Health Matters 11/1: Staying balanced this winter


By: Soo Ahn, P.T., D.P.T., L.S.V.T.

With the days getting shorter and the nights getting colder, it can only mean one thing – winter is around the corner.

Winter weather can make getting around difficult for almost everyone, but for people with health conditions that affect balance and gait, stepping outside can be especially dangerous.

Older adults, as well as people with strokes, multiple sclerosis, Parkinson’s disease and other neurologic disorders, are at greater risk for falls at any time of year. Add snow and ice to the mix, and the risk increases even further.

The program at Penn Medicine Princeton Health Princeton Rehabilitation provides comprehensive physical therapy services for people with mobility problems, helping patients keep their balance during the winter – and all year long.

A Complex System

Good balance depends on your muscles, joints, tendons, eyes and inner ear all working together to keep you on your feet.

When any one of these is compromised, it can cause unsteadiness that can throw you off balance and lead to trouble, whether you’re walking or just standing still.

Common causes of balance problems may include:

  • Poor vision
  • Muscle weakness
  • Neurological disorders, such as stroke, Parkinson’s disease and multiple sclerosis
  • Recent surgery
  • Vestibular disorders
  • Low back pain
  • Lower body injury, such as a sprained ankle or arthritic knee
  • Certain medications that may cause dizziness

Additionally, balance tends to deteriorate with age, though it often goes unnoticed until a fall or other accident occurs.

Each year, more than one in four adults age 65 and older experience a fall, according to the Centers for Disease Control and Prevention. Further, as the CDC reports, falls are the number one cause of injuries and death from injuries among older adults.

If you are having trouble with balance or notice any of the following red flags, talk to your doctor about ways to improve your balance, including balance classes and physical therapy.

  • Grabbing on to furniture and counters to get from one place to another in your home
  • Trouble getting up from a chair
  • Relying heavily on your arms to get up
  • Fear of falling that prevents you from participating in daily tasks or leisurely activities
  • Experiencing a fall

Physical Therapy Can Help

In addition to treating existing conditions that impair balance, physical therapy can also help tune up your balance before a bigger problem occurs.

Through various techniques and physical exercise activities, physical therapists can help you strengthen your muscles, improve flexibility, increase your balance and reduce your risk for falling. Physical therapy can also help you regain confidence and reduce your fear of falling.

For patients with neurological conditions, physical therapy can decrease dizziness, falls and spasticity, while improving strength, mobility and balance.

Princeton Rehabilitation offers specific rehabilitation services to treat balance and gait dysfunction, including among patients with Parkinson’s disease, multiple sclerosis and strokes.

One of the specialized programs that Princeton Rehabilitation offers for patients with Parkinson’s is LSVT BIG, an evidence-based exercise treatment program founded on the principle that the brain can learn and change. The program grew out the Lee Silverman Voice Training (LSVT) program for patients with Parkinson’s and is focused on increasing amplitude of limb and body movements to improve gait, balance and function.

Tips for Staying on Your Feet  

To keep your balance and prevent falls this coming winter, think safety first. If you must go out in the ice and snow, here are a few tips for staying upright.

  • Walk with your feet further apart than normal. The wider your base, the likelier you are to stay balanced.
  • Take your time. Don’t rush to where you’re going.
  • Wear waterproof shoes or boots with good traction.
  • Don’t walk with your hands in your pockets. You may need your hands to stop you from falling.
  • Ensure walkways, steps and driveways are clear.
  • Keep snowy boots and shoes on a mat by the door to keep the floor from getting wet and slippery. Clean up any water right away.
  • Dress warm. Cold can cause your muscles to tense, which can hurt balance.
  • Take precautions when getting out of your car. Use the doorframe to steady yourself and plant both feet on the ground before moving.
  • Avoid alcohol. Alcohol alone can impair balance and when combined with some medications it can also increase the risk for dizziness and other side effects.
  • Ask for help. Rather than venturing out alone, ask a friend or family member to come along and assist you.
  • Though you may think reducing physical activity can reduce your risk for falls, the opposite is true. The stronger you are, the better able you are to keep you balance. Tai chi is a low-impact form of exercise that has been proven to help improve and maintain balance.

To learn more about balance and gait rehabilitation through the Penn Medicine Princeton Health Princeton Rehabilitation, call 609.853.7840 or visit

Soo Ahn, P.T., D.P.T., L.S.V.T., is a physical therapist certified in LSVT BIG therapy at Penn Medicine Princeton Health Princeton Rehabilitation.