She Thought Her Balance Was Declining. The Assessment Revealed Something Else.

When AB came to LiveWell Health, she expressed a concern we hear frequently: she felt that her balance was changing.

AB is 61 years old, loves to travel, and wants to remain active for many years to come. Her motivation is also deeply personal. After serving as her mother’s primary caregiver, she saw what declining strength and independence could eventually mean. She wants to take action now rather than wait until her limitations become more serious.

AB told us that stairs and getting up and down had become more difficult. She had experienced knee and ankle/foot discomfort for more than a year, and although the pain had begun improving, she had become more cautious during activity. Her definition of success was clear: lose another 5–10 pounds, exercise consistently, avoid surgery if possible, and feel like a happy, healthy version of herself.

Her concern about balance was important—but it was only the beginning of the investigation.

What the Assessment Found

We first measured AB’s static postural stability using Area of Ellipse, a measure of how much the body moves while a person attempts to stand still. AB scored in the 90th percentile for her age and sex.

In simple terms, she demonstrated excellent standing balance.

We then assessed her functional lower-body power during a squat. She scored in the 66th percentile for concentric power, which reflects her ability to produce force while rising, and in the 77th percentile for eccentric power, which reflects her ability to absorb force and control herself while lowering.

Again, these were solid results.

If we had stopped there, we might have concluded that AB had no meaningful lower-body limitations. But whole-body movements tell us what someone can accomplish—not always how they accomplish it.

More specific strength testing revealed the missing pieces:

• Knee-flexion strength was in the 22nd percentile on the right and the 41st percentile on the left, creating a 21% side-to-side difference.
• Hip-flexion strength was in the 18th percentile on the right and the 28th percentile on the left, creating a 17% side-to-side difference.
• Knee-extension strength was in the 5th percentile.

The knee-extension result was especially important. The quadriceps help straighten the knee and support the body during stairs, rising from a chair, lowering toward the floor, and many other daily movements. Significant weakness in this area closely matched the activities AB said had become more difficult.

Why Someone Can Feel Unsteady Despite Having Good Balance

When people say, “My balance is not what it used to be,” they are describing an experience—not necessarily identifying the underlying cause.

A person may feel unsteady because the legs do not generate enough force, because one side is doing more work than the other, because pain reduces confidence, or because demanding movements require more effort than they once did. The sensation is real even when static balance itself is not impaired.

AB’s results suggest that she can control her posture very well when standing still. However, stairs, getting up and down, stepping over obstacles, and navigating unfamiliar environments while traveling require much more than static balance. They require adequate strength, power, coordination, and confidence in both legs.

Her above-average squat power also does not contradict the isolated weakness. The body is remarkably good at finding alternative ways to complete a task. AB may be using stronger muscle groups, shifting work toward one side, or relying on an effective movement strategy to maintain good overall squat performance. Isolated testing helps reveal what the larger movement can conceal.

What AB’s Program Should Prioritize

AB does not need a generic “balance program.” Her exercise plan should be built around the limitations the assessment identified while maintaining the abilities she already possesses.

The initial priorities should include:

1. Improving knee-extension strength, with appropriate exercises that strengthen the quadriceps through tolerable ranges of motion.
2. Strengthening knee flexion and hip flexion, with additional attention given to the weaker right side.
3. Reducing meaningful side-to-side differences without unnecessarily limiting the stronger side.
4. Integrating new strength into functional tasks such as step-ups, stair patterns, controlled lowering, rising from progressively lower surfaces, and floor-transition preparation.
5. Gradually increasing exposure to the movements and environments that matter to her, including the walking, carrying, stepping, and repeated transitions involved in travel.

Progress should be measured in more than pounds lifted. We would expect to see improved isolated strength, reduced asymmetry, greater ease with stairs and transitions, less reliance on compensation, and increased confidence during movement. Periodic reassessment can determine whether the underlying deficits are changing—not simply whether AB feels tired after a workout.

Exercise cannot guarantee that surgery will never be necessary, and it should not replace appropriate medical evaluation. It can, however, help AB improve the physical qualities within her control and build greater capacity for the activities she wants to preserve.

The Bigger Lesson

The most important part of AB’s assessment was not a single percentile. It was the way the results fit together.

Her balance concern was valid, but static balance did not appear to be the primary problem. Her results instead pointed toward specific strength deficits—especially knee extension—that were more consistent with her difficulty on stairs and getting up and down.

This is why individualized assessment matters.

We should listen carefully when someone says they feel unsteady, but we should not assume we already know why. The right measurements help us move beyond a symptom label and identify what should actually be trained.

For AB, the goal is not merely to become better at exercise. It is to keep traveling, move without unnecessary hesitation, protect her independence, and remain the happy, healthy person she wants to be.