Falls are usually multifactorial, but spine conditions can sometimes contribute. Cervical spinal cord compression can affect balance, coordination, hand function, and walking, while lumbar and lumbosacral nerve-root problems can contribute to leg weakness, foot drop, altered sensation, or reduced walking tolerance. These changes do not prove that the spine is causing a fall, but they are important clues – especially when they are new, progressive, or affecting daily function. A careful evaluation considers symptoms, neurologic examination, walking pattern, imaging when appropriate, medications, vision, strength, peripheral nerve function, and other fall-risk factors together.
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DISCLAIMER:
Transcript lightly edited for clarity and readability. The views expressed are intended to explore the full range of clinical considerations in spine care and do not constitute medical advice. Outcomes vary by patient and pain pattern. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
Welcome to this explainer. If you or someone you care about has ever started to feel a little less steady on their feet, you know how unsettling that can be. It’s easy to chalk those changes up to getting older, but unsteadiness deserves a closer look.
Today we’re exploring one part of that picture that may be overlooked: how the spine and nervous system can contribute to balance, walking, and fall risk.
The important thing to understand from the beginning is that falls are usually multifactorial. Vision, medications, strength, peripheral neuropathy, blood-pressure changes, footwear, the environment, and the vestibular system can all contribute. The spine can be one important piece of that larger picture.
Falls Are Common—but They Are Not Something to Ignore
In the United States, more than one in four adults age 65 and older reports a fall each year, and older-adult falls account for about three million emergency department visits annually. Falls are also the leading cause of injury among adults 65 and older.
The consequences are not only physical. After a fall, some people understandably become afraid of falling again. That fear can lead to less activity, and over time, reduced activity can contribute to loss of strength, conditioning, and confidence.
So a fall—or even a pattern of near-falls—is not something we should simply dismiss as “getting older.” It is information worth understanding.
Look Beyond the Pain Score
When someone becomes less steady, we often start with the usual and very important questions: Is the home environment safe? Has vision changed? Could a medication be contributing to dizziness? Is there peripheral neuropathy? Are there blood-pressure changes?
Those questions matter because falls rarely have just one cause.
But we also need to look at function. Instead of asking only, “How bad is the pain?” ask: How reliable are my hands and legs?
Are you dropping things more often? Do your feet catch when you walk? Are you reaching for walls or railings more frequently? Has your walking distance decreased?
A pain score alone may miss important neurologic changes. Changes in strength, dexterity, gait, balance, and walking tolerance can provide essential clues.
The Cervical Spine: When the Spinal Cord Is Involved
Not every balance problem comes from the neck. But the cervical spine is unique because the spinal cord passes directly through it.
When the spinal cord becomes compressed and neurologic function is affected, a condition called degenerative cervical myelopathy can develop. Because the spinal cord carries signals between the brain and the upper and lower body, the effects can extend well beyond neck pain.
A person may notice increasing hand clumsiness—dropping objects, difficulty buttoning a shirt, or changes in handwriting. They may also notice stiffness or heaviness in the legs, symptoms affecting both hands, greater caution while walking, or changes in balance and gait.
Importantly, cervical myelopathy does not always cause severe neck pain. That is one reason changes in function deserve attention even when the neck itself does not hurt very much.
The key distinction is that cervical myelopathy involves the spinal cord, while cervical radiculopathy involves an individual nerve root. A pinched cervical nerve root more commonly causes pain, tingling, numbness, or weakness in a particular arm or hand distribution. Myelopathy can create a broader pattern involving hand dexterity, coordination, and walking.
New hand clumsiness together with progressive balance or gait changes is an important neurologic pattern that deserves prompt evaluation.
The Lumbar Spine: When Nerve Roots Affect Walking
Moving lower in the spine, the anatomy changes. The spinal cord itself ends above the lowest lumbar levels, leaving a bundle of nerve roots known as the cauda equina.
These lumbar and lumbosacral nerve roots contribute to strength and sensation in the legs. When they become compressed or irritated, a person may experience leg pain, weakness, altered sensation, or difficulty walking.
One common pattern is neurogenic claudication, which is associated with lumbar spinal stenosis. Patients may notice aching, heaviness, numbness, tingling, or weakness in the legs that becomes worse with prolonged standing or walking. Symptoms often improve with sitting or bending forward, which is why some patients find themselves leaning over a shopping cart at the grocery store.
That pattern is different from cervical myelopathy and can provide an important clue about where the problem may be coming from.
Leg Weakness, Foot Drop, and Altered Sensation
Lumbar nerve-root dysfunction can also affect specific muscles in the leg. Depending on the nerve root involved, a person may have difficulty lifting the foot, straightening the knee, pushing off the ground, or stabilizing the leg while walking.
Foot drop refers to weakness in the muscles that lift the front of the foot. The toes may catch or drag while walking, increasing the risk of tripping. A lumbar nerve-root problem can cause foot drop, but peripheral nerve disorders—particularly peroneal neuropathy—and other neurologic conditions can cause it as well.
