Is Losing My Balance Just a Normal Part of Getting Older?
Is Losing My Balance Just a Normal Part of Getting Older? A Physical Therapist Answers
By Nova Physical Therapy | North Hollywood, CA
Patient Question
“I’m getting older and I’ve noticed that my balance isn’t as good as it used to be. I sometimes feel unsteady when I get up, turn quickly, walk in the dark, or step over something. Is this just normal aging, or can physical therapy help improve my balance?”
The Short Answer
Some physical abilities can change with age, but frequent loss of balance and falls should not simply be dismissed as an unavoidable part of getting older.
The Centers for Disease Control and Prevention reports that more than one in four adults age 65 and older reports falling each year, representing roughly 37 million falls. The CDC specifically emphasizes that falls are not simply a normal part of aging and that many can be prevented.
Balance is complex.
It depends on multiple systems working together, including:
- Vision
- Sensory information
- Inner-ear/vestibular input
- Muscle performance
- Joint mobility
- Reaction ability
- Walking ability
- Coordination
- Attention
- The environment
A balance problem therefore does not automatically have one cause.
Physical therapists can evaluate movement, balance, walking, muscle performance, mobility, and functional limitations and determine whether physical therapy is appropriate.
Why Does Balance Sometimes Change With Age?
Maintaining balance requires your brain and body to continuously answer three questions:
Where am I?
Where am I moving?
What do I need to do to stay upright?
Your nervous system receives information from several sources.
Your eyes provide visual information.
Your vestibular system helps detect head movement and orientation.
Sensory receptors in your feet, muscles, and joints provide information about your body's position.
Your muscles then have to respond quickly enough to maintain or recover balance.
Changes affecting any of these systems can influence steadiness.
That is why balance problems should not automatically be attributed to “old age.”
Why Do I Feel More Unsteady in the Dark?
This is an especially useful question.
When you are walking in a well-lit environment, your visual system provides substantial information about:
- Where the floor is
- Where objects are located
- How your body is moving
When the lights are reduced, your body has to rely more heavily on other sensory systems.
Some people therefore notice that they are relatively comfortable during the day but become significantly less confident:
- Walking to the bathroom at night
- Entering a dark room
- Walking outside after sunset
This can provide useful information during a physical therapy evaluation.
Why Do I Lose My Balance When I Turn?
Walking straight ahead is different from changing direction.
Turning requires the body to:
- Slow down
- Shift weight
- Rotate
- Reposition the feet
- Continue moving in a new direction
Some people can walk relatively well in a straight hallway but become unsteady when making quick turns.
A balance assessment may therefore include direction changes rather than evaluating only straight-line walking.
Why Do I Feel Unsteady When I First Stand Up?
Several possibilities can contribute.
From a movement perspective, standing up requires:
- Lower-extremity strength
- Forward weight shift
- Balance
- Coordination
However, dizziness or lightheadedness immediately after standing can also have causes that require medical evaluation, including blood-pressure or medication-related factors.
Physical therapists should not assume every balance complaint is musculoskeletal.
The CDC recommends discussing falls and unsteadiness with healthcare providers and notes that medications, vision, feet, hypotension, and other health conditions can contribute to fall risk.
Is Muscle Weakness Related to Balance?
It can be.
Standing up, walking, climbing stairs, stepping over objects, and recovering from a loss of balance all require muscle force.
Relevant muscle groups may include:
- Hip muscles
- Quadriceps
- Hamstrings
- Calf muscles
- Trunk muscles
For example, if someone begins to lose balance sideways, the body may need to rapidly reposition the leg to prevent a fall.
Balance rehabilitation therefore often includes strengthening when muscle-performance deficits are identified.
Does Walking Improve Balance?
Walking is valuable physical activity, but walking alone may not challenge every component of balance sufficiently.
Someone may comfortably walk 30 minutes on a flat sidewalk but still have difficulty:
- Standing on one leg
- Stepping backward
- Turning quickly
- Walking on uneven terrain
- Recovering from an unexpected loss of balance
Balance training may therefore include activities that specifically challenge the abilities that are limited.
Can Balance Actually Improve After Age 65?
Yes.
Older adults retain the ability to respond to training.
A large 2026 network meta-analysis examined 423 randomized trials involving 33,901 participants aged 60 and older.
Eighteen of the 19 exercise categories examined improved overall balance compared with control conditions.
