The Type of Balance Most People Have Never Heard Of

"Stand on one leg, close your eyes, and turn your head to the left," the physical therapist instructed me.

What sounded like a sobriety test was actually part of a diagnostic procedure to determine the cause of my recent bout of vertigo.

I write a lot about balance, because falling is often the first domino that kicks off a progression of health issues that can lead to hospitalizations — and worse — for those of us over 60.

As a former trainer, I've known about the value of balance, and I regularly perform one-legged exercises. So I felt confident I'd ace this thing, vertigo or not.

I failed miserably.

What I didn't realize was that he wasn't testing just one type of balance. I knew about the one-legged balance, but closing my eyes and turning my head kicked up the challenge several notches.

Fact is, there's not just one type of balance — but three. And the most important one you've probably never heard of.

Balancing act

Traditional balance training — such as yoga or standing on one leg — primarily targets static stability. While the ability to stand on one leg is an important indicator of longevity, these practices are poor predictors of actual fall risk.

Most falls result from unexpected slips or trips, which require a split-second reflex. Called "reactive balance," this type of balance is as much a cognitive skill as a physical one.

It relies on executive functions like inhibitory control and the brain's ability to "re-weight" sensory input, prioritizing signals from sight, the vestibular system, and physical sensors to avoid taking a tumble.

It's the ability to regain your balance after an unexpected event. This includes recovering from a trip on a curb, a slip on water, or a sudden shove.

Focusing on conventional balance training, such as tai chi and yoga, improves static and dynamic balance. In real life, however, falls are fast and unpredictable. Balancing on one leg won't help you if you can't catch yourself when stepping off an unexpected curb.

In addition, myths about balance can be misleading.

For instance, balance is more than having strong leg strength. Balance is dependent on the brain's executive function and sensory integration, not muscular strength.

Most importantly, falling is not an inevitable part of aging and should not be accepted as such.

Balance remains largely trainable throughout life.

The most important type of balance training for fall prevention — reactive balance — incorporates several different systems.

Reactive balance refers to a person's ability to make a "change-in-support" response — stepping, reaching, or grabbing something to regain stability. A specific type of balance training called perturbation-based training (PBT) can significantly reduce injury risk by rewiring the nervous system much faster than traditional exercises.

In essence, this approach to mobility treats balance as a mental and physical team effort.

Mostly in your head

Most conversations about balance focus on the inner ear or leg strength, but researchers now categorize balance as a series of systems managed by the brain.

For example, inhibitory control is the brain's ability to suppress a poorly timed step and execute the correct one instead during a moment of sudden stress. Who hasn't misjudged a step on the stairs, jarred by suddenly hitting the landing when you expected one more step?

This situation triggers rapid brain processing, where your brain has to make a split-second decision in its change-in-support.

The brain also has to function as a central processor, constantly deciding which "teammate" to trust — vision, the vestibular system, or proprioception. This process, called sensory reweighting, allows the brain to shift its reliance on these systems, depending on the environment.

The easiest way to demonstrate the cognitive nature of balance is evidenced by "dual-task walking" research.

Performing a mental task while walking often results in a drop in stability because the brain is dividing its attention.

Many real-world falls occur not because of physical weakness, but because the brain's attention was elsewhere. The recovery response is a neuromotor adaptation. Training this response can actually rewire the brain's "oh no!" reflex in as few as one or two sessions — further supporting the trainable mental and neurological capability of the brain.

The good news: improving reactive balance isn't a long or arduous process — and reactive balance training can reduce fall rates by 23% to 50%.

And, while traditional PBT requires specialized equipment and professional supervision, some elements of reactive balance can be safely practiced as part of daily routines.

Before you begin

Improving your reactive balance requires challenging it slowly and progressively. I would not have done the test my PT subjected me to if he hadn't been there for support.

Ensure your environment is well-lit and free of tripping hazards like loose rugs or clutter — and be near a sturdy chair, counter, or a trusted person who can catch you if you lose your balance. Plus, be sure to wear supportive footwear.

To train your mental process:

1. Remove visual input

We rely heavily on our vision for balance without realizing it. By removing it, you force your brain to shift its reliance to proprioception (sensory input from your environment) and the vestibular system.

• Eyes-Closed Stance: Practice standing on both feet, a tandem (heel-to-toe) stance, or one leg with your eyes closed.
• Darkened Environments: Safely practice walking or standing in low-light conditions to simulate environments where visual feedback is distorted or unavailable.

2. Challenge the vestibular system

The inner ear is crucial for orientation, especially when your head is moving. The vertigo I experienced was due to dysfunction of this system.

• Head Turns: While standing on one leg, practice turning your head from side to side or looking up and down.
• Dynamic Movement: Activities like turning corners or changing directions quickly challenge the vestibular system to maintain stability during motion.

3. Alter proprioceptive feedback

Proprioception is your body's sense of where it is in space, provided by your muscles and joints. You can "distort" this information to force the brain to lean more on vision and the inner ear.

• Stand on unstable surfaces: Practice balance exercises on a soft surface, such as a thick carpet, foam pad, or soft sand.
• Narrow your base: Standing on one leg or in a tandem stance narrows your base of support, making your muscles and joints work harder to provide accurate feedback.

4. Layer in cognitive challenges

Because balance is partly a cognitive skill managed by executive function, adding a mental challenge tests your brain's ability to process sensory information while distracted.

While performing any of the balance drills above, try counting backward by threes, naming animals alphabetically, or spelling words backward. This simulates real-world falls that often happen when attention is elsewhere, such as talking or searching for keys.

My physical therapist quickly determined that my vertigo stemmed from benign paroxysmal positional vertigo (BPPV), and he treated it successfully in a single visit. The balance tests came so quickly I never had a chance to ask what he was evaluating. Now I know and see the value of adding another layer of challenge to my own balance training.

Let's (Not) Go For A Spin A three-minute inner-ear malfunction, and what it took to undo it

I've Been Working Out for 45 Years — These Findings Still Blindsided Me What no one tells you about working out as you age