Sensation matters too. Safe walking depends on information coming from the feet and legs as well as proprioceptive signals from muscles, tendons, and joints that tell the brain where the body is in space. When that sensory information is impaired, navigating uneven ground, low-light conditions, or unexpected changes in surface can become more difficult.
Cervical and Lumbar Patterns Are Different
It can help to think about the patterns side by side.
A cervical spinal cord pattern may include hand clumsiness, symptoms affecting both hands, leg stiffness, coordination changes, and a changing gait.
A lumbar nerve-root pattern may include one-sided leg pain, focal weakness, foot drop, altered sensation, or heaviness and reduced walking tolerance associated with neurogenic claudication.
These patterns are clues, not diagnoses. A person’s symptoms still need to be interpreted alongside the neurologic examination, medical history, and imaging.
The MRI Shows Anatomy. The Examination Shows Function.
When someone sees a specialist, imaging may be part of the evaluation—but an MRI alone does not answer every question.
An MRI can show a disc herniation, arthritis, narrowing of the spinal canal, or compression of a nerve root or spinal cord. But degenerative findings are common, especially as we age, and not every abnormality on an MRI is responsible for a person’s symptoms.
That is why the clinical examination matters so much.
A clinician may assess strength, reflexes, sensation, hand coordination, balance, gait, and walking tolerance. The goal is to determine whether the anatomy shown on imaging actually matches the person’s neurologic and functional pattern.
A useful way to remember it is:
The MRI shows anatomy. The neurologic examination helps show what that anatomy is doing to the patient.
Falls Usually Have More Than One Cause
Even when the spine contributes to unsteadiness, it may not be the only factor.
Peripheral neuropathy can impair sensation in the feet. Vestibular disorders can cause dizziness, vertigo, or imbalance. Some medications can contribute to sedation, dizziness, or changes in blood pressure. Vision, muscle strength, footwear, environmental hazards, and overall health also matter.
That is why the goal should not simply be to ask, “Is this coming from the spine?”
A better question is:
“What combination of factors is making this person less steady?”
Know the Warning Signs
Most fall-risk factors and degenerative spine conditions develop gradually, but some neurologic changes deserve prompt attention.
New or progressive hand clumsiness, worsening balance, significant gait changes, rapidly worsening leg weakness, or a new foot drop should be evaluated promptly.
Some patterns require emergency evaluation. New numbness in the saddle area—around the groin or inner thighs—combined with urinary retention, difficulty initiating urination, new loss of bladder or bowel control, or rapidly progressive severe weakness can raise concern for cauda equina syndrome and should be treated as an emergency.
After a fall, an acute injury with inability to bear weight, severe pain, significant head injury, or other concerning symptoms may also require urgent or emergency evaluation depending on the situation.
Finding a Spine Problem Does Not Automatically Mean Surgery
One of the most important things to understand is that identifying a spine-related contributor does not automatically mean surgery.
Treatment depends on the diagnosis, severity of symptoms, neurologic findings, impact on daily function, and the patient’s goals. Physical therapy, strength and balance work, activity modification, medication review, treatment of peripheral neuropathy or other contributing conditions, and safer movement strategies may all be part of the plan.
For some patients with lumbar spinal stenosis and neurogenic claudication, structured nonsurgical treatment and rehabilitation can be useful. Other patients may need surgical evaluation when symptoms remain significantly function-limiting or neurologic deficits are present.
Cervical myelopathy is different because spinal cord dysfunction can require earlier specialist evaluation depending on its severity and progression.
The treatment should fit the actual diagnosis, not simply an abnormal MRI.
The Vertrae® Approach
At Vertrae®, a comprehensive spine center specializing in minimally invasive and robotic spine surgery, balance and walking changes are evaluated in the context of the whole neurologic picture.
Dr. Kamal Woods and the Vertrae® team look at the patient’s symptoms, strength, sensation, reflexes, coordination, walking pattern, imaging, and daily function. They also consider whether non-spine contributors such as peripheral neuropathy, vision, medications, or other medical conditions may be part of the picture.
The goal is not to label every balance problem as a spine problem. It is to determine what is actually contributing to the loss of function and what can be modified.
When surgery is appropriate, treatment is individualized based on the patient’s diagnosis, anatomy, neurologic findings, and goals.
What Can You Do Right Now?
Start by noticing your pattern.
Are your hands becoming clumsier? Do your legs feel heavy or unreliable? Are your toes catching when you walk? Are you reaching for the wall or railing more often?
Track near-falls, not just actual falls. A sudden grab for the railing or countertop can be useful clinical information.
Pay attention to changes in function. Has your safe walking distance shortened? Are stairs becoming harder? Are activities you used to perform confidently becoming more difficult?
And bring those specific observations to your medical team. The more clearly you can describe the pattern, the easier it is to determine what may be contributing.
Final Takeaway
Your body has patterns, and those patterns are worth paying attention to.
Falls are usually multifactorial, and not every balance problem comes from the spine. But cervical spinal cord compression can affect hand dexterity, coordination, balance, and walking, while lumbar nerve-root problems can contribute to leg weakness, foot drop, altered sensation, and reduced walking tolerance.
