How Arthritis Affects Your Balance

Although you might associate arthritis with issues like joint pain and stiffness, the condition can also have a significant effect on balance. That's because arthritis can lead to a more limited range of motion and muscle weakness, causing changes in how you move. When that happens, it increases the risk of arthritis-related balance problems and unstable movement.

The biggest danger comes with increased risk of falls. The Centers for Disease Control and Prevention reports that falls are the leading cause of injury and death for adults aged 65 and older, with one in four older adults falling every year. Fall prevention is essential among seniors, and if you have arthritis, that makes it extra important to address any issues related to balance, starting with strategies for improving mobility and stability.

How Can Arthritis Cause Balance Problems?

Balance is defined as a "dynamic integration of sensory inputs, neural control processes, and biomechanical mechanisms across multiple systems," according to a recent research analysis in the Journal of Clinical Medicine. Put more simply, your balance depends on three systems—vision, the inner ear, and your muscles and joints—working together, says Mallory Behenna, D.P.T., a doctor of physical therapy and outpatient orthopedic program coordinator at Brooks Rehabilitation in Jacksonville, FL.

Of those three categories, arthritis primarily affects biomechanical mechanisms, by impacting muscle strength, walking patterns, and movement control. Once biomechanics have been affected, it becomes harder for your sight and hearing to properly interpret your movement, thus leading to changes in your balance.

Joint Pain and Stiffness Can Affect Stability

Arthritis-related pain and stiffness change the way you load and move through a joint, says Pamela Mehta, M.D., an orthopedic surgeon and founder of Resilience Orthopedics in Los Gatos, CA.

"You start to walk differently or use your arms and legs in a way that puts undue strain on other muscles and joints, to prevent pain from a sore joint," Dr. Mehta says. "If your knee, hip, or ankle does not bend normally, it becomes harder to react quickly when you lose your footing. Joint pain also makes people hesitant to put full weight through one side. That hesitation can affect stability, especially during turns, stairs, or walking on uneven ground."

In cases of types of arthritis such as osteoarthritis, the cartilage that usually provides cushion and lubrication for the bony surfaces of a joint is severely damaged or gone, allowing bone to touch bone directly, says Behenna. This stimulates pain receptors and affects joint stability.

Muscle Weakness Reduces Mobility

In an effort to avoid joint pain with arthritis, it's natural to think you should move less often. Ironically, moving less often creates imbalances in muscle strength, making your joint pain worse. "Muscle weakness makes the joint less stable and reduces your ability to control movement," says Dr. Mehta. "I often see this in people who struggle to get out of a chair, climb stairs, or control the knee when stepping down. The joint may feel like it's giving way, but sometimes the real issue is that the surrounding muscles are not strong enough to support it." Weakness makes fatigue set in sooner, she adds. Once the muscles tire, walking quality gets worse and the risk of tripping or falling increases.

"Your muscles are the biggest support structures around your joint," says Emily Poirier, D.P.T., a doctor of physical therapy at WAVE Physical Therapy & Pilates in Cincinnati, OH. "Being strong doesn't always mean you will be pain-free, but it can significantly improve your mobility, balance, and functionality."

Changes in Walking Patterns and Posture

People naturally change the way they move to improve their comfort, Dr. Mehta explains. They may take shorter steps, spend less time on the painful knee, lean to one side, or keep their legs slightly bent. "Those changes shift stress to other parts of the body," she says. "In the short term, you can walk with a limp or unevenly. But over time, it leads to pain in the opposite knee, the other hip, or the lower back, making the problem even worse."

Gait and posture changes due to arthritis vary widely from person to person, adds Behenna. Talk with a physical therapist and get evaluated on how well you're walking so you can better understand how arthritis may be affecting your walking patterns.

Arthritis in the Knees, Hips, and Ankles

Osteoarthritis can affect almost any joint in the body, but some joints play a larger role in maintaining balance than others, and that includes the knees, hips, and ankles.

Arthritis in the Knees

In healthy knee joints, impact is absorbed with every step. But arthritis can make bending and straightening the joint painful, and a stiffer knee joint results in a more acute impact. That can lead to shortening your stride or favoring one leg, with a subsequent effect on stability. When there's muscle weakness as well, that reduces support for the knee joints and compromises balance as a result, says Behenna.

