Our balance system works through constant communication back and forth between the brain, inner-ear balance (vestibular) system, eyes and proprioceptive system (skin, muscles and joints). There are many parts to this delicate and complex process - it is no wonder balance and dizziness problems often are multifactorial (have more than one cause).

People with balance and dizziness disorders commonly have one or more conditions that:

• appear at the same time as dizziness and imbalance
• start before a diagnosis of a balance or dizziness disorder
• happen after a balance and dizziness disorder

Some medical conditions have similar symptoms. This makes it difficult to distinguish between them. When conditions overlap, it is often hard to make an accurate diagnosis. Some patients are incorrectly diagnosed. For these patients, years may be lost while they struggle with dizziness and imbalance.

Conditions contributing to multifactorial balance and dizziness include:

• Poor vision
• Weak muscles
• Poor coordination
• Poor sensation, especially on the feet (peripheral neuropathy)
• Impaired proprioception (for example not being able to tell if your toe is being held up or down, or if your head is straight, turned or tilted)
• Medications, particularly those that are sedating or lower blood pressure
• Advancing age (90% of Canadian over 65 suffer from at least one chronic condition)

The most common cause of chronic imbalance is probably multi-factorial, involving mild sensory loss, decreased muscle strength and other medical problems such as arthritis. This can be diagnosed by a neurological examination and is best treated through a physical therapy program of balance, strengthening and endurance exercises.

A comprehensive, evidence-based approach, delivered by a team of professionals such as physicians, audiologists and physiotherapists, is the most effective treatment for most people.