The complex system behind our balance

Balance is more than a simple reflex – something you either have or lose. The work of Horak (2006), shows us a much more exciting picture: balance is a highly complex motor skill.

It is not a fixed state, but a dynamic process. Just like an orchestra, many different instruments have to be tuned to each other. Postural control is based on the interplay of dynamic sensorimotor processes. When we become insecure, it is usually not due to a total breakdown, but to the fact that individual “instruments” are no longer playing precisely.

The two pillars of posture control

In order for us to get through everyday life safely, our nervous system must constantly achieve two functional goals:

  • Postural orientation: This is the active alignment of the head and torso. Our brain uses information about gravity, the ground beneath our feet and the visual environment to position us in space.
  • Postural balance: This involves the coordination of strategies that stabilize our body’s center of gravity – regardless of whether we move ourselves or are bumped into from the outside.

Why age increases the risk of falling

The risk of falling does not increase with age because “the one” balance system ages. There is no single center for balance. Rather, there are various subsystems that can lose efficiency independently of each other:

  • Biomechanical restrictions: This includes above all the loss of strength in the feet and ankle joints. Today we speak of sarcopenia – an age-related loss of muscle mass, but above all of Muscle function and strength (Stefanini 2025).
  • Sensory losses & weighting: We normally rely on 70% on our own perception (somatosensory system), 10% on vision and 20% on the organ of balance in the inner ear (vestibular system). In old age, the brain often finds it more difficult to quickly “rebalance” these senses when the environment changes – for example, when it gets dark.
  • Verticality & Cognition: An often underestimated factor is the “internal representation of verticality”. This is your brain’s mental map for the “plumb line”. If this map becomes inaccurate, you sway even though your muscles are actually strong enough. In addition, postural control requires more conscious attention in old age, making multitasking while walking more dangerous.

Conclusion

Falls are not an inevitable fate of ageing. They are the result of identifiable changes in a highly complex network. The good news is that the human brain and musculature can be trained well into old age. Precise diagnosis of the subsystems allows targeted countermeasures to be taken so that you can go through life safely and with pleasure again.

Article created with the support of NotebookLM.

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Literature:

Horak, F. B. (2006). Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age and Ageing, 35(suppl_2), ii7-ii11.

Stefanini, N., et al. (2025). Sarcopenia: current state of knowledge and its implications in orthopaedics and traumatology. Musculoskeletal Surgery.