Arthritis in the Hips

With the hips, arthritis-related pain and stiffness can limit your ability to shift weight smoothly from one leg to the other. This has a significant effect on movement, including walking, climbing stairs, or doing everyday tasks, Dr. Mehta says. Muscle weakness plays a part here, too, since weakened muscles around the hips or pelvis leads to balance difficulties on uneven surfaces such as a gravel walkway. It can also interfere with movements like lifting your leg to step onto a curb.

Arthritis in the Ankles

Although arthritis in the ankles is less common than knee arthritis, it can happen and may significantly affect balance in notable ways. The ankles play an important role in stabilizing the body through three-dimensional motions called pronation and supination (rotating the ankle to the outside or inside when it bears weight). When you walk, your ankles are constantly adjusting to keep the body in the right position for movement. If there is weakness, stiffness, swelling, or pain in the joint from arthritis, that can reduce mobility and make it difficult to adapt to changes in direction or uneven ground.

Signs Arthritis May Be Affecting Your Balance

While falls or almost-falls are a clear indication that arthritis is affecting your balance, other indications that arthritis may be having an impact on your balance, as well as your overall stability and mobility, are more subtle. Dr. Mehta says these are some signs to watch for:

• Holding onto furniture when walking around the house.
• Feeling unsteady when you turn or change direction.
• Avoiding uneven surfaces.
• Becoming afraid of climbing or descending stairs.
• Feeling like a joint is unstable or about to buckle.

"One of the biggest signs is gradually doing less because you no longer trust the joint with arthritis," says Dr. Mehta. "That loss of confidence can quickly lead to more weakness and worse balance."

Why Balance Is Important for Everyday Mobility

Balance is something you need all day long, from putting on your socks to carrying groceries to changing a lightbulb. Every time you go up a flight of stairs, there's a moment between steps when one foot is lifted and the other is anchored, requiring you to balance on one leg. Other moments of balance include:

• Bending down to tie your shoes
• Carrying a bag
• Getting into and out of a car
• Lifting a foot or leg to get in a bath or shower
• Reaching for a pot or pan in the kitchen
• Stepping off a curb to enter a crosswalk
• Walking on uneven ground

Even turning to talk to someone when you're standing requires balance and stability. If balance starts to decline, these everyday tasks become more challenging and more tiring, and they can affect your confidence, says Dr. Mehta. When that happens, you may move less often, and that comes with significant difficulties as well, since being more sedentary can lead to more muscle weakness, reduced bone density, and higher risk of developing other chronic conditions.

How to Improve Balance With Arthritis

Balance and strength go hand-in-hand; to have one, you need to work on the other, says Spencer Simmons, D.P.T., a doctor of physical therapy and clinical director at FYZICAL in West Hartford, CT. He suggests strategies such as:

• Balance exercises to improve stability
• Low-impact exercise such as walking, swimming, cycling, or water aerobics
• Strength training for the hips, legs, ankles, and core
• Stretching to reduce stiffness and improve mobility
• Working with a physical therapist for an individualized treatment plan

"In order to improve balance and stability, you need to be evaluated to see where exactly the issues are arising," adds Behenna. "If your balance issues are primarily from muscle weakness, you would need to find ways to strengthen your muscles without causing further issues from the arthritis." If your balance issues are linked to problems with your inner ear or vision, that would need different interventions than just muscle strengthening, she adds.

Mobility Aids That Improve Stability

The number one way to improve your balance while walking is to walk more. Aids like walkers and rollators can help because they allow you to head out for a stroll more often and for greater distances than you might do otherwise. Rollators include a built-in seat, so you can rest momentarily if you become tired. "Especially for those dealing with balance issues along with arthritis, a mobility aid that improves safety can make walking more approachable," says Poirier.

Staying Steady and Independent With Arthritis

Although balance issues are common with arthritis, that doesn't mean you need to live with limitations and instability. And it certainly doesn't mean you should spend more time resting or being sedentary in general.

"Joint pain often causes people to become less active, gradually weakening the muscles that support the joints," says Simmons. "As strength declines, everyday activities become more challenging, including walking, climbing stairs, and getting up from a chair. Weakness also increases fatigue, which can further reduce movement."

Break that cycle by addressing any balance issues you are facing so you can stay active. Talk with your doctor about mobility concerns, arthritis symptoms, and what you can do right now to ensure you can keep living your life fully tomorrow.