Understanding Postural Control and Risk for Falling

Falls are an increasingly critical concern for older adults as well as healthcare providers. Each year approximately 30% of community dwelling older adults (65 years and older) report having at least one fall. These falls can lead to a cascade of consequences and morbidities, including hospitalization, functional decline, psychological changes, as well as, possible injuries leading to disability or even mortality.1,2 Disability due to falls increased by 54% from 1990 to 2010 resulting in falls being the 11th most common cause of disability in 2010.1

If fall prevention does not improve, there will be 48.8 million falls and 11.9 million fall injuries by the year 2030.3 Education is paramount in prevention. We must fully understand how to use the results of appropriate outcome measures to identify patient’s primary impairments and functional limitations in order to prescribe appropriate intervention.

One aspect of fall prevention is taking into account the aging body’s interaction with balance and postural control. It’s an important piece to understanding why we should be concerned about falls in later life. The goal is to grasp the underlying neurophysiological mechanism of postural control, and know how postural control changes over the lifespan.


Balance and Postural Control Basics

Postural control is a complex motor skill that requires interaction of multiple body systems.4,5 This interaction is constantly influenced by the limitations/impairments of the person, complexity of the task, and the type of environment.4 Successful interaction results in the ability to maintain postural orientation and postural equilibrium/postural stability. Postural control is the underlying quiet stance, also known as, static balance. In healthy individuals, quiet stance is characterized by a vertical line at midline between mastoid process, a point in front of the shoulder joint, hip joint, and a point in front of the ankle joint.4

Changes Over Time

Changes to the balance and postural control systems are gradual and variable depending on the adult in question. For things like vision, changes can be slight like sensitivity to glare or the narrowing of the peripheral field, while some changes are abnormal, like cataracts, glaucoma, macular degeneration, or diabetic retinopathy.

The neuromuscular and musculoskeletal systems also experience changes. Noticeable differences include decrease in muscular performance, flexibility, and power. More drastic implications of aging include onset of sarcopenia, postural changes, osteoporosis and osteoarthritis.

The key to a systematic assessment and affective treatment strategies is a thorough understanding of the conceptual definitions like postural orientation and control, the contributing anatomy and physiology, as well as the effect of aging and disease on the human body.

  1. Stubbs B, Binnekade T, Eggermont L, Sepehry A, Patchay S, Schofield P. Pain and the risk for falls in community-dwelling older adults: Systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2013;95(1):175–187
  2. Nilsson M, Eriksson J, Larsson B, Odén A, Johansson H, Lorentzon M. Fall risk assessment predicts fall-related injury, hip fracture, and head injury in older adults. Journal of the American Geriatrics Society. 2016;64(11):2242–2250.
  3. Falls and fall injuries among adults aged ≥65 years — United States, 2014 weekly/September 23, 2016 / 65(37);993–998. MMWR. Morbidity and Mortality Weekly Report. 2016;65. https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm. Accessed January 7, 2017
  4. Samuel A SJ, and Mohan D. A critical review on normal postural control. Physiotherapy and occupational Journal 2015;8(2):71-75.
  5. Pardasaney PK, Slavin MD, Wagenaar RC, Latham NK, Ni P, Jette AM. Conceptual limitations of balance measures for community-dwelling older adults. Phys Ther. 2013;93(10):1351-1368