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How Does Balance Work?

Our balance system is often taken for granted. On a day to day basis when you are feeling well, you might not sit to ponder or research the complexities that go into balance. However, when a component of your balance system is not functioning optimally, you may be left with dizziness, imbalance, and fatigue and seeking answers for the cause of your condition. To understand your symptoms, it's helpful to understand the three systems that are involved in maintaining your balance.

1. Inner Ear (vestibular system)

Vestibular System

The anatomy of the inner ear is complex but can be divided into two parts: hearing (the snail looking end) and balance. For now, we will discuss the balance part—called the labrinyth.

The labryinth contains a bony outside, and a membranous/jelly inside. All of our motion is detected through a change in fluid dynamics inside the components of this jelly system. It helps tell us how our head is moving in relation to gravity and speed.

The labryinth contains:

  • Utricle and Saccule: they are the base of the labyrinth and they help us detect gravity.

  • These organs contain hair cells which sit in a membrane. On top of the membrane, sits little rocks (called otoconia). In a crazy domino effect, when we move, fluid in this system moves, which moves the rocks, which moves the membrane and moves the hair cells. This all helps stimulate nerves from this system to tell your brain “Hey, I’m moving!”

  • Semicircular canals: they help us detect rotational head motion and velocity (speed). There are 3 of these crazy looking tubes

  • anterior, posterior and horizontal

  • each respective canal has a job and helps tell our brain and body about how we are moving our head either up/down, tilting, or turning side/side

  • at the end of each these tubes, there is a bulb with an organ called the cupula.

  • As we move our head, fluid in these canals is pushed around and moves the cupula, which stimulates nerves to tell our brain and our eyes that we are moving

This all helps us to give you a steady image while you look at something while moving (like scanning for items in the grocery store), and focus on a moving target while being still (watching your kids soccer game from the sideline).


Is your head spinning yet? Because mine is….

2. Visual System

Our visual system has direct connections to our vestibular system called Vestibular Ocular Reflex, or VOR for short.

When your head is moved in any direction, fluid is moved in those semicircular canals and produce a signal indicating velocity and direction of your motion.

Our visual (oculomotor) system is amazing because it responds to this signal by rotating the eyes at equal and opposite directions of our head motion.


So try this for a second… continue to try to read this screen and turn your head to the right.


Even though your head is turned, you are still reading. That’s because while your head moved to the right, your eyes moved to the left (that’s what equal and opposite direction means!).

Thats how your vestibular system communicates to your eyes to help maintain your vision with your head position and balance.

3. Joint Sense

For explanation on joint sense we are going to need to use some more fancy words...

SOMATOSENSATION! umm somato what now?...

Somatosensation is your bodies ability to sense your external environment through touch.

So this means you have information about where your body is in space because your feet sense you are on the ground when you stand. The joints in your feet send signals to your inner ear and brain that says you are standing on solid ground.

Our joints have direct connections to our vestibular system to help tell us where we are in relation to space and gravity: called vestibular spinal reflex (VSR).

  • Through this system, we are able to detect body motion in order to maintain upright posture.

Been walking on the beach lately? Do you notice that you have a harder time with you balance on sand than you do on concrete? You might have a weakness with your VSR!

difficulty walking on the beach

So why does this all matter?

how balance works

1. No individual system can provide all the necessary information for sensing motion of the whole body

2. Each system may contribute unique and essential information to our brain which allows for motor output (motion and action!)

3. Damage, injury, or weakness along any part of these systems has the potential of causing symptoms of dizziness, imbalance, headaches, and/or falls. But, the brain and body are always adapting and recovery is possible!

At Piton PT, we are certified in concussion and vestibular therapy and are the experts are getting the root of your issue and providing a specific program to get you back to living a better balanced and active life.

Piton PT provides physical therapy to all of NJ virtually.

Contact us to find out more information on how we can help you!

Call or text us at 732-691-4681 or email us at

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