Balance and the Systems That Drive It

PART 1: THE THREE SENSORY SYSTEMS

When I say the word “balance” in a Pilates class, I can predict what will happen. Bodies tense. Breath halts. Heads drop. Students close in on themselves, trying to hold onto stability by clenching every muscle they can recruit. But what if balance isn’t just about standing on one leg without falling? After more than twenty years teaching Pilates, ballet, and working with post-rehabilitation and special populations, I’ve come to understand balance as a trainable neuromuscular system involving multiple sensory pathways.

A client once told me, “I just can’t balance. I have this list of ailments and the minute I try, I lose it. I don’t think it can get better.” This was a seventy year old woman, a self described daredevil with strong core muscles who wasn’t afraid of physical challenges. But she was facing osteoporosis and the very real fear of what a fall could mean. Then I told her something that shifted everything: balance and proprioception create a neuromuscular pathway. The more you travel that pathway, calmly, the more it improves. It’s not about having balance or not having balance, it’s about building the pathway through practice.

We put her age into perspective. At seventy, being able to balance on one leg for two seconds with eyes closed is typical. The challenge increases with age because our visual perspective tends to shift more downward and inward, changing our center of balance. The solution? Adjust expectations appropriately. Start doing what helps. Shift the focus outward and ahead. Take a few breaths, release unnecessary tension, and calm down. When she understood balance as a skill she could progressively build, she smiled and breathed a visible sigh of relief. That relief wasn’t just emotional. The calming breath, the release of unnecessary tension, and the clarity of a realistic goal improved her balance almost immediately. That reaction signaled something important. Balance isn’t just mechanical. It’s neurological. Her progress makes sense when we understand what balance truly depends on. Balance is not a single skill but an integration of three sensory systems working together in real time.

THE THREE SENSORY SYSTEMS OF BALANCE

Balance depends on the brain’s ability to integrate information from three primary sensory systems, each providing distinct information about body position and movement in space.

The Visual System

The role of vision in balance control is well documented. According to Richard Collings and colleagues, vision can improve two legged upright stability during standing and locomotion as part of the integrated sensory feedback system, while vision impairment has been demonstrated to reduce postural stability. Most people would agree that this is obvious.

What the visual system contributes to balance: The eyes send signals to the brain that help the vestibular system (inner ear) and the muscles (proprioception) make necessary adjustments. This intricate signaling system forms a feedback loop such that when vision is impaired or when conflicting inputs arrive from different sensory sources, the likelihood of falls and disorientation increases dramatically. Under stressful conditions, blood supply to these sensory areas is reduced to conserve energy and supply larger muscles, which can further increase impairments. This is one reason why calm breathing can significantly improve balance outcomes in my experience, regardless of the client population.

Marcus Wettstein and colleagues found that stress as a psychosocial factor plays a unique role in predicting the occurrence and progression of sensory problems. Their research suggests that interventions aimed at stress prevention or improvement of stress management, through adequate coping strategies, might promote not only vision and hearing health, but also quality of life and autonomy in middle aged and older adults. This brings us back to the importance of breath in Pilates practice and reducing fear and stress (sympathetic system aka fight or flight) responses in our clients. The research supports the assertion that along with age, fear and stress can alter our sensory processing. Breathing can help calm the nervous system and support improved sensory outcomes.

Challenge your visual system. What exactly happens when you close your eyes? Closing your eyes immediately disrupts the standard signaling system by removing the initial visual signal and reducing the information available to the brain for maintaining or correcting balance. Now the brain has to rely more heavily on the vestibular and proprioceptive systems to determine spatial awareness and balance. Without the visual system, the proprioceptive and vestibular systems have to take over as best they can.

Using the moving reformer carriage: Standing on the moving reformer carriage challenges the visual system specifically (though the vestibular system is also engaged) because the moving surface complicates perception and the brain’s processing of where you are in space compared to a static position. Essentially, it adds the complexity of the brain having to distinguish between your movement and the still background, with potential for inaccuracies and optical illusions when the system is impaired or unaccustomed. Add a wink of the eyes and alternate them, or blink slower than usual for a purely visual system variation.