So don’t judge your neurologic health by pain alone. Look at function.
What are your hands doing? What are your legs doing? Is your walking changing? Are near-falls becoming more frequent?
Stay curious, stay appropriately active, and don’t automatically dismiss new or progressive unsteadiness as simply part of getting older.
That’s how we protect not only balance—but independence.
Thank you for joining me for this Vertrae® 360 explainer.
Falls Aren’t Just About Balance
If you or someone you love has started to feel less steady, the usual advice is to clear the clutter, improve the lighting, review medications, and check vision. That advice is important. But it is not the whole story.
Falls usually involve more than one factor. Vision, the inner ear, medications, blood-pressure changes, muscle weakness, peripheral neuropathy, footwear, cognition, and the home environment can all play a role. One contributor that can be overlooked is the nervous system – and sometimes the problem begins in the spine.
The cervical spine can affect the spinal cord pathways involved in coordination and walking. The lumbar and lumbosacral spine can affect the nerve roots that help power and sense the legs. When those systems don’t work normally, a person may notice clumsy hands, a changing gait, leg weakness, foot drop, altered sensation, or a shorter walking distance before anyone connects the problem to the spine.
This Falls Prevention Awareness Week article widens the lens beyond one region of the spine. We will look at how both the neck and lower back can contribute to unsteadiness, how those patterns differ, and why a good fall-risk evaluation should never assume that one abnormal MRI explains everything.
Key Takeaway
A fall or near-fall is not a diagnosis. It signals the need to look at the whole pattern. Cervical spinal cord compression may affect coordination, balance, and gait. Lumbar nerve-root problems may contribute to leg weakness, foot drop, altered sensation, or walking intolerance. These findings can raise concern that the spine is contributing, but falls are often multifactorial. The goal is to identify what is modifiable and what needs prompt attention.
Why Falls Deserve Your Attention
Falls are the leading cause of fatal and nonfatal injury among adults age 65 and older. More than one in four older adults reports falling each year, and emergency departments record nearly three million visits for older-adult falls annually (Centers for Disease Control and Prevention, 2026). A previous fall also raises the likelihood of falling again.
The consequences are not only physical. After a fall, many people become afraid of falling again. That fear can lead to less activity, less activity can reduce strength and confidence, and the result can be an increasingly restricted life. Fall prevention works best when we identify all contributors rather than assuming unsteadiness is simply part of aging.
Pain is one piece of the puzzle. A systematic review found that older adults living with pain had higher odds of falling, and about half of older adults with pain reported at least one fall over a year compared with about one in four without pain (Stubbs et al., 2014). Low back pain has also been associated with poorer balance performance in older adults (Ge et al., 2021).
How Neck Problems Can Affect Balance and Walking
Not every balance problem comes from the neck. But the cervical spine is unique because the spinal cord passes through it. When the spinal cord becomes compressed – a condition called degenerative cervical myelopathy – the effects may extend beyond neck pain or a single arm symptom.
Cervical myelopathy can interfere with the way the brain communicates with the hands, trunk, and legs. Clinical guidelines describe common features such as abnormal gait, decreased hand dexterity, sensory changes, increased muscle tone, and other signs of spinal cord dysfunction (Fehlings et al., 2017).
- Balance or walking changes. A person may feel less steady, walk more cautiously, or notice that the legs do not respond as precisely as they used to.
- Leg stiffness or heaviness. Some people describe the legs as stiff, slow, heavy, or less coordinated rather than simply painful.
- Hand clumsiness. Dropping objects, difficulty with buttons, changes in handwriting, or trouble with fine motor tasks can accompany gait changes.
- Symptoms in both hands. Bilateral numbness or tingling deserves a different level of attention than the typical one-sided pattern of cervical radiculopathy.
- Near-falls or unexplained stumbling. A person may not describe true weakness but may notice more trips, trouble on uneven ground, or increasing dependence on a railing.
The important distinction is that cervical radiculopathy and cervical myelopathy are not the same problem. Cervical radiculopathy affects an individual nerve root and usually causes pain, tingling, numbness, or weakness in a particular arm or hand distribution. Cervical myelopathy affects the spinal cord and can interfere with coordination, balance, and walking. A combination of hand clumsiness plus new gait or balance changes deserves prompt evaluation and should not simply be dismissed as normal aging.
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Patient Question “My neck barely hurts. Could my balance problem still be related to my cervical spine?” Potentially, yes. Cervical myelopathy does not always begin with severe neck pain. In some patients, changes in hand coordination, gait, balance, or leg stiffness are more noticeable than pain. Those symptoms do not diagnose myelopathy on their own, but they warrant a neurologic evaluation when they are new, progressive, or functionally important. |
For a deeper look at the cervical pattern, see Blog 9: Clumsy Hands, Dropping Things, and Balance Problems: Could It Be Cervical Myelopathy? In Blog 9, we will narrow the lens further and focus specifically on falls prevention, gait change, and cervical spinal cord compression.
