Essential Points:

• The somatosensory system is essential for balance, acting as the body's internal communication network by gathering sensory information from the environment to guide movements and maintain stability. It provides crucial data about touch, pressure, and proprioception, helping us navigate everyday activities confidently.

• Proprioception, part of the somatosensory system, is our 'sixth sense' for knowing body position and movement without visual input, allowing precise adjustments to prevent falls.

• Training and enhancing the somatosensory system can significantly improve balance, especially for older adults or those with sensory dysfunction. Exercises like barefoot walking, proprioception drills, and using unstable surfaces can refine sensory feedback, reduce fall risk, and support overall mobility. Although, it is important to note that these exercises should only be done as instructed by a healthcare provider if you have medical conditions such as neuropathy.

Balance is something we often take for granted, until we lose it. Whether it's walking on an uneven surface, climbing a set of stairs, or simply standing upright, balance plays a crucial role in nearly everything we do. It keeps us steady, safe, and allows us to move with confidence throughout our daily lives. For older adults, maintaining good balance is even more critical as it can significantly reduce the risk of falls and related injuries, preserving independence and overall quality of life into the later years

One of the key heroes of bodily balance is the somatosensory system. This complex and fascinating system is the body's internal communication network, constantly collecting and processing sensory information to help us understand the physical world around us. It tells us where our body is in space, whether we're standing on a hard surface or a soft one, and if we're tilting too far in one direction. In this article, we'll dive deep into the somatosensory system, exploring its components, how it works, and why it's so essential for maintaining balance.

So, let’s start by breaking down what this system actually is and how it operates as our body's sensory guide.

What is the Somatosensory System?

At its core, the somatosensory system is like the body's information highway, it gathers data from the environment through a network of specialized receptors spread throughout your body. (1) These receptors sense touch, pressure, temperature, vibration, and even pain, then send that information to the brain for processing. Essentially, it's the body’s way of monitoring the physical world and responding accordingly.

The primary function of the somatosensory system is to detect and interpret sensory information. (1) Think of it as a constant feedback loop, where the brain and body are in perpetual communication. For example, if you step on an uneven surface, the system immediately sends signals to your brain about what’s happening under your feet, prompting quick adjustments to keep you stable and upright.

It also plays a critical role in proprioception, which is your body's sense of position and movement. (2) Without proprioception, you'd have a hard time knowing if your arm was raised or lowered without looking. It's the somatosensory system that lets you touch your nose with your eyes closed or navigate a dark room without bumping into walls.

Key Components of the Somatosensory System

To understand how the somatosensory system maintains balance, it’s important to explore its key components. These include different types of receptors and pathways that send and process sensory data:

Mechanoreceptors

Mechanoreceptors are specialized nerve endings found in the skin, muscles, and connective tissues. (3) They respond to physical forces like pressure, stretch, and vibration, and are critical for providing the brain with information about the body's interaction with the environment. There are several types of mechanoreceptors, each tuned to specific types of stimuli:

• Meissner’s Corpuscles: Detect light touch and changes in texture, essential for tasks like reading Braille or feeling the surface of an object.

• Pacinian Corpuscles: Respond to deep pressure and vibration, helping the body sense movement and adjustments underfoot.

• Ruffini Endings: Sensitive to skin stretch, providing cues about joint position and helping the brain understand body posture.

• Merkel Cells: Detect sustained pressure and texture, giving us detailed information about the shapes and edges of objects.

Proprioceptors

Proprioceptors are another essential component, specifically designed to provide information about body position and movement. (2) They are found in muscles, tendons, and joints, offering a constant stream of data to the brain about where your limbs are and how they’re moving:

• Muscle Spindles: Detect changes in muscle length, helping the body adjust tension to maintain posture.

• Golgi Tendon Organs: Monitor tension within tendons, preventing muscle damage by sensing excessive force.

• Joint Receptors (Ruffini Endings): Located in the connective tissue around joints, these receptors provide feedback on joint angle, contributing to precise movement control and knowledge of where your limbs are in space.

Nerve Pathways

All of this sensory information needs to get to the brain somehow, and it does so through a complex network of nerve pathways:

• The spinal cord and peripheral nerves act as a major highway, relaying signals from the body's extremities to the brain for processing.

• Once these signals reach the brain, they are interpreted in a portion of the parietal lobe called the somatosensory cortex, a specialized region responsible for making sense of all the sensory data we receive. (4) This interpretation allows us to make quick adjustments and remain stable in various environments.

