Reset Your Equilibrium: Alleviate Dizziness and Improve Your Balance
Dizziness is an indicator your body is not keeping you balanced. Between 15-20% of adults experience dizziness in a year, rising to 40% in adults over 40. Whether you've experienced migraines, a sudden drop in your sugar levels, or loose crystals in the inner air you'll know all about the uncomfortable side-effects of light-headedness to severe vertigo. It can last minutes or days.
Balance requires a synergy between the inner ear, your eyes and sensors in your muscles and joints. If there is any conflict between these three, dizziness can occur. It may be poor sight, loss of feeling in your feet after cancer treatment or loose crystals in the inner ear.
Why else would Exercise Instructors torture you with challenging balance exercises by making you stand on one leg like a flamingo or wobble around on balance pads with eyes closed? It's for your own good - promise.
The good news is that alongside specific vestibular exercises, there are other simple remedies to address dizziness.
Why Do People Get Dizzy?
Dizziness happens when your brain receives conflicting or incomplete signals about where your body is in space. The causes range from something as simple as standing up too fast to conditions affecting the inner ear, blood pressure, or brain.
The Anatomy & Physiology
Our sense of balance depends on three systems working together: your inner ear, your eyes, and sensors in your muscles and joints that track your body’s position. Deep inside each inner ear sits a set of structures called the vestibular system, which includes three semicircular canals and two small organs called the utricle and saccule. These structures are filled with fluid and lined with microscopic hair cells. When your head moves, the fluid shifts, bending the hair cells, which fire electrical signals through the vestibular nerve to your brain.
Your brain constantly cross-references these inner ear signals with what your eyes see and what your muscles and joints report about your posture. When all three inputs agree, you feel steady. When they conflict, you feel dizzy. This is the core mechanism behind nearly every type of dizziness, from a brief lightheaded moment to full-blown vertigo where the room seems to spin.
Causes
Loose Crystals in the inner ear is the most common cause of vertigo. Episodes are brief but very disorientating. It can be resolved with specific head movements that guide the crystals back to where they should be.
Standing Up too fast. What I didn't know was that it is defined as a drop of at least 20 points in systolic blood pressure (the top number) or 10 points in diastolic pressure (the bottom number) within three minutes of standing. Or that it's caused by gravity pulling blood towards your legs and that too slow a response from your nervous system to tighten the blood vessels and increase the heart rate means your BP drops and your brain doesn't get enough blood flow. Dehydration makes this worse. So drinking more fluid after exercise or on a hot day is useful.
Common medications can cause dizziness, poor balance, or drowsiness. The major categories include:
Blood pressure drugs, including diuretics, calcium channel blockers, and ACE inhibitors, which can lower blood pressure enough to cause lightheadedness
Antidepressants, particularly SSRIs and SNRIs
Anti-anxiety medications like benzodiazepines
Antihistamines, especially older ones that cause drowsiness
Pain medications, including opioids and gabapentin
Diabetes medications that can drop blood sugar too low
Sleep aids
Heart medications like beta blockers and nitrates
It's worth flagging with your GP the timing of your dizzy spells if they correlate to starting a new medication.
Meniere's Disease & Fluid Build Up. This is a chronic inner ear condition caused by excess fluid building up in the vestibular system. That extra fluid disrupts both balance and hearing signals traveling to the brain. The hallmark is episodes that combine vertigo (sometimes so severe people fall), hearing loss that tends to affect lower-pitched sounds first, ringing in the ear, and a feeling of fullness or pressure in one ear. Episodes come and go unpredictably, and over time, hearing loss can become permanent.
Vestibular Migraines. Vestibular migraines cause moderate to severe dizziness or vertigo that can last anywhere from five minutes to 72 hours. About 30% of people with vestibular migraines have episodes lasting minutes, another 30% experience hours-long attacks, and roughly 30% deal with episodes stretching over several days. At least half of episodes come with typical migraine features: one-sided pulsating head pain, sensitivity to light and sound, or visual aura.
Motion Sickness
Low Blood Sugar & Metabolic Causes. This is fascinating. Your brain runs almost entirely on glucose. When blood sugar drops too low, whether from skipping meals, overexerting yourself, or as a side effect of diabetes medication, the brain’s energy supply falters and dizziness is one of the first symptoms. This type of dizziness usually feels like lightheadedness or faintness rather than spinning, and it typically improves quickly after eating or drinking something with sugar.