How Lower-Back Problems Can Affect Safe Walking
The neck is not the only part of the spine that can affect mobility. Nerve roots in the lumbar and lumbosacral spine contribute to the motor and sensory pathways serving the legs. When those nerve roots are compressed or irritated, walking can become less reliable in several different ways.
- Leg weakness. Lumbar nerve-root dysfunction can weaken muscles involved in lifting the foot, straightening the knee, or pushing off the ground. A weak leg may buckle or fail to catch the body during a misstep.
- Foot drop. A lumbar nerve-root problem can contribute to foot drop, causing the toes to catch or drag. Foot drop can also come from peripheral nerve or other neurologic conditions, so the source should be evaluated rather than assumed.
- Altered sensation. Reduced sensation in the feet or legs can make it harder to detect the ground and adjust foot placement, particularly when other sensory systems are also impaired.
- Neurogenic claudication. In lumbar spinal stenosis, standing or walking can bring on leg heaviness, aching, cramping, numbness, or weakness that improves with sitting or leaning forward. Some patients describe the legs as feeling unreliable or as though they may “give out” (Katz et al., 2022).
- Pain and guarding. Ongoing back or leg pain can change stride length, trunk movement, and weight shifting, which may contribute to less stable movement (Stubbs et al., 2014; Ge et al., 2021).
Patient-Friendly Reframe
Ask more than “How bad is the pain?” Ask: “How reliable are my hands and legs?” Are you dropping things? Do your feet catch? Do your legs become heavy when walking? Has your walking distance changed? Are you reaching for walls or railings more often? Function often reveals the pattern more clearly than a pain score alone.
Could the Problem Be Coming From the Neck or Lower Back?
These patterns are clues, not diagnoses. A neurologic examination is important when symptoms overlap, and assess fall risk in the context of other medical and environmental contributors.
Falls Usually Have More Than One Cause
A spine problem may contribute to fall risk, but it should rarely be evaluated in isolation. Medication side effects, low blood pressure, vision changes, vestibular disorders, deconditioning, peripheral neuropathy, foot and ankle problems, cognition, footwear, and home hazards can all affect steadiness.
That is why a thoughtful fall-risk evaluation does not simply ask, “Is this the spine?” It asks, “What combination of factors is making this person less steady, and which of those factors can we change?”
Warning Signs That Deserve Prompt Attention
Most fall-risk factors develop gradually and can be evaluated in a scheduled visit. But new or rapidly progressive neurologic changes should not be watched casually.
If you have already fallen, nearly fallen, or noticed that your hands or legs are becoming less dependable, tell your medical team even if the situation does not feel like an emergency.
What a Spine Specialist Is Actually Looking For
A useful spine evaluation begins with the pattern, not only the MRI. The goal is to determine whether a cervical or lumbar finding actually explains the patient’s loss of function. The clinician will first ask what changed, whether symptoms involve one side or both, whether hand dexterity has changed, whether the legs feel weak or stiff, whether walking tolerance has shortened, and what happens before a stumble or near-fall. The examination then tests the neurologic functions that help connect symptoms to anatomy.
- Strength testing in the arms and legs
- Sensation and reflexes
- Hand coordination and fine motor function
- Gait, balance, and walking tolerance
- Assessment for foot drop or focal weakness
- Cervical or lumbar imaging when the history and examination suggest a spine source
- Peripheral nerve testing such as EMG/nerve-conduction studies when the source is unclear
- Consideration of non-spine contributors such as medications, vision, neuropathy, blood-pressure changes, and home hazards
Clinical Principle
The MRI shows anatomy. The neurologic examination helps show what that anatomy is doing to the person. The goal is not to find an abnormal MRI; it is to determine whether that abnormality explains the symptoms, functional change, and walking pattern.
The Encouraging Part: Many Fall-Risk Factors Are Modifiable
Falls are not inevitable with aging. CDC prevention guidance emphasizes identifying individual risk factors, reviewing medications, strengthening the legs and balance system, addressing vision and home hazards, and treating osteoporosis when appropriate (Centers for Disease Control and Prevention, 2026).
When a spine condition contributes, treatment still depends on the diagnosis. Some patients benefit from physical therapy focused on strength, gait, balance, and safe movement. Others need treatment for a peripheral nerve problem, neuropathy, medication effect, or another non-spine contributor. Appropriately selected patients with clinically significant cervical spinal cord or lumbar nerve compression may need a spine procedure to address the neurologic problem.
Finding a spine problem does not automatically mean surgery. The goal is to understand whether the spine is truly contributing, what may happen if the condition is observed, and which treatment best protects function and independence.
What You Can Do This Week
- Notice the pattern. Are you dropping objects, reaching for walls, dragging a foot, or feeling less steady on stairs or uneven ground?
- Track near-misses. A stumble, grab for a railing, or sudden need to sit is useful clinical information.
- Measure function. Notice whether your walking distance, hand dexterity, or confidence has changed over the last several months.