How the Somatosensory System Contributes to Balance

The somatosensory system is crucial for maintaining balance, primarily through its role in proprioception, the sense of where your body is in space. Here’s a closer look at how it keeps you steady:

Proprioception

Proprioception is often called our "sixth sense" because it operates outside our conscious awareness to keep us upright. (2) It allows you to know the position of your limbs and the orientation of your body without needing to look. For example, if you’re walking in the dark, proprioception is what helps you stay balanced, sensing the angle of your feet and legs with each step.

Touch and Pressure Cues

Even subtle changes in pressure can make a big difference when it comes to balance. The skin’s mechanoreceptors pick up on tiny shifts in weight distribution, such as when you lean to one side or start to slip. (3, 5) These cues allow your body to make micro-adjustments, shifting your weight to regain stability.

Feedback Loops

The somatosensory system operates through a series of rapid feedback loops, constantly sending sensory information to the brain and receiving instructions in return through the major nerve highways. (6, 7) When you start to lose balance, the system triggers a rapid response, like widening your stance or extending your arms for stability, within milliseconds. This real-time feedback is crucial for preventing falls.

Occasionally, these feedback loops can bypass the brain in a response known as a reflex if harmful stimuli are detected. (8) This occurs as the spinal cord receives a message and sends back an immediate command such as moving your hand away from a hot stove. This may also occur when stepping on a sharp object as a nail, leading to a sudden shift of weight and recoil of the injured foot.

Interplay with Other Balance Systems

Balance isn’t just about the somatosensory system; it works in collaboration with the vestibular system (which senses head movement and orientation) and the visual system (which uses sight for spatial awareness). Together, these systems create a network that allows the brain to cross-check information and make accurate adjustments, ensuring steady balance across a variety of environments. I call these the three bodily balance systems.

The Process of Sensory Integration for Balance

The ability to stay balanced relies heavily on sensory integration, which is how the brain processes and combines input from all three balance systems (somatosensory, visual, and vestibular) to establish an appropriate response. (9) The brain constantly evaluates the reliability of the information coming from each system and determines which information to use for effective completion of the current goal. One important aspect of sensory integration is the ability to lend more importance to one system over another depending on the situation.

Reweighting of Sensory Information

The brain is smart, it can adjust or “reweight” the importance of different sensory inputs for balance depending on the situation in a process called sensory reweighting. (10, 11, 12) For example, when you’re walking on a soft surface like sand, the somatosensory system is heightened, helping you feel the texture and pressure shifts underfoot. This flexibility is crucial for navigating complex environments, from city streets to hiking trails. Or perhaps you are walking in the dark and your vision is unreliable. In this scenario, your brain will reweight to using more somatosensory and vestibular information because your vision is unreliable.

Sensory reweighting is a constant ever changing process and is based on environmental differences as well as individual differences.

Examples of Sensory Integration in Different Environments

• Walking on uneven ground: The brain combines tactile information from the feet with data about the angle of joints to maintain stability, while ensuring you stay level with signals from the eyes and vestibular system

• Navigating in low light: The brain downplays visual input and relies on proprioceptive and vestibular data in darker environments as visual stimuli may be unreliable.

• Standing on a moving platform: Somatosensory input from the feet helps the brain compensate for motion, while the vestibular system adjusts for changes in head orientation.

How Somatosensory Dysfunction Impacts Balance

When the somatosensory system isn’t functioning correctly, the impact on balance can be significant. This dysfunction can stem from a variety of sources, such as neuropathy, injuries, or the natural decline of sensory systems with aging. Here, we’ll dive into some common issues that affect somatosensory function and, consequently, balance.

Common Causes of Somatosensory Dysfunction

• Neuropathy: A condition that damages peripheral nerves, leading to numbness, tingling, and even pain. (13) For many, this affects the feet and hands, reducing the accuracy of sensory feedback. With less accurate information coming from the limbs, it becomes much harder to know exactly where your body is in space.

• Aging: As we age, the sensitivity of our sensory systems tends to decline. (14) This can result in reduced proprioception, slower reaction times, and increased difficulty in detecting subtle changes in the environment, like a slightly uneven surface.

• Injury: Damage to sensory nerves, whether from surgery, accidents, or medical conditions, can lead to lasting disruptions in balance. The brain might receive distorted or diminished information about the body’s position and movements.