The researchers found favorable estimates for several approaches, including perturbation training, sensory training, dance, agility stepping, Tai Chi, Pilates, aquatic exercise, and other forms of balance-oriented activity. Importantly, the authors cautioned that these estimates do not prove that one approach is universally superior.
The key message is:
Balance is trainable.
What Is Balance Training?
Balance training means intentionally challenging the body's ability to maintain or recover stability.
An exercise program might progress from:
Wide stance → narrow stance → altered foot position → reaching → stepping → walking challenges → direction changes → more complex functional tasks.
The exact progression depends on the person.
Simply performing the hardest possible balance exercise is not necessarily better.
Exercises should provide enough challenge to stimulate adaptation while remaining appropriately safe.
Is Standing on One Leg Good for Balance?
It can be one useful exercise for some people.
But balance involves much more than standing still.
Real-life balance requires you to:
- Walk
- Turn
- Reach
- Step
- Change speed
- Navigate obstacles
- Respond when something unexpected happens
A comprehensive program may therefore progress beyond static single-leg standing.
What Is Reactive Balance?
Reactive balance is your ability to respond after your balance has already been disturbed.
Imagine accidentally catching your shoe on an uneven sidewalk.
Your body may need to rapidly take a step to keep you upright.
That recovery step is an example of a reactive balance response.
This area has received significant recent research attention.
A 2026 systematic review and meta-analysis found that perturbation-based balance training reduced fall rates by approximately 23% and injurious falls by approximately 24% compared with control conditions among community-dwelling adults age 65 and older. The certainty of evidence for fall-rate reduction was rated low, so these findings should be interpreted cautiously rather than as a guarantee.
What Is Perturbation-Based Balance Training?
Perturbation training exposes a person to controlled challenges to stability so that they practice recovering balance.
In research settings, this can involve specialized equipment.
Clinical balance training may also incorporate appropriately supervised stepping and reaction activities.
The objective is not to make someone fall.
The objective is to progressively train the body's ability to respond to balance disturbances in an appropriately controlled environment.
Should Older Adults Practice Walking Backward?
Backward walking may be used in rehabilitation for selected patients.
Walking backward changes:
- Visual information
- Foot placement
- Coordination demands
- Balance demands
But it is not an exercise everyone should attempt independently.
For someone with significant fall risk, backward walking without appropriate supervision could be unsafe.
What About Tai Chi?
Tai Chi is one of several forms of exercise commonly studied for balance and fall prevention.
The large 2026 network meta-analysis found favorable estimates for Tai Chi in overall/global balance, although the authors emphasized that comparative rankings should not be interpreted as definitive proof of superiority.
Tai Chi may be a useful option for some people because it involves:
- Controlled weight shifting
- Coordinated movement
- Postural control
- Slow directional changes
But it is not the only effective way to train balance.
What About Strength Training?
Strength and balance training often complement one another.
A 2026 systematic review and component network meta-analysis examined 69 randomized controlled studies of fall-prevention programs.
Among exercise programs, gait-and-balance training was associated with lower recurrent-fall risk, and programs combining gait/balance with strength/resistance training also showed favorable fall-related outcomes.
This supports an individualized approach rather than prescribing only balance or only strengthening.
Does Exercise Actually Reduce Fall Injuries?
Current research suggests it can.
A 2026 systematic review and meta-analysis published in Frontiers in Public Health examined 29 randomized controlled trials involving 6,367 community-dwelling older adults.
Compared with control conditions, exercise interventions were associated with reductions in:
- Overall fall-related injuries
- Falls requiring medical attention
- Severe fall-related injuries
- Fall-related fractures
The pooled estimates suggested approximately a 13% reduction in all fall-related injuries, 29% reduction in injuries requiring medical attention, 33% reduction in severe injuries, and 44% reduction in fall-related fractures.
These are population-level research findings.
They do not mean exercise guarantees that an individual will never fall.
Does Fear of Falling Matter?
Yes.
After a fall—or even after several near-falls—some people begin restricting activity.
They may stop:
- Walking outside
- Going shopping
- Exercising
- Using stairs
- Visiting friends
- Traveling
That can create another problem.
Less activity may reduce opportunities to maintain strength, mobility, and confidence.
A physical therapist may therefore consider both physical ability and confidence when designing rehabilitation.
The goal should not be:
“Never move because you might fall.”