- Bring it up. Tell your clinician about falls, near-falls, new weakness, numbness, clumsiness, or changes in walking.
- Keep moving safely. Staying active supports strength and balance. If you are unsure what is safe, ask for guidance rather than simply doing less.
- Address the whole risk picture. Review medications, vision, footwear, home hazards, and other health conditions in addition to evaluating the spine when symptoms suggest it may be contributing.
How Vertrae® Approaches Falls, Unsteadiness, and Spine Symptoms
At Vertrae®, the goal is not to label every balance problem as a spine problem. The team looks at the whole neurologic pattern: symptoms, strength, sensation, reflexes, hand coordination, walking, imaging, previous treatment, and the function that matters in daily life.
Dr. Kamal Woods is a dual fellowship-trained neurosurgeon and spine surgeon specializing in minimally invasive and robotic spine surgery. Vertrae®, a comprehensive spine center specializing in minimally invasive and robotic spine surgery, evaluates balance, gait, weakness, and other neurologic symptoms in the context of the whole patient – not an MRI finding alone. Vertrae® serves Miamisburg, Dayton, Centerville, Kettering, Beavercreek, Springboro, West Chester, Cincinnati, and Southwest Ohio. When surgery is appropriate, selected advanced outpatient spine procedures may be performed at Vertrae® Surgery Center, our outpatient surgery center for advanced spine care.
When balance or walking changes are present, the question is not simply whether an MRI looks abnormal. It is whether the cervical spine, lumbar spine, peripheral nerves, or another factor is actually contributing to the loss of function – and what options make sense from there.
Key Takeaway
Falls are usually multifactorial. Cervical spinal cord compression can affect coordination, hand function, balance, and gait. Lumbar nerve-root problems can contribute to weakness, foot drop, altered sensation, and reduced walking tolerance. These patterns deserve context, not assumptions. New or progressive neurologic changes deserve prompt evaluation, and many fall-risk factors can be modified once the contributing causes are identified.
FAQ: Your Spine and Fall Risk
Can neck problems really affect balance?
Yes, certain cervical spine conditions can. Degenerative cervical myelopathy affects the spinal cord and can cause gait changes, hand clumsiness, leg stiffness, sensory changes, and balance problems. These symptoms are not specific to myelopathy, so diagnosis requires the full clinical pattern and examination.
Can a lower-back problem make me more likely to fall?
It can contribute. Lumbar nerve-root problems may cause leg weakness, foot drop, altered sensation, or walking intolerance. Low back pain has also been associated with poorer balance in older adults. Falls usually have more than one risk factor, so the spine should be evaluated in context.
How do I know whether a fall is coming from my neck or lower back?
The pattern provides clues. Hand clumsiness, bilateral hand symptoms, leg stiffness, or progressive gait changes raise concern for cervical spinal cord involvement. Foot drop, one-sided leg symptoms, or walking-induced heaviness that improves with sitting can point toward lumbar or peripheral nerve causes. A neurologic exam helps determine the source.
Does cervical myelopathy always cause neck pain?
No. Some patients notice changes in hand dexterity, gait, balance, or leg stiffness more than neck pain. Lack of severe neck pain does not exclude spinal cord dysfunction.
What symptoms are urgent?
Seek urgent evaluation for rapidly worsening weakness, new foot drop, saddle-area numbness, urinary retention or new loss of bowel/bladder control, or rapidly progressive neurologic symptoms. Progressive hand clumsiness, balance decline, or walking difficulty also deserves prompt medical evaluation.
If the spine is contributing, can treatment lower fall risk?
Potentially. If a treatable neurologic problem is contributing to weakness, gait limitation, or sensory change, addressing that condition may improve mobility or function. Fall prevention should still address other contributors such as medications, vision, strength, balance, footwear, neuropathy, and home hazards.
What else can I do to prevent falls?
Stay active with appropriate strength and balance exercise, review medications that may cause dizziness or sleepiness, check vision, use supportive footwear, address home hazards, and discuss osteoporosis and other health risks with your clinician. The best plan is individualized to your risk factors.
Why am I suddenly tripping more often?
Frequent tripping can have many causes, including foot drop, weakness, altered sensation, peripheral neuropathy, vision or vestibular problems, medication effects, or changes in balance and coordination. If tripping is new, progressive, or accompanied by weakness, hand clumsiness, gait change, or numbness, it deserves medical evaluation rather than being assumed to be normal aging.
Can numb feet increase fall risk?
Yes. Reduced sensation in the feet can make it harder to detect the ground and adjust foot placement, especially in low light or on uneven surfaces. The cause may be peripheral neuropathy, a spine condition, or another neurologic problem, so persistent or progressive numbness should be interpreted with the examination and the rest of the symptom pattern.
Listen to This Topic: Why Falls Aren’t Just About Balance: The Spine Connection
Prefer to listen? In this Vertrae® 360 episode, we have a calm, practical discussion of why falls are often multifactorial; how cervical spinal cord compression can affect balance, coordination, and walking; how lumbar nerve-root problems can contribute through weakness, foot drop, sensory changes, or reduced walking tolerance; and which patterns deserve prompt medical attention.