Effects of Dysfunction on Balance

When the somatosensory system struggles to provide accurate input, the brain may fail to make appropriate adjustments, leading to instability or even falls. In particular, older adults are more susceptible to falls due to decreased somatosensory function. Here’s a quick case study to illustrate the impact:

Case Study
My former patient, we will call her Samantha, was 73 at the time I was working with her. Samantha had a history of diabetes leading to neuropathy in her feet, in addition to diabetic retinopathy that started to affect her vision greatly. Due to the neuropathy she had a hard time distinguishing what her feet were feeling while walking. She would walk with her feet wide apart for balance, but still stumble often. This loss of balance worsened the darker it got throughout the day as her eyes could not pick up reliable information to give her orientation to the world.

Conditions Related to Somatosensory Dysfunction

Certain conditions are particularly notorious for affecting somatosensory health. For instance, diabetes often leads to peripheral neuropathy, severely impacting balance. (13) Another example is multiple sclerosis, where damage to nerve fibers can interfere with how the brain interprets sensory signals. (15) In both cases, balance training becomes even more critical to compensate for these deficits and reduce the risk of falls.

Training and Enhancing the Somatosensory System for Better Balance

Maintaining and improving somatosensory health requires specific training approaches that challenge and refine the body’s sensory capabilities. Here are some proven strategies for enhancing your somatosensory function to improve balance.

Balance Exercises to Boost Somatosensory Input

• Barefoot Exercises: Removing your shoes lets you feel the ground more intimately, heightening the sensory feedback from the feet which may allow heightened responses from the brain. (16, 17) Simple activities like barefoot walking, standing on one leg, or performing calf raises without shoes can be incredibly beneficial.

  • Note: This shouldn’t be done if you have a history of neuropathy as you may not notice injury to the bottom of your foot while walking. This can lead to advanced wounds over time and secondary complications.

• Walking on Uneven Surfaces: Whether it’s a grassy field, a pebble-covered path, or a soft sand beach, walking on uneven surfaces forces the brain to process constantly changing inputs, refining proprioception, balance, and working important ankle musculature for increased control.

• Proprioception Drills: These are exercises that directly target your sense of body position. Examples include standing on one leg with your eyes closed, practicing single-leg squats, or using external cues like tapping a cone with one foot while the other balances. Dive deeper on some of these exercises here.

Tools for Somatosensory Training

Incorporating balance tools can make training more engaging and effective:

• Balance Boards: These boards rock and tilt, challenging you to stabilize against the movement.

• Wobble Cushions and Foam Pads: These create an unstable surface that forces your body to make micro-adjustments, enhancing sensory awareness.

• Sensory-Rich Environments: Spaces that feature a mix of textures, surfaces, and environmental challenges (like playgrounds or nature trails) are excellent for somatosensory practice.

• Cones: Cones placed around the body with intention of tapping with a floating foot while the other balances. Can be useful to enhance awareness of foot and leg position without explicit visual targeting of the cone.

Sensory Awareness and Mindfulness

Mindfulness practices can significantly boost your awareness of sensory information. (18) Activities like body scanning, mentally noting sensations from head to toe, or yoga can heighten your attention to subtle shifts in balance and body positioning.

Technology and Tools for Assessing and Enhancing Somatosensory Balance

With advancements in technology, assessing and improving somatosensory balance has become more accessible. Here's a look at the tools that can help.

Devices for Assessing Somatosensory Function

Pressure Plates and force platforms are tools that detect subtle shifts in weight distribution, pressure and force at the feet. (19, 20, 21) Clinicians can use them to analyze balance and help improve somatosensory feedback for equalizing foot pressure disparities in standing. They can also be used to measure exact forces exerted through the feet during different movements, providing a detailed analysis of balance, and force during more dynamic activities such as jumping and landing.

Wearable Technology for Monitoring and Improvement

Wearable devices, like smart insoles, use sensors to provide real-time feedback on your balance and posture. (22) These tools can alert you to uneven weight distribution or missteps, prompting adjustments. Some wearables even come with integrated training programs that guide you through exercises designed to boost proprioception and balance. Although these look like a promising tool, long-term effectiveness or strict practical utility is still a question.

How to Maintain Somatosensory Health as You Age

Taking care of your somatosensory system isn’t something that should be left for later years. It’s crucial to engage in habits now that preserve and even enhance somatosensory function as you age.