The goal is to help people participate as safely and confidently as reasonably possible.
Is Using a Cane a Sign That My Balance Is Getting Worse?
Not necessarily.
An appropriately selected assistive device can improve safety and mobility for some people.
The important questions include:
- Is the device appropriate?
- Is it the correct height?
- Is the person using it correctly?
- Does the person actually need a different device?
Using an assistive device should not be viewed as failure.
For some individuals, it may increase independence.
Can My Medications Affect My Balance?
Yes.
Some medications can contribute to:
- Dizziness
- Drowsiness
- Blood-pressure changes
- Slower reactions
The CDC specifically recommends that older adults have their medications reviewed by a physician or pharmacist because some medications can increase fall risk.
Physical therapists do not independently change prescription medications.
When medication-related concerns arise, communication with the appropriate healthcare professional is important.
Does Vision Matter?
Absolutely.
The CDC recommends regular eye examinations as part of fall-prevention strategies.
Balance depends partly on visual information.
Changes in:
- Vision
- Depth perception
- Lighting
- Eyewear
may affect mobility.
This is another reason fall prevention is often multidisciplinary rather than simply an exercise issue.
What About the Home?
The environment matters too.
Common hazards may include:
- Loose rugs
- Cluttered walking paths
- Poor lighting
- Cords
- Unstable furniture
- Difficult bathroom access
The federal Administration for Community Living recommends improving home safety, addressing tripping hazards, improving lighting, staying physically active, reviewing health factors, and participating in evidence-based fall-prevention programs.
Exercise is important, but fall prevention should not ignore environmental factors.
Can Physical Therapy Help?
Yes, when balance and mobility limitations are appropriate for physical therapy.
Physical therapy may address:
- Lower-extremity muscle performance
- Balance
- Walking
- Turning
- Stepping
- Functional mobility
- Sit-to-stand ability
- Coordination
- Mobility limitations
- Endurance
- Reactive balance when appropriate
- Assistive-device training when appropriate
- Patient education
- Home exercise
The program should be individualized.
A person who has difficulty getting out of a chair requires a different emphasis from someone who is strong but loses balance during quick direction changes.
What Does Research Say?
Several important 2026 publications make this an especially timely topic.
2026 Fall-Injury Meta-Analysis
An updated systematic review and meta-analysis examined 29 randomized controlled trials with 6,367 participants.
Exercise was associated with reductions in fall-related injuries, injuries requiring medical care, severe injuries, and fractures.
This provides current support for exercise as an important component of healthy-aging and fall-prevention strategies.
2026 Reactive-Balance Review
Sharma and colleagues evaluated perturbation-based balance training in adults 65 and older.
The analysis found approximately:
23% lower fall rates
and
24% fewer injurious falls
compared with controls.
Programs totaling at least six hours appeared to have stronger effects in subgroup analysis, but certainty of the overall evidence was limited and additional research is needed.
2026 Network Meta-Analysis
An exceptionally large systematic review and Bayesian network meta-analysis examined:
423 randomized trials
33,901 participants
and
19 exercise modalities.
Eighteen of 19 exercise categories improved overall balance compared with control.
Different exercise approaches appeared to influence different balance domains, supporting the idea that balance training should be task-specific and individualized.
2026 Multifactorial Fall-Prevention Review
A separate component network meta-analysis of 69 randomized studies found evidence supporting combinations involving:
- Risk assessment
- Appropriate advice
- Exercise
- Environmental modification
and found favorable outcomes for gait/balance combined with strengthening in exercise programs.
Together, these findings reinforce an important point:
Fall prevention is not one exercise. It is a strategy.
Why Is This Topic Especially Relevant Right Now?
September 2026 is Falls Prevention Awareness Month.
On September 3, the Administration for Community Living announced this year's national campaign emphasizing practical strategies to help older adults maintain health, independence, strength, confidence, and mobility.
The National Council on Aging will lead Falls Prevention Awareness Week September 21–25, 2026, encouraging older adults to assess their fall risk and participate in evidence-based prevention strategies.
The topic also has particular relevance in Southern California. Village Movement California is highlighting Falls Prevention Awareness Week this September while holding its statewide healthy-aging conference in Los Angeles County on September 17–18.
For patients and families in North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, Van Nuys, and greater Los Angeles searching:
“Why am I losing my balance as I get older?”
“Can physical therapy improve balance?”