Read the Full Podcast Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The conversational format is designed to explore concepts and tradeoffs, not to provide medical advice or apply to any individual patient. Outcomes vary by patient, pain pattern, technology used, and study population, and findings from one clinical trial may not generalize to every situation. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
Speaker 1:
Imagine you’re standing in your kitchen tomorrow morning, pouring a cup of coffee. Suddenly, your fingers fumble, you lose your grip, and the mug shatters on the floor.
Speaker 2:
Yeah, and it’s annoying. You might chalk it up to a bad night of sleep, arthritis, or simply being distracted.
Speaker 1:
Right. But what if that new hand clumsiness was happening along with subtle changes in your balance or walking—and a neurologic evaluation suggested those symptoms might actually be connected?
Speaker 2:
It sounds surprising. What do clumsy fingers have to do with the way your legs work?
Speaker 1:
That connection is exactly what we’re focusing on today. Welcome to today’s Deep Dive.
Speaker 2:
I’m really glad we’re tackling this. Since it is Falls Prevention Awareness Week, we’re taking a close look at the mechanics of unsteadiness—specifically how the spine can be one important part of the neurologic system that supports strength, sensation, coordination, and walking.
Speaker 1:
Our mission today is to decode some of the ways both the neck and the lower back can contribute to changes in steadiness.
We want to go beyond the traditional, well-meaning advice to check your vision and remove throw rugs.
Speaker 2:
Because those things absolutely matter. But falls are usually multifactorial. Vision, strength, medications, the vestibular system, peripheral neuropathy, the environment, footwear, and neurologic function can all play a role.
And sometimes changes in the hands and changes in walking can be part of the same neurologic pattern.
Why Falls Deserve Attention
Speaker 1:
There is also this tendency to brush off a stumble or a new sense of unsteadiness as, “I’m just getting older.”
Speaker 2:
And that’s worth challenging.
More than one in four older adults experiences a fall each year, and millions of older adults are evaluated in emergency departments for fall-related injuries.
A previous fall also increases the likelihood of falling again.
Speaker 1:
Is that because the body is somehow permanently changed after one fall?
Speaker 2:
Not necessarily. One important factor is fear of falling.
After a fall, some people understandably become more cautious. They may stop taking the stairs, shorten their walks, avoid uneven ground, or spend more time sitting.
Speaker 1:
Which seems protective at first.
Speaker 2:
Exactly. But if activity becomes too restricted over time, that can contribute to loss of strength, conditioning, and confidence. That, in turn, may increase fall risk.
So there can be a cycle: fear leads to less activity, less activity contributes to deconditioning, and deconditioning can make a person feel even less steady.
Speaker 1:
Which is why the goal isn’t simply to tell someone, “Be more careful.”
Speaker 2:
Right. It’s to identify the factors that may be modifiable.
Pain Can Change How You Move
Speaker 1:
Pain is one of those factors.
Speaker 2:
Yes. Research shows that older adults living with pain have a higher risk of falling. In one meta-analysis, chronic pain was associated with about 80% higher odds of falling compared with those without chronic pain.
Speaker 1:
How does pain contribute?
Speaker 2:
Part of it may be related to changes in movement.
Think about the last time your knee or lower back hurt. You probably didn’t walk exactly the same way.
Speaker 1:
Definitely not.
Speaker 2:
You may shorten your stride, stiffen your trunk, shift weight away from the painful side, or move more cautiously.
Pain can alter gait and posture, which may reduce mobility and contribute to instability in some older adults.
Speaker 1:
But what if there isn’t much pain?
What if the problem is more about the signals traveling between the brain and the body?
Speaker 2:
That’s where the neurologic side of the spine becomes especially important.
The Cervical Spine: When the Spinal Cord Is Involved
Speaker 1:
Let’s start at the neck—the cervical spine.
Speaker 2:
This area is important because the spinal cord travels through the cervical spinal canal.
Think of it like a major communication pathway carrying information between the brain and much of the body.
Speaker 1:
So if the spinal cord becomes compressed in the neck, that can affect more than just the neck itself.
Speaker 2:
Exactly.
A condition called degenerative cervical myelopathy occurs when the cervical spinal cord is compressed and neurologic function is affected.
That can interfere with pathways involved in hand dexterity, strength, sensation, coordination, and walking.
Recognized symptoms can include decreased hand dexterity, abnormal gait, sensory changes, weakness, increased muscle tone, and abnormal reflexes.
Speaker 1:
Which brings us back to that coffee mug.
Speaker 2:
Right.
A person might notice that they’re dropping objects more often, having trouble buttoning a shirt, or seeing changes in handwriting.
At the same time, they may notice that their legs feel stiff, heavy, or less coordinated, or that their balance and walking have changed.
Speaker 1:
And that doesn’t necessarily come with severe neck pain.
Speaker 2:
Correct.
Cervical myelopathy can occur without prominent neck pain. That’s part of why changes in function are so important.
