Imbalance means the inability to keep your balance, especially when standing or walking. Loss of balance or equilibrium is a symptom not a diagnosis. The most common causes of imbalance without dizziness result from dysfunction of the muscles, joints and peripheral nerves (proprioceptive system) or the central nervous system (brain).

People with bilateral vestibulopathy have balance issues but no dizziness if the damage affects both ears at the same time. Those with peripheral neuropathy that does not affect the autonomic nerves have balance issues without dizziness.

Medical conditions and other issues that might cause you to lose balance without experiencing dizziness include:

• Cancer
  Some cancers and cancer treatments affect the nerves or the brain and may cause problems with balance and coordination. Radiation treatments may cause problems with balance and coordination, even many months or years after treatment.
  More information: BC Cancer: Balance & Coordination
• Charcot-Marie-Tooth disease (CMT)
  CMT is one of the most common inherited neurological disorders. Symptoms include a high-stepped gait with frequent tripping or falls. Studies suggest up to 70% of certain subtypes may be strongly associated with profound loss of function of the balance part of both inner ears (bilateral vestibulopathy).
  More information: NINDS: Charcot—Marie-Tooth Disease Fact Sheet
• Fear of falling
  Between 20 and 30% of Canadian seniors fall each year. Fear of falling can become a vicious cycle in which a fear of falling becomes a risk for future falls. Fear of falling can lead to limiting activities that in turn leads to a decline of physical capacity (deconditioning). The result is an increased risk of falling. And then the cycle starts again with a fear of future falling.
• Myasthenia gravis
  Myasthenia gravis is a chronic, autoimmune condition that causes muscles to tire and weaken easily. People with this disorder are at increased risk of falling.
  More information: Myasthenia Gravis Society of Canada
• Neurodegenerative diseases
  Neurodegenerative diseases attack neurons, specialized cells in the nervous system that help with muscle control. These diseases are usually progressive, meaning there is no cure. Neurodegenerative diseases associated with imbalance and falls without dizziness include:
  • Amyotrophic lateral sclerosis (ALS)
    Early symptoms of ALS include tripping and falling. Other names for ALS include Lou Gehrig’s disease and motor neurone disease.
    More information : ALS Canada
  • Huntington disease (HD)
    Symptoms of this inherited disease include impaired gait (walking), posture and balance.
    More information: Huntington Society of Canada
  • Muscular dystrophy
    Muscular dystrophy is a group of inherited diseases that usually strike children. These diseases damage and weaken muscles over time. This leads to imbalance and risk of falling.
    More information: Muscular Dystrophy Canada
  • Progressive supranuclear palsy (PSP)
    Also called Steele-Richardson-Olszewski syndrome, PSP is an uncommon neurodegenerative disorder. It causes serious problems with walking and balance.
    More information: Progressive Supranuclear Palsy: Essential Facts for Patients
  • Spinocerebellar ataxia (SCA)
    SCA is a genetic, neurodegenerative disease. It causes imbalance and gait problems.
    More information: National Ataxia Foundation
• White matter disease
  White matter disease is a condition in which tiny areas of the brain become oxygen deprived. It is common in the brains of people above the age of 60. Gait and balance disturbances are hallmarks of white matter disease. Older adults with significant white matter disease are at a greater risk of falling. Adopting the same healthy lifestyle habits that reduce the risk of heart attack and stroke can minimize white matter damage. Other names for this condition include leukoaraiosis, cerebral small vessel disease and small vessel ischemic disease.
  More information: White Matter Disease Fact Sheet
• Normal pressure hydrocephalus (NPH)
  NPH is a brain disorder in which excess cerebrospinal fluid (CSF) builds up in the brain’s ventricles. It causes thinking and reasoning problems, difficulty walking, and loss of bladder control. People with NPH are at a high risk of falling.
  More information: Alzheimer’s Association: Normal Pressure Hydrocephalus
• Rheumatoid arthritis (RA)
  Rheumatoid arthritis increases the risk of falling. Contributing factors include decreased muscle strength, postural instability, fatigue, joint pain and reduced functioning.
  More information: Arthritis Society
• Spinal cord injuries and disorders
  Spinal cord injuries and disorders can be congenital (malformations present at birth) or acquired (such as spinal cord compression). They can cause difficulty with balance and change in gait.
  More information: Spinal Cord Injury Canada
• Vision impairment
  Poor vision impairs balance and increases fall risk as we age. Effective fall prevention strategies include addressing vision challenges.
• Vitamin B12 deficiency anemia
  In addition to making you feel weak and tired, Vitamin B12 deficiency can cause imbalance.
  More information: HealthLink BC: Vitamin B12 anemia deficiency
• Weak muscles
  Age-related muscle loss (sarcopenia -(saar-kow-PEE-nee-uh) is a natural part of aging. Physically inactive people can lose as much as 3% to 5% of their muscle mass each decade after age 30. Weak muscles have a harder time holding you upright and in proper alignment. Quick movements, such as trying to avoid slipping on wet leaves, can throw you off balance and lead to falls. Regular physical activity that includes strength training helps to maintain and build muscles.

Sources

Muscle weakness as a risk factor for falls in the elderly. Am Fam Physician. 2005. May 1;71(9):1791. Available from: https://bit.ly/2TbKBOs

Rea PA, Ronan N. Systemic disease considerations in the management of the dizzy patient. Lea J, Pothier D (eds): Vestibular Disorders. Adv Otorhinolaryngol. Basel, Karger, 2019, vol 82, pp 150-163.

Seniors’ Falls in Canada. Second Report. Public Health Agency of Canada, 2014. Available from: https://bit.ly/2r7gU36

Stanmore EK et al. Risk factor for falls in adults with rheumatoid arthritis: a prospective study. Arthritis Care Res. 2013 Aug; 65(8): 1251-1258. Available from: https://bit.ly/2YF74si

Tusa RJ. Non-vestibular dizziness and imbalance. Wolf SL (ed): Vestibular Rehabilitation, 4^th ed. Philadelphia, FA Davis, 2014. Pp556-568.