DCs are uniquely positioned to detect early signs of proprioceptive decline, intervene with targeted care and help their patients remain active, independent and safe.
DCs are uniquely positioned to detect early signs of proprioceptive decline, intervene with targeted care and help their patients remain active, independent and safe.Aging is inevitable; falling is not. Yet, for far too many older adults, a decline in proprioception, the body’s innate ability to sense position, movement and balance, leads to instability, falls and a cascade of health complications. However, with the right tools and clinical approach, we can shift the conversation from fall recovery to fall prevention, and, in doing so, impact longevity and quality of life.
Why proprioception matters in aging
Proprioception is often described as our “sixth sense;” the body’s ability to know where it is in space without visual input. It integrates signals from muscles, joints, tendons, the vestibular system and vision to coordinate movement and maintain stability.
When proprioception declines, the effects are subtle at first: a slight hesitation stepping off a curb, a bit more sway when standing still, a slower walking pace. But left unchecked, these changes increase the risk of mobility issues, loss of independence and falls.
Falls are the leading cause of injury among older adults, resulting in more than eight million emergency room visits every year. They are also the second leading cause of unintentional injury-based deaths worldwide. Loss of balance and proprioceptive acuity typically accelerates after age 50. The landmark study by Araujo and colleagues, published in the British Journal of Sports Medicine, found the inability to hold a 10-second one-legged stance was associated with an 84% higher risk of all-cause mortality over a seven-year follow-up; independent of age, body mass index (BMI) and comorbidities.1
Why you should care
DCs evaluate and treat the spine, nervous system and musculoskeletal structures that directly influence proprioceptive function. Many conditions we see, such as degenerative joint changes, neuropathies, vestibular issues and postural changes, can impair sensory feedback and integration. We are also trusted by our patients to provide lifestyle guidance, which creates a natural opportunity to integrate balance testing and proprioceptive training into wellness and prevention programs. Offering balance assessments not only adds clinical value but also creates a compelling point of differentiation, and patients appreciate proactive strategies that help preserve their independence.
A practical chiropractic approach to proprioceptive health
A practical chiropractic approach to proprioceptive health starts with making balance screening part of every routine exam. The Unipedal Stance Test, also known as the Single Leg Standing Assessment, is quick, reliable and easy to work into your evaluations. By testing patients with both eyes open and closed, documenting results and comparing them to age-based norms, you can spot declines before they turn into bigger problems.
In the largest normative study to date, published in the Journal of Geriatric Physical Therapy, healthy adults aged 18–80+ were assessed for their ability to balance on one leg with eyes open and eyes closed.2 Results revealed a significant, age-related decline. Those aged 60–69 averaged 27 seconds with eyes open, those 70–79 averaged 18 seconds, and those 80 and older averaged just six seconds. Even healthy, active seniors exhibited measurable decreases, reinforcing the importance of routine testing.
For DCs, the single-leg stance is a fast, inexpensive and highly reproducible in-office screen. It requires no equipment beyond a stopwatch and can be completed in under a minute per patient.
Patient education
Education is the next essential piece. Many patients don’t realize their balance has slipped until they experience a fall, so explaining why balance matters can be eye-opening. Sharing simple facts, such as poor balance predicts health decline and mortality, most falls happen at home and balance relies on systems we can strengthen, helps patients understand why it deserves their attention.
Strengthen proprioception through care and collaboration
Once they’re on board, it’s time to integrate targeted proprioceptive exercises into their care plan. Start with single-leg stands, using support if necessary and progress to more challenging variations, such as eyes closed or adding gentle movement. Core stability work, such as planks, bridges or Pilates-style exercises, lays a strong foundation. Dynamic balance challenges including tandem walking, foam pad drills or even light wobble board activities keep things interesting and functional. For those with significant instability, it’s best to begin in a safe, supported environment before progressing to more advanced movements.
No program is complete without addressing the underlying neuromusculoskeletal issues that contribute to proprioceptive decline. Chiropractic adjustments can restore joint mobility, improve postural control and enhance the flow of sensory information between the body and brain. By tackling restrictions, reducing pain and improving spinal and extremity function, you create the best conditions for balance to improve.
And finally, remember that we don’t work in isolation. If a patient has severe vestibular problems, advanced neuropathy or unexplained rapid balance loss, partnering with neurologists, physical therapists or vestibular rehabilitation specialists ensures they get comprehensive care. Your role remains vital in maintaining musculoskeletal health and supporting proprioceptive function, even as part of a wider team.
Proprioception as a mortality predictor
The British Journal of Sports Medicine study makes a compelling case for the clinical significance of proprioception testing. In their research, 20.4% of adults aged 51–75 could not complete a 10-second one-legged stance. Those unable to complete the test had a 17.5% mortality rate over seven years, compared to 4.6% for those who could. Even after adjusting for comorbidities, inability to balance for 10 seconds increased all-cause mortality risk by 84%. These numbers rival, and in some cases exceed, the prognostic power of traditional risk factors. The takeaway is clear: Balance testing belongs alongside blood pressure, BMI and cholesterol as part of routine preventive screening.
Communicating the value to patients
When patients see their results compared to age norms, it creates a powerful “aha” moment. A simple statement such as, “Mr. Jones, your balance test shows you can stand on one leg for seven seconds. For your age, we’d like to see closer to 20 seconds. Research shows low scores such as this can predict higher fall risk and even health outcomes. The good news? With targeted exercises and care, we can improve this,” can spark motivation. By framing results in both functional and health terms, you increase patient buy-in and compliance.
A call to action
Proprioceptive decline in our aging population is both measurable and modifiable. The chiropractic profession is in an ideal position to detect early decline with quick, validated tests, address contributing neuromusculoskeletal dysfunction, implement safe, progressive proprioceptive training, collaborate with other providers when needed and educate patients and communities on the link between balance, falls and longevity.
Final thoughts
Our aging patients want more than pain relief; they want to keep doing the things they love without fear of falling. By making proprioception assessment and training a standard part of our care, we not only help them stay on their feet but also, quite possibly, extend their lives. As the evidence shows, a few seconds on one leg can tell us a lot about a patient’s future. Let’s make those seconds count.
Mark Sanna, DC, ACRB LEVEL II, FICC, is the CEO of Breakthrough Coaching, a practice management company for chiropractic and multidisciplinary practices. He is a Board member of the Foundation for Chiropractic Progress, a member of the Chiropractic Summit and a member of the Chiropractic Future Strategic Plan Leadership Committee. To learn more, call 800-723-8423 or visit mybreakthrough.com.
References
Aruajo CG, et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. Br J Sports Med. 2022;56(17):975-980. https://pubmed.ncbi.nlm.nih.gov/35728834/. Accessed September 15, 2025.
Springer BA, et al. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther. 2007;30(1):8-15. https://pubmed.ncbi.nlm.nih.gov/19839175/. Accessed September 15, 2025.