Radiculopathy and Myelopathy Are Different
Speaker 1:
And this is different from a standard pinched nerve in the neck.
Speaker 2:
Yes.
Cervical radiculopathy involves an individual cervical nerve root. It commonly causes pain, tingling, numbness, or weakness following a particular pattern into one arm or hand.
Cervical myelopathy involves the spinal cord itself.
Because the spinal cord carries signals to both the upper and lower body, myelopathy may produce a broader pattern—such as hand clumsiness combined with gait or balance changes.
Speaker 1:
So bilateral hand symptoms plus a changing gait would get your attention.
Speaker 2:
Absolutely.
That combination doesn’t diagnose cervical myelopathy by itself, but new hand clumsiness together with gait or balance changes is an important neurologic pattern that deserves prompt evaluation.
Moving Down to the Lower Back
Speaker 1:
Now let’s move down the spine.
What if the cervical spine isn’t the source, but someone is still dragging a foot or noticing that their legs are becoming less reliable?
Speaker 2:
Then we have to think about the lumbar and lumbosacral spine.
By the lower lumbar spine, the spinal cord itself has ended and the canal contains a bundle of nerve roots called the cauda equina.
Those nerve roots contribute to movement and sensation in the legs.
When lumbar nerve roots are compressed or irritated, walking can become more difficult in a very different way from cervical myelopathy.
Leg Weakness and Foot Drop
Speaker 1:
One example is leg weakness.
Speaker 2:
Yes. Depending on which nerve root is affected, weakness may interfere with lifting the foot, straightening the knee, pushing off the ground, or stabilizing the leg during walking.
Speaker 1:
And then there’s foot drop.
What exactly does that mean?
Speaker 2:
Foot drop means weakness in the muscles that lift the front of the foot.
A person may notice that the toes catch or drag during walking.
A lumbar nerve-root problem can cause foot drop, but peripheral nerve disorders and other neurologic conditions can cause it as well.
Speaker 1:
So it isn’t automatically a lower-back diagnosis.
Speaker 2:
Exactly.
But regardless of the cause, foot drop can increase the risk of tripping, so a new foot drop deserves prompt medical evaluation.
Sensation and Position Awareness
Speaker 1:
What about numbness in the feet? How can that affect balance if the legs are still strong?
Speaker 2:
Safe walking depends on several types of sensory information.
The skin of the feet helps detect pressure and contact with the ground, while receptors in muscles, tendons, and joints provide proprioceptive information—information that helps the brain understand where the body is in space.
Speaker 1:
So the brain is constantly receiving feedback while we walk.
Speaker 2:
Exactly.
When sensation is impaired, the nervous system has less information available to make those rapid adjustments.
That can make uneven ground, low-light conditions, or unexpected changes in the walking surface more difficult to navigate.
Neurogenic Claudication and Lumbar Spinal Stenosis
Speaker 1:
And then there is neurogenic claudication.
Speaker 2:
Right.
Neurogenic claudication is a classic symptom pattern associated with lumbar spinal stenosis.
Patients may develop pain, heaviness, aching, numbness, tingling, or weakness in the legs with standing or walking.
Speaker 1:
And sitting or leaning forward can help.
Speaker 2:
Often, yes.
Symptoms commonly improve with sitting or lumbar flexion—such as leaning forward on a shopping cart. That’s where the well-known “shopping cart sign” comes from.
Flexing the lumbar spine can temporarily increase space available for the neural structures in certain types of stenosis, which may reduce symptoms.
Speaker 1:
So someone may not say, “My back hurts terribly.”
They may say, “I can only walk so far before my legs become heavy and I have to sit.”
Speaker 2:
Exactly.
And that’s an important functional clue.
Function Matters, Not Just Pain
Speaker 1:
This brings us to one of my favorite ideas from the blog.
Instead of asking only, “How bad is your pain?” maybe we should also be asking, “How reliable are your hands and legs?”
Speaker 2:
Exactly.
Pain matters, but a pain score alone may miss important neurologic changes.
We also want to know:
Has your walking distance changed?
Are you dropping things more often?
Are your toes catching?
Are you grabbing the wall or railing more frequently?
Are stairs becoming harder?
Has your balance changed?
Speaker 1:
So function adds information that a one-to-ten pain score simply can’t provide.
Speaker 2:
Absolutely.
The MRI Shows Anatomy. The Examination Shows Function.
Speaker 1:
At this point, it sounds like an MRI should solve everything.
Find the compressed area, and there’s the answer.
Speaker 2:
Not necessarily.
A useful clinical principle is:
An MRI shows anatomy. A neurologic examination helps show what that anatomy is doing to the patient.
Degenerative changes on imaging become increasingly common with age, and not every disc bulge, arthritic change, or area of narrowing is responsible for a person’s symptoms.
Speaker 1:
So you can’t treat the picture alone.
Speaker 2:
Exactly.
At Vertrae®, Dr. Kamal Woods and the spine team look at whether the symptoms, neurologic examination, walking pattern, and imaging actually fit together.