Anemia, where your blood carries less oxygen than normal, can produce a similar sensation. So can hyperventilation from anxiety or panic, which changes the balance of carbon dioxide in your blood and temporarily reduces blood flow to the brain.
What Else Affects Our Balance?
Other factors that contribute to unsteadiness on our feet are:
Nerve damage to your legs (peripheral neuropathy). The damage can lead to difficulties with walking.
Joint, muscle or vision problems. Muscle weakness and unstable joints can contribute to your loss of balance. Difficulties with eyesight also can lead to unsteadiness.
Medications. Loss of balance or unsteadiness can be a side effect of medications.
Certain neurological conditions. These include cervical spondylosis and Parkinson's disease.
Ways to Reset Your Equilibrium
The most effective way to reset your equilibrium depends on what’s throwing it off, but the single most common fix is a simple head maneuver that repositions tiny crystals inside your inner ear.
Epley maneuver, resolves vertigo in about 92% of people within one week. You'll need a qualified practitioner to guide you through these.
Brandt-Daroff exercises (Pic above) offer a gentler, repetitive approach you can do at home. These exercises gradually help your brain adapt to the abnormal signals and may also encourage stray crystals to resettle over time.
Sit on your bed with feet flat on the floor
Quickly lie down on one side with your head turned slightly upward. Stay in that position until any dizziness subsides, plus an additional 30 seconds.
Sit back up and wait another 30 seconds. Then lie down on the opposite side and repeat. Do five repetitions of this cycle, three times per day.
These exercises tend to work more slowly than the Epley maneuver. Expect to practice for one to three weeks before noticing consistent improvement.
Vestibular Rehabilitation is used when the cause is not loose crystals and is related to a head injury, aging and other conditions. The cornerstone of vestibular rehabilitation is gaze stabilization exercises. These involve holding your eyes fixed on a target while moving your head in different directions. The goal is to strengthen the reflex that keeps your vision steady during head movement, which is often weakened after inner ear damage. Over several weeks, these exercises improve visual clarity during motion and reduce the sensation of dizziness. A vestibular physical therapist will tailor the program to your specific deficits, progressively increasing the speed and complexity of the movements as your brain adapts.
Other exercises in a vestibular rehab program may include standing on unstable surfaces, walking with head turns, or practicing balance with your eyes closed. The common thread is deliberately challenging your balance system in controlled ways.
Lifestyle Factors. Migraine-associated dizziness can cause spinning, swaying, or a vague sense of imbalance without any headache at all. Common dietary triggers include alcohol (particularly red wine and beer) and caffeine from coffee, tea, or coke cola. Reducing or eliminating these can meaningfully decrease episodes in people whose imbalance has a migraine component. Dehydration and poor sleep also undermine the balance system.
Dizziness can occasionally indicate a stroke. This needs medical intervention.
5 Balance Exercises
Once you've reset your equilibrium, make these exercises a daily habit as recommended by the NHS to improve your balance.
Exercises 1, 2 and 3
Exercises 4 and 5
Side to Side: Stand tall, feet together, knees soft. Step out to the left in a slow, controlled way, keeping your hips level. Bring the other foot in. Repeat on the other side. x 10
Grapevine: Cross your right foot over your left foot and bring your left foot next to your right. Repeat in the opposite direction. x 10
Heel to Toe: Bring your right foot in front of your left foot, standing tall and looking forwards. Bring your left foot in front of your right foot. Continue until you run out of space. Use a wall if needed. x 2
One Leg Standing: face a wall with fingers touching, transfer your weight to the right foot and lift up your left foot. Hold for up to 30 secs. Gently place your foot back down. Repeat the other side. x 6
Step Up: Stand at the bottom of the staircase or in front of a step with a banister or wall to one side. Step up with your right leg. Bring your left leg to join. Step down again using the starting foot. x 10
To summarise, dizziness is a problem for many. Its causes are not always obvious though loose crystals in the inner ear is the most common cause of vertigo. Whether you experience migraines, dizziness or poor balance, it is worth checking any medication side-effects, eating a balanced diet to manage your glucose levels, reducing caffeine and alcohol or being referred to a vestibular physical therapist if symptoms persist. When you're symptom-free try doing the 5 balance exercises as a daily practise to strengthen your ankles and deep postural muscles for better balance.
If you're interested in joining a regular pilates class to improve your balance and posture and strengthen your core, you can book my November course here
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