The New York Times
Balance: In Search of the Lost Senseby Scott McCredie
Although vital to our well-being and even to our success as a species, the physical sense of balance has never attained the same recognition as sight, hearing, touch, smell, or taste. Now, with an epidemic of debilitating falls sweeping America's aging population, the time is ripe for a lively and illuminating tour of the human body's most exquisitely intricate and… See more details below
Although vital to our well-being and even to our success as a species, the physical sense of balance has never attained the same recognition as sight, hearing, touch, smell, or taste. Now, with an epidemic of debilitating falls sweeping America's aging population, the time is ripe for a lively and illuminating tour of the human body's most exquisitely intricate and least understood faculty. BALANCE is the first book written for a general audience that examines the mysteries of the human balance systemthe astonishingly complicated mechanisms that allow our bodies to counteract the force of gravity as we move through space. A scientific, historical, and practical exploration of how balance works, BALANCE also provides the keys to remaining upright for as long as humanly possible. From simple motion sickness to astronauts' "space stupids," and from fetal somersaults to the Flying Wallendas, McCredie guides readers on a delightful quest to elevate balance to its rightful place in the pantheon of the senses.
The New York Times
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BalanceIn Search of the Lost Sense
By Scott McCredie
Little, Brown and CompanyCopyright © 2007 Scott McCredie
All right reserved.
PrologueIn Search of the Lost Sense
Aristotle was wrong. Often credited as the first to catalog the human body's primary senses, he neglected to mention one of our most important: the sense of balance, that intricate orchestration of nerve impulses that allows us to dance with gravity. His oversight, however, is understandable. While it's easy to detect the role of the eyes, nose, skin, tongue, and ears, the receptors of balance are hidden from view and don't easily give up their secrets. Because the equilibrium sense is mostly autonomic, working below the level of consciousness, like breathing or the beating of a heart, the great philosopher apparently was unable to sense its subtle operation.
Nearly two thousand years later, the American writer Diane Ackerman made a similar error. In her popular book A Natural History of the Senses, she glossed over the balance and equilibrium faculties in just a few sentences. Ackerman's short shrift of balance is less defensible than Aristotle's, but it still reflects the common view. For a number of reasons, many people today aren't aware that balance is a legitimate sense. Not only is there disagreement among medical professionals about what constitutes a sense, but balance is a devilishly31 complicated phenomenon, and to this day it remains halfveiled in mysteryand ambiguity.
But among those who have studied the balance sense in depth - specialists in scientific research, physical therapy, and clinical medicine - many would argue that without it we might not have much use for the other senses. Not only is the primary balance organ, called the vestibular apparatus, older than most of the other sense organs on an evolutionary scale - an indication of its importance to the survival of our primordial ancestors - but balance is as vital to our existence today as it ever was. Without balance, many of the things we take for granted would be impossible. We could not stand on two legs, never mind walk or run. We couldn't see images in sharp detail as we move, or navigate without visual landmarks, or perhaps even think clearly.
One reason balance is the "lost" sense is that it was missing in action for so long, hidden in shadows as humans toiled to figure out how their bodies worked. Only in the past 150 years or so have we been able to discover just exactly what it is, how it operates, what can go wrong with it, and how to maintain and improve it. Because it is such a latecomer to the table already occupied by the other senses, balance has had to elbow its way to any sort of recognition. Now it's beginning to get some well deserved notice. And the timing couldn't be better. Balance is becoming a bigger issue now than at any time in history, mainly because people are "losing" it more frequently than ever before. And when you lose your balance, even for a moment, whether from disease, the effects of aging, or anything else that interrupts your dance with gravity, bad things can happen.
A few years ago my father and I were hiking together on a popular trail that leads to the top of Mount Si, on the western edge of the Cascade Mountains near Seattle. After stopping at the summit to eat lunch and catch our breath, my dad, who was sixty-seven at the time, grabbed his blue daypack, draped it casually over one shoulder, and began exploring. After a few minutes, he stopped on top of a large rock, and I idly watched him slide the pack strap slowly off his right arm. In what seemed like slow motion, his whole body then proceeded to lean awkwardly toward that side and, to my astonishment, he spun into a headfirst dive, disappearing from sight. Horror-struck, with my heart pounding, I scrambled quickly down to where I imagined him lying, in a crumpled heap, bleeding and badly injured. But by the time I reached him a few seconds later he was already beginning to sit up. Some miracle had caused him to land harmlessly on a patch of ground between boulders. Only his pride had been hurt.