Tips for Preserving Sensory Health

• Stay Physically Active: Diverse movement keeps your somatosensory system sharp. (23, 24) Incorporate activities like walking, dancing, tai chi, weightlifting to keep your muscles and sensors engaged.

• Foot Care: Pay special attention to foot health, as it’s often the first area where somatosensory decline can be noticed. (25) Keep your feet clean, moisturized, and check regularly for any signs of skin breakdown or decreased sensation.

• Hydration and Nutrition: Proper hydration helps maintain nerve health, while a healthy diet supports proper nervous system function. (26, 27, 28)

• Get Quality Sleep: Sleep plays a significant role in nerve healing and overall sensory health. Prioritize restful and regular sleep patterns to mitigate declines in sensory systems. (29, 30)

Strategies for Addressing Neuropathy or Other Sensory Conditions

• Regular Medical Check-ups: For conditions like diabetes, maintaining regular check-ups helps catch neuropathy early.

• Targeted Exercise: Focus on exercises that stimulate proprioception, like balance drills and weight-shifting activities to help adapt and compensate for loss sensation.

• Mindful Practices: Mindfulness and gentle yoga can improve your overall body awareness, even if sensation is slightly diminished.

Final Thoughts: Feel Your Way to Better Balance

Understanding the role of the somatosensory system in balance is crucial for maintaining stability and preventing falls. This often-overlooked network of sensors and signals is your body's way of knowing where you are in space, allowing you to navigate through life confidently and securely.

Now that you’re familiar with how the somatosensory system operates, don’t hesitate to start integrating some balance exercises into your routine. Whether it’s a simple barefoot walk or a more advanced proprioception drill, paying attention to your somatosensory health can make a significant difference in your overall well-being and balance as you age.

If you’re struggling with balance or notice signs of somatosensory decline, consider seeking an assessment from a healthcare professional or start working your balance with my Beginner to Intermediate Balance Program. Addressing these issues early can help you maintain your independence and reduce the risk of falls as you age.

References

1. Donkelaar HJT, Broman J, Van Domburg P. The somatosensory system. In: Springer eBooks. ; 2020:171-255. doi:10.1007/978-3-030-41878-6_4

2. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiological Reviews. 2012;92(4):1651-1697. doi:10.1152/physrev.00048.2011

3. Iheanacho F, Vellipuram AR. Physiology, mechanoreceptors. StatPearls - NCBI Bookshelf. Published September 4, 2023. https://www.ncbi.nlm.nih.gov/books/NBK541068/#:~:text=Mechanoreceptors%20are%20an%20important%20receptor,for%20human%20development%20and%20sensation.

4. Raju H, Tadi P. Neuroanatomy, somatosensory cortex. StatPearls - NCBI Bookshelf. Published November 7, 2022. https://www.ncbi.nlm.nih.gov/books/NBK555915/

5. Marzvanyan A, Alhawaj AF. Physiology, sensory receptors. StatPearls - NCBI Bookshelf. Published August 14, 2023. https://www.ncbi.nlm.nih.gov/books/NBK539861/

6. Biga LM, Bronson S, Dawson S, et al. 14.5 sensory and motor pathways. Pressbooks. Published September 26, 2019. https://open.oregonstate.education/aandp/chapter/14-5-sensory-and-motor-pathways/

7. Peterka RJ. Sensory integration for human balance control. Handbook of Clinical Neurology. Published online January 1, 2018:27-42. doi:10.1016/b978-0-444-63916-5.00002-1

8. Derderian C, Shumway KR, Tadi P. Physiology, withdrawal response. StatPearls - NCBI Bookshelf. Published January 3, 2023. https://www.ncbi.nlm.nih.gov/books/NBK544292/#:~:text=The%20reflex%20arc%20is%20the,synapse%20in%20the%20spinal%20cord.

9. Guardado KE, Sergent SR. Sensory Integration. StatPearls - NCBI Bookshelf. Published July 31, 2023. https://www.ncbi.nlm.nih.gov/books/NBK559155/#:~:text=Sensory%20integration%20(SI)%20is%20a,stimuli%20and%20give%20it%20meaning.