“What exercises help prevent falls?”
or
“How can my parent reduce their risk of falling?”
this is an especially timely conversation.
What Happens During a Physical Therapy Evaluation?
At Nova Physical Therapy, an evaluation for balance or mobility concerns may include, when appropriate:
- Fall history
- Near-fall history
- Symptom history
- Medical history
- Review of relevant precautions
- Lower-extremity muscle performance
- Joint mobility
- Sit-to-stand ability
- Standing balance
- Dynamic balance
- Walking
- Turning
- Stepping
- Direction changes
- Functional mobility
- Assistive-device use
- Patient goals
Standardized measures may also be appropriate, such as:
- Timed Up and Go
- Five Times Sit-to-Stand
- Balance measures
- Gait-speed assessment
- Other functional mobility tests
The CDC's STEADI program similarly emphasizes screening, assessment, and targeted intervention for older adults at increased fall risk.
California Business and Professions Code §2620 places physical therapy evaluation, treatment planning, instruction, consultation, physical rehabilitation, exercise, and movement-related health and wellness within physical therapy practice. It also specifies that a physical therapist license does not authorize diagnosis of disease.
If findings suggest a condition requiring care beyond physical therapy scope, appropriate referral is required under California direct-access provisions.
When Should You Seek Medical Attention?
New or suddenly worsening balance problems should not automatically be treated as an exercise problem.
Seek urgent medical attention for balance problems accompanied by symptoms such as:
- Sudden weakness or numbness
- New facial drooping
- New difficulty speaking
- Sudden severe headache
- Sudden significant vision change
- Loss of consciousness
- Chest pain
- Severe shortness of breath
- New severe dizziness
- New inability to walk
- Significant head injury following a fall
- Other sudden or severe neurological symptoms
Medical evaluation may also be appropriate for:
- Repeated unexplained falls
- New or progressive dizziness
- Significant medication-related concerns
- Fainting
- Persistent unexplained weakness
- Rapidly worsening balance
- Significant injury following a fall
Balance problems can have neurological, cardiovascular, vestibular, visual, medication-related, musculoskeletal, and other causes.
Symptoms alone should not be used to diagnose the cause.
Why Patients Choose Nova Physical Therapy
At Nova Physical Therapy, our mission is simple:
We Care.
Losing confidence in your balance can change much more than the way you walk.
Some people begin avoiding:
- Walking outside
- Stairs
- Shopping
- Exercise
- Social activities
- Travel
- Playing with grandchildren
because they are afraid of falling.
Our goal is not to make people afraid of movement.
We want to understand:
What activities do you want to feel more confident doing?
Our rehabilitation philosophy emphasizes:
- Evidence-based care
- Individualized treatment
- Progressive strengthening
- Balance training
- Functional movement
- Walking
- Appropriate balance challenges
- Patient education
- Healthy aging
- Maintaining meaningful activity and independence
Balance training should not simply be difficult.
It should be purposeful, progressive, and appropriate for the individual.
Frequently Asked Questions
Is losing balance a normal part of aging?
Some physical abilities change with age, but frequent falls or significant unsteadiness should not simply be dismissed as normal aging. The CDC states that falls are preventable and are not an inevitable part of getting older.
How common are falls after age 65?
More than one in four adults age 65 and older reports falling each year.
Can physical therapy improve balance?
Physical therapy can address balance, strength, walking, mobility, and functional limitations when appropriate. Large 2026 research syntheses show that multiple forms of exercise can improve balance in older adults.
Can exercise prevent falls?
Exercise can reduce fall risk and fall-related injuries at the population level, although no exercise program can guarantee that an individual will never fall.
What exercises are best for balance?
There is no single best exercise for everyone. Exercise selection should reflect the individual's specific balance limitations, safety, goals, and functional needs.
Is walking enough for fall prevention?
Walking is beneficial physical activity, but some people also require specific balance, strength, stepping, or reactive-balance training.
Does strengthening my legs improve balance?
Strength can contribute to functional mobility and balance. Programs combining gait/balance and strengthening have demonstrated favorable fall-related outcomes.
Is Tai Chi good for balance?
Research supports Tai Chi as one useful form of balance-oriented exercise for some older adults, although it is not necessarily superior for every individual.
Why am I more unsteady in the dark?
Reduced visual information places greater demands on other systems involved in balance.
Why do I lose my balance when turning?