As we descended back down the trail, I began thinking about my father's fall. It was an unsettling demonstration of his growing frailty, and of the dimming of his once dynamic sense of balance. For as long as I had known him he'd been an athletic and graceful man, a renowned fast-pitch softball player, and a professional woodsman who had spent years wading streams and tramping across the slippery backs of fallen logs. I then recalled a friend telling me about a fall his own mother, who was seventy-five, had recently taken. She was a vigorous exerciser who for years had walked several miles at a rapid clip three or four times a week. But on one occasion she suddenly lost her balance and fell forward onto the sidewalk, unable even to get her arms up to protect her face. My friend, though walking at her side, couldn't prevent her fall. The results were gory but not serious.
These two incidents made a deep impression on me and started me wondering about the nature of balance. What controls it? Is the decline of the human balance system - and falling - an inevitable part of growing old? Why isn't balance as commonly talked about in fitness circles as strength training or aerobics or stretching? I was bemused at first by the lack of information. But the further I looked into the subject, the more intrigued I became, not least because I had to search so far and wide to come up with answers to my questions.
One thing I learned is that balance, like all the other senses, begins to degrade after you reach your thirties - unless the process is forestalled by techniques I'll talk about later. Balance disorders are one of the most common forms of disability in the United States. Although reliable epidemiological data are scarce, a 1989 National Institutes of Health report estimated that some 90 million people over age seventeen "have experienced dizziness or balance problems." This figure includes the broadest range of balance disorders, from serious to mild. For comparison, about 32 million Americans suffer from hearing loss today. In this country, an epidemic of falls is mowing down the elderly like scythes, and soon it will begin thinning the ranks of the used-to-be baby boomers. After the age of sixty-five, one out of three Americans falls each year, adding up to more than 10 million falls annually. Dr. Owen Black, one of the leading clinicians in the field of vestibular disorders, reports that 70 percent of falls are mediated by an impairment of the vestibular system. While most falls don't result in serious injury, they are like a game of Russian roulette. Sooner or later the bullet - in the form of fractures, lacerations, and sometimes death - will sit in the firing chamber. While losing your sense of balance, or any sense, is a predictable part of aging, a number of other diseases and disorders also contribute to the danger, such as ear infections, certain types of brain injuries, diabetes, and the dislodging of tiny stones that reside within the inner ear (yes, every one of us has rocks in our head). Tragically, another source of severe balance loss can afflict otherwise healthy people when they contract a bacterial infection that requires a hospital stay.
Cheryl Schiltz was a vibrant, energetic, thirty-nine-year-old woman living in a small town near Madison, Wisconsin, when she suddenly lost her balance. In 1997, after undergoing routine surgery, she developed a postoperative infection that required the prolonged use of a common antibiotic called gentamicin. Seventeen days later, the drug had succeeded in killing the bacteria. But unbeknownst to her or her doctor, it had also destroyed much of the function of her vestibular system, the pair of tiny bizarre-looking organs nestled within her inner ears. These are the body's dedicated gravity- and motion-sensing organs, similar in function to the gyroscopic guidance systems on a modern airplane. Cheryl's world was soon to be turned - literally - upside down.
Back at home two days after the antibiotic treatment ended, she got up from bed in the morning and, as if struck by a shotgun blast, crumpled to the floor. Despite repeated attempts, she was unable to get to her feet. Her vision was blurry and distorted. After crawling to the bathroom, she managed to slide down the stairs of her two-story home on her rear end. "It was like being incredibly intoxicated," she remembers. "The first thing I thought was: Holy cow, what's going on?"
A short time later, Cheryl was back at her doctor's clinic undergoing tests to determine the cause of her problem. She recalls standing in the corridor - a feat she was able to perform only by bracing herself against a wall - when he delivered the bad news: her balance and vision had been disabled - perhaps permanently - by the effects of the antibiotic. Cheryl was among the small subset of people for whom gentamicin is seriously "ototoxic" - literally ear poison. She was diagnosed with "bilateral vestibular dysfunction," or BVD.
Over the next few years, Cheryl's life proceeded to unravel. She tried going back to work, but her symptoms made that difficult. Driving the hundred-mile daily round-trip commute was nearly impossible due to her blurred vision. It's hard for someone with an intact vestibular system to imagine what it's like to look through the eyes of someone with BVD. "If you were to take a video camera and put it against your chest and just walk around and not pay any attention to what you were doing with it, and then watch the video, that's kind of similar to what it looks like," Cheryl explains. "Things wiggle and bounce around. Your eyes are like they're on springs; they don't want to stay still."
