Balance Disorders & Fall Prevention

Why Balance Matters at Every Age

Falls are the leading cause of injury-related hospitalization for Canadians over 65, and the consequences extend far beyond the immediate injury — fear of falling itself reduces activity, weakens muscles, and creates a vicious cycle that accelerates aging. The good news: balance is a skill that can be retrained at any age, and physiotherapy is the most evidence-supported intervention for fall prevention.

At Réhabital in Côte Saint-Luc (CSL), Montreal, our balance and vestibular physiotherapy program serves two main populations: seniors looking to prevent falls and maintain independence (a major focus given Côte Saint-Luc's substantial senior community), and patients of all ages dealing with vertigo, dizziness, post-concussion balance issues, or vestibular disorders such as BPPV (benign paroxysmal positional vertigo) and vestibular neuritis.

Conditions We Treat

• Benign paroxysmal positional vertigo (BPPV) — the most common cause of vertigo, often resolved in 1–2 sessions with the Epley or Semont maneuver

• Vestibular hypofunction — following vestibular neuritis, labyrinthitis, or unilateral vestibular loss

• Cervicogenic dizziness — dizziness originating from neck dysfunction (very common after whiplash)

• Post-concussion vestibular and balance disorders

• Age-related balance decline in seniors

• Fall risk after recent falls or near-falls

• Balance dysfunction following stroke (subacute and chronic phases)

• Balance issues in Parkinson's disease and other neurological conditions

• Persistent postural-perceptual dizziness (PPPD)

The Three Systems of Balance

Balance depends on the seamless integration of three sensory systems: the visual system (your eyes telling you where you are in space), the vestibular system (the inner ear sensing head movement), and the somatosensory system (proprioception from joints, muscles, and skin telling you about ground contact and joint position). When any of these systems is impaired — by aging, injury, neurological disease, or vestibular dysfunction — balance suffers.

Effective balance physiotherapy assesses all three systems and targets the specific deficits identified. A senior with mainly somatosensory loss from peripheral neuropathy needs different exercises than someone with vestibular hypofunction or fear-related balance avoidance. Generic "balance exercises" rarely produce lasting change — individualized, system-specific programs do.

Our Balance & Vestibular Approach

1. Comprehensive assessment. We use validated outcome measures: the Berg Balance Scale, Timed Up and Go (TUG), Functional Gait Assessment, mini-BESTest, Dix-Hallpike (for BPPV), head impulse test, and visual-vestibular interaction tests. This identifies which systems are involved and quantifies your starting point.

2. Vestibular rehabilitation therapy (VRT). For vertigo and dizziness of vestibular origin, evidence-based protocols include canalith repositioning maneuvers (Epley, Semont, BBQ roll for BPPV), gaze stabilization exercises (VOR adaptation), habituation exercises for motion sensitivity, and substitution training when vestibular function is permanently reduced.

3. Progressive balance retraining. Static and dynamic balance challenges, gradually progressing in difficulty: stable surface → unstable surface, eyes open → eyes closed, single task → dual task. Real-world functional training (turning, stepping, reaching) is integrated throughout.

4. Strength and gait training. Lower extremity strength (especially hip abductors and ankle dorsiflexors) is fundamental to balance. We integrate strengthening with balance challenges and gait re-training.

5. Education and home program. Falls happen at home — so we provide home safety advice, footwear recommendations, and a daily balance routine that fits your life.

How Osteopathy Can Support Balance Recovery

While vestibular and balance physiotherapy is the primary evidence-based treatment, osteopathy can be a valuable adjunct, particularly for cervicogenic dizziness and post-concussion presentations. Cranial osteopathy can address restrictions in the temporal bones and cranial sutures that influence vestibular function, while articular techniques on the upper cervical spine can dramatically improve balance in patients with cervical-related dizziness. Myofascial work on the deep cervical fascia and cranial base often produces immediate improvements in proprioception and head-eye coordination.

For seniors specifically, the gentle, whole-body approach of osteopathy is well-tolerated and complements physiotherapy strengthening and balance training nicely. Many of our older patients alternate weekly physiotherapy with bi-weekly osteopathy for comprehensive care.

For more reading: Osteopathy for Chronic Pain Management and What Does an Osteopath Do?

BPPV: A Special Note

If you have brief (under one minute) intense vertigo triggered by specific head movements — rolling over in bed, looking up to a high shelf, lying down — you very likely have benign paroxysmal positional vertigo (BPPV). This is one of the most rewarding conditions in physiotherapy: a properly performed Epley maneuver resolves more than 80% of BPPV cases in a single visit. If your dizziness fits this pattern, do not suffer for weeks or months — book an assessment and you may walk out symptom-free.

Why Réhabital for Balance Care in Montreal?

Located at Cavendish Mall, Côte Saint-Luc — directly accessible to the substantial senior population of Côte Saint-Luc, Hampstead, Snowdon and surrounding areas — our clinic combines balance/vestibular physiotherapy with osteopathy, massage and acupuncture for comprehensive senior care. Direct insurance billing, evening appointments. Book your balance assessment today and reclaim your confidence on your feet.