Turning requires weight shifting, foot repositioning, coordination, and dynamic balance.
Why do I feel dizzy when I stand up?
There are several possible causes, including factors requiring medical evaluation. Persistent or significant dizziness should not automatically be assumed to result from weak balance.
Can medications affect balance?
Yes. Some medications can contribute to dizziness, drowsiness, or other factors associated with falls. Medication concerns should be reviewed with a physician or pharmacist.
Should I use a cane?
Some people benefit from an assistive device. A physical therapist can assess mobility and help determine appropriate device use within PT scope.
What is reactive balance training?
It trains the body's response to a disturbance of balance. A 2026 review found that perturbation-based training reduced falls and injurious falls in studied older adults, although certainty of some findings was limited.
My parent has already fallen. Is it too late to work on balance?
No. A history of falls is an important reason to discuss fall risk with healthcare professionals and determine whether targeted interventions are appropriate.
Schedule an Evaluation
If you or a family member has noticed increasing unsteadiness, difficulty walking, reduced confidence, near-falls, or limitations in everyday mobility, Nova Physical Therapy can help determine whether physical therapy is appropriate.
Our licensed physical therapists provide individualized evaluations and rehabilitation programs focused on:
- Balance
- Muscle performance
- Walking
- Functional mobility
- Strength
- Physical capacity
- Confidence with meaningful activities
Contact Nova Physical Therapy today to schedule a comprehensive physical therapy evaluation in North Hollywood.
Disclaimer
This article is intended for educational and informational purposes only and does not constitute medical advice, medical diagnosis, fall-risk clearance, or individualized physical therapy treatment.
Balance problems, dizziness, weakness, unsteadiness, and falls can have many causes, including medical, neurological, cardiovascular, vestibular, visual, medication-related, environmental, and musculoskeletal factors.
Physical therapists evaluate and treat movement and functional impairments within their professional scope. California Business and Professions Code §2620 includes physical therapy evaluation, treatment planning, instruction, consultation, rehabilitation, and exercise within physical therapy practice while specifying that a physical therapist license does not authorize diagnosis of disease.
Exercise and physical therapy can reduce fall risk at the population level but cannot guarantee that an individual will not fall or sustain an injury.
Balance exercises that are appropriate for one person may be unsafe for another. Individuals with significant balance impairment should not attempt challenging exercises, backward walking, unstable-surface activities, or reactive-balance exercises without appropriate professional guidance.
Seek appropriate medical care for sudden or rapidly worsening balance problems, new neurological symptoms, loss of consciousness, severe dizziness, chest pain, shortness of breath, significant injuries following a fall, or other concerning symptoms.
Individual results vary. Nova Physical Therapy does not guarantee fall prevention, independence, recovery time, or specific outcomes.
References
- Administration for Community Living. Falls Prevention Awareness Month Is Here. September 3, 2026.
- National Council on Aging. As the Fall Season Arrives, NCOA Urges Older Adults to Take Action to Prevent Falls.September 1, 2026.
- Centers for Disease Control and Prevention. Still Going Strong: Information for Older Adults—Preventing a Fall.
- Centers for Disease Control and Prevention. STEADI: Older Adult Fall Prevention—Provider Training and Continuing Education. Updated February 6, 2026.
- Sharma S, Szabo IZ, Danielsen MB, et al. Perturbation-Based Balance Training Reduces Falls and Fall Injuries in Older People: Insights on Mechanisms and Training Parameters From a Systematic Review. Journal of the American Medical Directors Association. August 2026;27(8):106316.
- Wang J, Guo S, Yang Y, et al. Exercise Modalities for Overall and Domain-Specific Balance Performance in Older Adults: A Systematic Review and Bayesian Network Meta-Analysis. Ageing Research Reviews. 2026;121:103303.
- Effects of Exercise Interventions on Fall-Related Injuries in Community-Dwelling Older Adults: An Updated Systematic Review and Meta-Analysis. Frontiers in Public Health. 2026.
- Luo Y, Miao Y, Zhao Y, et al. Effectiveness of Multifactorial and Exercise Programs in Preventing Falls Among Older Adults: A Systematic Review and Component Network Meta-Analysis. Worldviews on Evidence-Based Nursing. 2026;23(2):e70136.
- Physical Therapy Board of California. California Laws and Regulations Related to the Practice of Physical Therapy. Business & Professions Code §2620.