Outside of the studio, encourage staying calm and looking forward rather than looking at the feet: Great dance teachers drill this principle into beginning students at the barre who constantly want to look down at their feet. “Don’t look down,” the teacher insists. “Feel it. Better to check in the mirror than look at your feet.” Whether the dance teacher understands it or not, when looking straight ahead, there’s better depth perception and more time to make postural changes as needed. Looking down at your feet also shifts the body’s center of gravity forward, potentially causing extra loading on the front of the body and unnecessary strain in the neck and shoulders, tension, and fatigue in the anterior muscles. With this forward lean, the body is already ahead of its axis and already in a partial state of falling forward. A greater force would be needed to correct a forward fall, and the likelihood of overcompensating, combined with a possible lack of conditioning in the posterior chain from habitual forward loading, increases the risk of falling backward. Of course, it’s necessary to occasionally glance down to navigate obstacles properly, but encourage proper alignment for the majority of time.

While vision provides external reference points, balance cannot rely on sight alone. Another contributor to balance is the Vestibular System.

The Vestibular System

What the vestibular system is: The vestibular system comprises structures in the inner ear and is largely responsible for spatial awareness and balance. It helps determine rotation, gravitational pull, and motion sensing. When impaired, we experience dizziness and vertigo. When our relationship to gravity changes, such as in an airplane at increasing altitude, we feel pressure and our ears pop.

Why vestibular function declines with age: According to Vasiliki Paplou and colleagues, as we age, we lose muscle tissue, including muscle tissues that affect the inner ear. Our immune systems become less robust, resulting in inflammation and oxidative stress. The small hair cells in the inner ear are gradually damaged and reduced, which directly impacts our ability to hear and relay correct information to the brain. We also experience delays in our reflexes and their response to stimuli. Believe it or not, some of these factors can actually be improved with a positive outlook and reduced stress, along with beneficial lifestyle habits, like diet, and exercise. Some factors however, are simply environmental and genetic.

What I observe in clients with vestibular issues: I notice clients with balance issues directing their gaze downward, exhibiting some kyphosis or tech neck. Often, they are displaying an inward gaze, in deep concentration (focused on the sensations of the movement). Others have jerky movements, may appear anxious, or need to constantly move. These clients experience dizziness when bending down and standing up or when moving from lying to standing. They may also have difficulty with head movements while balancing, even subtle movements like nodding “yes” or “no” while balancing on one leg. They may feel like they’re walking around while a Merry-go-round is started.

How “spotting” trains the vestibular system: In dance training, we learn spotting, fixing visual focus on one point while the body turns, then whipping the head around to find the focus again. This isn’t just for pirouettes. Spotting teaches tolerance for vestibular disturbance by creating the deliberate combined challenges of turning, changing visual focus, and moving the head while balancing. Through this repeated and coordinated practice, the brain-body pathway strengthens, building neuroplasticity. Over time, the system learns to adapt, recalibrate, and respond more effectively.

Vestibular tolerance can be trained progressively, just like strength or endurance. Here is one way to structure it:

A practical progression for vestibular training in Pilates:

1. Start with gentle head turns and nods while standing on a stable surface perhaps hold onto something sturdy and stable first.
2. Progress to head turns and nods holding onto a stable surface lightly or with just one hand, then progress to no hands.
3. Take the challenge onto the moving reformer carriage doing head turns or nods now on a moving surface while doing simple rowing or side arm exercises. (Pictured)
4. Depending on your ability and age, stand on the floor and try balancing standing with (one or both) feet on the floor with eyes either opened or closed while someone walks around the room either whistling or playing music on a cellphone.

Eventually progress to small circles of the head or reducing the base of support. In advanced dance training with the late innovative NYC ballet teacher Maggie Black, dancers from ABT (American Ballet Theater) performed ronds de jambes (leg circles) with the arms and legs moving in opposing circular pathways while the eyes follow the arm’s pathway. In Vaganova ballet training, we practiced ronds de jambes (leg circles) while also turning by quarter, half, and full turns. All of these challenges, done to live or recorded music, progress gradually and are based on demonstrated ability. There’s a reason ballet dancers are known for great balance: they’re practicing for it in their training! Start slowly and gradually progress as you gain confidence and show improvement.

If the visual system gives us orientation and the vestibular system gives us gravitational reference, proprioception tells us where we are within that space.

