatment for stroke, and chiropractic care should never replace appropriate medical assessment, stroke management or neurological rehabilitation.

Instead, I am interested in the relationship between the brain, the nervous system and the body.

My approach to chiropractic is based on the idea that the nervous system is constantly receiving information from the body and the environment, processing that information and coordinating the body's responses.

This is one reason I use a gentle neurological approach called Torque Release Technique (TRT).

Rather than thinking only in terms of muscles, joints and symptoms, I am interested in how the body and nervous system are functioning as a whole.

That doesn't mean that a chiropractic adjustment can "fix" a damaged area of the brain.

It means that, where appropriate, chiropractic care can be considered as one part of a broader approach to nervous-system and physical health.

Looking at the whole person

When someone presents with balance problems, particularly following a neurological event, there are many questions worth asking.

For example:

How is their walking?
How stable are they when standing?
Can they turn safely?
How well can they respond when their balance is challenged?
Is there a visual component?
Is there a vestibular component?
How is their proprioception?
How well are the trunk and limbs coordinating?
Are there changes in strength or sensation?
How confident are they when moving?
What does their existing rehabilitation programme look like?

These questions help us move away from simply asking:

"What muscle is weak?"

and towards asking:

"How well is the nervous system coordinating the person as a whole?"

That is a very different way of looking at movement.

The importance of working as a team

For someone who has experienced a stroke or mini-strokes, this is particularly important.

A chiropractor should not work in isolation.

Depending on the individual, their care may involve a neurologist, GP, physiotherapist, occupational therapist, vestibular therapist, speech therapist or other healthcare professionals.

Good healthcare is not about one profession having all the answers.

It is about asking:

"What does this person need, and how can each member of their healthcare team contribute?"

Current stroke rehabilitation recommendations specifically emphasise coordinated, person-centred rehabilitation and ongoing assessment of balance, mobility and function.

Your nervous system is constantly adapting

One of the fascinating things about the nervous system is its ability to adapt.

The brain is not static.

Through practice, repetition and appropriate rehabilitation, the nervous system can learn and refine movement strategies.

This is one reason rehabilitation after stroke often focuses on repeated, meaningful movement and progressively challenging balance and mobility.

Research into post-stroke balance also uses measures such as the Berg Balance Scale, Mini-BESTest, walking tests and other functional assessments to understand changes in balance and mobility over time.

Recovery isn't necessarily about returning to exactly the way things were before.

Sometimes it is about helping the nervous system discover new and better ways of achieving a movement or task.

A different way of thinking about balance

If you are struggling with balance, it may be tempting to think:

"My legs aren't strong enough."

But balance is much more complicated than that.

It is the result of an ongoing conversation between your:

Brain → Eyes → Inner ears → Muscles → Joints → Spinal cord → Brain

All of these systems have to communicate effectively and respond appropriately.

That is why, when someone has a neurological history and is experiencing balance difficulties, it can be useful to look beyond the obvious symptom and consider the bigger picture.

And that is where the nervous system becomes so interesting.

Important note

If you have experienced a stroke, transient ischaemic attack (TIA), unexplained dizziness, sudden loss of balance or other new neurological symptoms, appropriate medical assessment is essential.

Chiropractic care is not a replacement for emergency medical care, neurological assessment or stroke rehabilitation.

For people already receiving medical or rehabilitation care, chiropractic care should be considered within the context of their individual circumstances and, where appropriate, alongside communication with their healthcare team.