Walking became an act of will. Canes, usually one but sometimes two, were a necessity. As if struggling against the altered gravity of another planet, she had to be constantly vigilant about where she was in space, to think about how she was going to get from one point to the next. Assuming what she describes as a "Frankenstein" gait, her body stiff and rigid, her stance wide to compensate for her instability, Cheryl had to keep her gaze focused on the ground in front of her to minimize visual distortion, looking up only to make sure she wasn't going to run into anything. "It's like being in zero gravity," she says. "You just don't have a concept of rightness, or what's up and down. The sense of grounding is gone. It's as if the whole world and everything in it is made out of Jell-O. You don't have anything steady under your feet. And then when you hit that, the Jell-O, everything in the distance starts shaking and that's what you see."
Because she couldn't manage the commute to work, Cheryl was forced to leave the job she loved. She found another closer to home, but her new boss didn't cut her any slack and soon fired her. Although she was a bright, articulate, highly motivated woman by nature, well liked by past employers and colleagues, the BVD not only lowered her self-confidence but diminished many cognitive skills.
"Multitasking was out of the question," she says. "Before the BVD, I'd have two phones going, plus the computer, grabbing this and grabbing that." After the onset of the BVD, "One thing at a time was all I could do. And trying to use a computer, I couldn't take my eyes from the computer to the paper and then back up, it was awful. It would make me feel like I was falling out of my chair. I actually had to get a new chair. I had to ask the company to get me a chair with arms on it, or I would literally fall out of it."
The BVD also affected her short-term memory. She would have trouble remembering information she'd just read. While speaking, words she wanted to say were lost in a kind of brain fog. Simple math became problematic. "I remember making cookies once," she says, "and I got so frustrated, to the point of tears, because I had to go to the other room with the measuring cup and ask my son, 'What is three fourths plus three fourths?' I could not figure it out."
What Cheryl's experience shows us is the utter dependence we humans have on our balance system - not only for maintaining an upright posture, but for vision and even mental acuity. Cheryl, like most of us, never thought about her balance system before it was compromised. Yet we rely on our sense of balance for everything from watching a heron flapping across a marsh to the action (though most people don't think of it as an action) of standing still, which involves constant, nearly imperceptible movements, as well as the integration of many different sensory inputs. Without it we could not perform any of the amazing feats of agility and athletics for which our species is known, from walking a high wire to spinning on ice at eighty revolutions per minute.
Karl Wallenda, the founder of the Flying Wallendas, the famous circus high-wire troupe, possessed arguably the most precisely honed balance of any human in the twentieth century. He came by what most people would consider his almost supernatural balance skills early in life, as many gifted athletes do.
At about the age most kids are learning to ride bicycles, Wallenda was teaching himself to perform handstands in unusual places. It wasn't for sport or his own amusement or because he had nothing better to do. His parents, who had been professional circus performers in Germany, had taught him the rudiments of hand balancing to prepare him for a life in the circus. But when his stepfather was drafted into the German army in World War I, Karl, his mother, and his three siblings were forced to survive on war rations. To supplement the family's skeletal income, the ten-year-old boy, small for his age but agile and strong, would sneak out of the apartment at night, after his mother had gone to bed, and walk alone into town.
Here, at several of the town's restaurants and bars, he would perform a brief but sensational balancing act. First he would do a conventional handstand on the floor, walking around on his hands to arouse the crowd's interest. Then, rising back to a standing position, he would grasp the back of a wooden chair and press up into a handstand. Next he would tilt the chair up so that it was balancing on just its two front legs. The applause would grow a little louder. As the coup de grace, he would then set several chairs on top of one another, balancing all but the bottom chair on two legs. He'd push into a precarious but spectacular handstand on the back of the upper chair, managing to find the column's center of gravity, his feet nearly extending to the ceiling. To magnify the crowd's empathy, he would purposely shift his weight quickly to one side, making it appear that he was about to fall, then recapture his balance. In circus parlance, this bit was known as "selling" the trick to the crowd, making them believe it was extremely difficult. Then he would leap to the ground, landing on his feet, and the coins would fall like sleet into his upturned hat as applause and shouts and whistles engulfed the room.
For Wallenda, whose name would become synonymous with the art of high-wire performing, this entr?e was the beginning of a long career spent challenging the limits of human balance. He is an example of how doing so in a methodical way can produce extraordinary results. Even as an old man, he retained supremely good balance, performing regularly through his fifties and sixties, before finally succumbing to gravity at the age of seventy-three. Because of his balance skills, the odds that Wallenda would have fallen the way contemporary older Americans often do were infinitesimally small. Although few health professionals would advocate that their patients learn handstands or wire walking as a way to improve balance, the principles behind Wallenda's approach are the key to unlocking our own mastery of balance. For balance, like aerobic capacity and strength and agility, is highly trainable. And the better your balance, the less likely you are to fall, whether walking down the sidewalk with a cane or slaloming through a mogul field on skis.
Excerpted from Balance by Scott McCredie Copyright © 2007 by Scott McCredie . Excerpted by permission.
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