The Proprioceptive and Somatosensory System

What proprioception is and where the information comes from: Proprioception is our sense of body position in space. This information comes from mechanoreceptors in joints, muscles, tendons, and skin that signal to the brain about where our body parts are and how they’re moving. So, unstable surfaces reduce the precision of input, forcing the central nervous system to process more actively and adapt. Essentially, these proprioceptive tools help your reflexes and your response times improve, like practicing a volley in tennis. With regular and consistent repetition, your appropriate response becomes increasingly accurate and automatic.

Who particularly struggles with proprioceptive input: People with neuropathy, joint replacements or injuries, and aging populations often struggle with proprioception. As stated earlier, in aging populations reflexes slow, blood flow and circulation are often reduced, and muscle loss and tone changes; these all impact proprioceptive abilities too. According to An Xiang and colleagues, psychological interventions including cognitive behavioral therapy, emotional support, behavioral therapy, and educational training help older adults recognize and address negative thought patterns, alleviate anxiety and loneliness, and enhance self-efficacy (belief in your abilities) and awareness of fall prevention. Their research shows that such interventions significantly reduce fear of falling by 40%, anxiety by 35%, and improve physical activity by 25% and self-confidence by 30%, leading to better quality of life and strengthened social interactions.

How to identify proprioceptive deficits: When a balance challenge on a stable surface is manageable, but a moving or wobbly surface causes immediate loss of balance, proprioception may be compromised. A vibration plate is a great example of this moving surface. A Bosu is another proprioceptive tool. (Not recommended for those with unmanaged hypermobility.)

There are countless ways to strengthen proprioceptive responses. Here are a few that I regularly use:

Examples of proprioceptive and balancing challenges:

1. Try balancing on the soft (or hard) part of the BOSU ball with one or both feet, on the knees (soft part only), or on the hands. (Pictured below)
   
2. Try balancing on one leg on a rotational disk isometrically staying in neutral, lateral or medial rotation while bending and stretching the standing leg, or while pressing the roll down bar. (Pictured below)
3. Stand on the floor and try shifting from one foot to the other (side to side) with your eyes closed. Start narrow and widen steps to the sides.
4. Try standing on one leg and crossing the other leg way across and in front of you and tap the toes lightly on the floor and then circling it way across and behind. Repeat several times. What strategies did you use to counter balance the weight shift? Consider reducing or eliminating a strategy for added challenge. (ie: keep the arms close to the body rather than counter balancing in a “T” position.)

“Photography by Jennifer Zmuda Photography“

Challenges out and about: Ever walked on cobble stones? Gone hiking? Navigated an unfamiliar metropolis on foot (navigating around pot holes, construction and irregular surface)? This is proprioception in your day to day life!

Here’s how I structure balance progressions on one leg, with gradually increasing duration:

Level 1: Balance on one leg with eyes open, holding onto something stable with two hands

Level 2: Same position, holding on with one hand

Level 3: Same position, using only a finger or two for light support

Level 4: Balance on one leg with eyes open, holding the wooden roll down bar (attached to tower springs, providing unstable support and varied by spring choice)

Level 5: Balance on one leg with eyes closed, holding something stable

Level 6: Balance on one leg with eyes closed, with a light touch

Level 7: Balance on one leg with eyes closed, holding the roll down bar

Level 8: Balance on one leg with eyes closed, no support

For variety, the levels can be done with the knee in flexion. Try using surround sound or having someone walk around the perimeter of the room and play music on their cellphone while balancing with eyes closed for added challenge. All levels can be done with the heel lifted and ankle in plantar flexion as this reduces the surface area from which to gather sensory outputs and decreases the base of support from which to balance, counter balance, or correct. The center of gravity must now be more precise. This variation is useful for elite athletes and specifically ballet dancers. Progress from 15 seconds to 1 minute.

Most clients work within levels 1-6 up to 1 minute; level 7+ represents elite athletic capacity.

These progressions are not simply about testing balance. They are about training integration. Each variation challenges the visual, vestibular, and proprioceptive systems in different combinations, gradually strengthening the neuromuscular pathways that support our balance. Over time, what once felt unstable becomes manageable, and what once triggered fear becomes familiar. Just like my seventy-year-old client, progress doesn’t begin with perfection. It begins with exposure, calm breathing, and repetition. It begins with understanding that balance is not something we either have or lose. It is something we choose to practice. Balance is not a trait. It’s a progression of the mind and body that we can intentionally train.

Practice with intention. Keep building the sensory pathway.