10. Assländer L, Peterka RJ. Sensory reweighting dynamics in human postural control. Journal of Neurophysiology. 2014;111(9):1852-1864. doi:10.1152/jn.00669.2013

11. Haran FJ, Keshner EA. Sensory reweighting as a method of balance training for labyrinthine loss. Journal of Neurologic Physical Therapy. 2008;32(4):186-191. doi:10.1097/npt.0b013e31818dee39

12. Liu XX, Wang G, Zhang R, et al. Sensory reweighting and self-motion perception for postural control under single-sensory and multisensory perturbations in older Tai Chi practitioners. Frontiers in Human Neuroscience. 2024;18. doi:10.3389/fnhum.2024.1482752

13. Peripheral neuropathy. Cleveland Clinic. Published June 27, 2024. https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy

14. Shaffer SW, Harrison AL. Aging of the Somatosensory System: a Translational perspective. Physical Therapy. 2007;87(2):193-207. doi:10.2522/ptj.20060083

15. Cameron MH, Nilsagard Y. Balance, gait, and falls in multiple sclerosis. Handbook of Clinical Neurology. Published online January 1, 2018:237-250. doi:10.1016/b978-0-444-63916-5.00015-x

16. Park JH, Benson RF, Morgan KD, Matharu R, Block HJ. Balance effects of tactile stimulation at the foot. Human Movement Science. 2022;87:103024. doi:10.1016/j.humov.2022.103024

17. Kim T, Seo DY, Bae JH, Han J. Barefoot walking improves cognitive ability in adolescents. Korean Journal of Physiology and Pharmacology. 2024;28(4):295-302. doi:10.4196/kjpp.2024.28.4.295

18. Bakker K, Moulding R. Sensory-Processing Sensitivity, dispositional mindfulness and negative psychological symptoms. Personality and Individual Differences. 2012;53(3):341-346. doi:10.1016/j.paid.2012.04.006

19. Lee CH, Sun TL. Evaluation of postural stability based on a force plate and inertial sensor during static balance measurements. Journal of PHYSIOLOGICAL ANTHROPOLOGY. 2018;37(1). doi:10.1186/s40101-018-0187-5

20. Błaszczyk JW. The use of force-plate posturography in the assessment of postural instability. Gait & Posture. 2015;44:1-6. doi:10.1016/j.gaitpost.2015.10.014

21. Paillard T, Noé F. Techniques and methods for testing the postural function in healthy and pathological subjects. BioMed Research International. 2015;2015:1-15. doi:10.1155/2015/891390

22. Almuteb I, Hua R, Wang Y. Smart insoles review (2008-2021): Applications, potentials, and future. Smart Health. 2022;25:100301. doi:10.1016/j.smhl.2022.100301

23. Aman JE, Elangovan N, Yeh IL, Konczak J. The effectiveness of proprioceptive training for improving motor function: a systematic review. Frontiers in Human Neuroscience. 2015;8. doi:10.3389/fnhum.2014.01075

24. Popovich C, Staines WR. Acute aerobic exercise enhances attentional modulation of somatosensory event-related potentials during a tactile discrimination task. Behavioural Brain Research. 2014;281:267-275. doi:10.1016/j.bbr.2014.12.045

25. Peripheral neuropathy. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy

26. Gomez‐Pinilla F, Gomez AG. The influence of dietary factors in central nervous system plasticity and injury recovery. PM&R. 2011;3(6S). doi:10.1016/j.pmrj.2011.03.001

27. Soury ME, Fornasari BE, Carta G, Zen F, Haastert-Talini K, Ronchi G. The role of dietary nutrients in peripheral nerve regeneration. International Journal of Molecular Sciences. 2021;22(14):7417. doi:10.3390/ijms22147417

28. Foundation for Peripheral Neuropathy. Nutrition | The foundation for Peripheral Neuropathy. The Foundation for Peripheral Neuropathy. Published September 19, 2024. https://www.foundationforpn.org/living-well/lifestyle/nutrition/#:~:text=Establish%20your%20diet%20around%20vegetables,little%20added%20sugars/caloric%20sweeteners

29. Ferini-Strambi L. Neuropathic Pain and Sleep: a review. Pain and Therapy. 2017;6(S1):19-23. doi:10.1007/s40122-017-0089-y

30. Krause AJ, Prather AA, Wager TD, Lindquist MA, Walker MP. The Pain of sleep Loss: a brain characterization in humans. Journal of Neuroscience. 2019;39(12):2291-2300. doi:10.1523/jneurosci.2408-18.2018