That matters particularly with falls because falls are usually multifactorial.
The Spine May Be Only One Piece of the Puzzle
Speaker 1:
What are some of those other factors?
Speaker 2:
Peripheral neuropathy is one.
Peripheral neuropathy can impair sensation in the feet, including the ability to detect pressure, vibration, or position accurately.
Speaker 1:
And diabetes is one possible cause.
Speaker 2:
Yes, among others.
Then there’s the vestibular system in the inner ear, which helps the brain detect head movement and maintain balance. Disorders affecting that system can cause dizziness, vertigo, or unsteadiness.
Medications can also matter—especially medications that contribute to dizziness, sedation, or blood-pressure changes.
Vision matters. Strength matters. Footwear matters. The home environment matters.
Speaker 1:
Which means finding an abnormal lumbar MRI doesn’t automatically mean that abnormality caused the fall.
Speaker 2:
Exactly.
A patient could have lumbar stenosis on imaging and still have another major contributor to unsteadiness.
That’s why the clinical question isn’t simply:
“Is there something abnormal on the MRI?”
It’s:
“What combination of factors is making this person less steady?”
Finding a Spine Problem Does Not Automatically Mean Surgery
Speaker 1:
And that’s reassuring because identifying a spine problem doesn’t automatically mean someone is headed for surgery.
Speaker 2:
Absolutely.
Treatment depends on the diagnosis, the severity of symptoms, neurologic findings, impact on function, and the patient’s goals.
For many lumbar conditions, treatment may begin with nonsurgical approaches such as education, activity modification, appropriately selected physical therapy, and other conservative treatments.
Evidence supports exercise and multimodal rehabilitation as useful nonsurgical options for some patients with lumbar spinal stenosis and neurogenic claudication.
Speaker 1:
And surgery has a role when appropriate.
Speaker 2:
Yes.
For lumbar stenosis, surgery may be considered when symptoms remain significantly function-limiting despite appropriate nonsurgical care or when meaningful neurologic deficits are present.
Cervical myelopathy is different. Evidence-based guidelines recommend surgery for moderate and severe degenerative cervical myelopathy, while treatment of mild disease can depend on symptoms, progression, and the individual clinical situation.
So the treatment decision has to match the diagnosis.
When Symptoms Deserve Urgent Attention
Speaker 1:
How does someone know when a symptom deserves prompt attention rather than simply mentioning it at the next routine appointment?
Speaker 2:
New or rapidly worsening neurologic changes deserve evaluation.
That includes new or progressive leg weakness, a new foot drop, rapidly worsening hand dexterity, or significant new changes in walking or balance.
Speaker 1:
And then there are true emergencies.
Speaker 2:
Exactly.
New saddle-area numbness—numbness around the groin, inner thighs, or areas that would contact a saddle—combined with new urinary retention, difficulty initiating urination, loss of bladder or bowel control, or rapidly progressive neurologic deficits can raise concern for cauda equina syndrome.
That requires emergency medical evaluation.
Speaker 1:
And with the cervical spine?
Speaker 2:
Rapidly progressive neurologic deterioration involving the hands, arms, legs, walking, or other major functions also warrants urgent evaluation.
The exact level of urgency depends on the clinical picture, but rapidly changing neurologic function should not simply be watched at home.
Track Near-Misses and Functional Changes
Speaker 1:
So this isn’t about panicking every time someone catches a toe on an uneven sidewalk.
Speaker 2:
Not at all.
We all trip occasionally.
The goal is to become more aware of patterns.
Are you grabbing the railing more often?
Have you had several near-falls?
Has your walking distance changed?
Are you dropping objects more often?
Are your feet catching on the carpet?
Speaker 1:
Those details are useful information to bring to a medical appointment.
Speaker 2:
Exactly.
Instead of saying only, “My back hurts,” tell your clinician:
“My walking distance has decreased over the last three months.”
“I’m dropping my keys more often.”
“My toes have started catching on the carpet.”
“I’ve had to grab the wall twice this week to steady myself.”
Those functional changes help tell the full story.
Keep Moving—Safely
Speaker 1:
And we don’t want fear of falling to turn into complete inactivity.
Speaker 2:
Right.
Staying appropriately active supports strength, mobility, and balance.
But if someone feels unsteady or isn’t sure what activity is safe, the answer isn’t to push through blindly.
Talk with your medical team. Physical therapy or another guided movement program may be appropriate depending on the cause of the symptoms.
Final Takeaway
Speaker 1:
So let’s bring the whole picture together.
Falls are not simply an inevitable part of aging.
And they’re usually not caused by one thing.
Speaker 2:
Exactly.
The spine can be one important contributor.
Cervical spinal cord compression can affect hand dexterity, coordination, balance, and walking.
Lumbar nerve-root problems can contribute to weakness, foot drop, altered sensation, and reduced walking tolerance.
But the spine is only one part of the fall-risk picture.
Speaker 1:
Vision, strength, medications, peripheral neuropathy, the vestibular system, footwear, environment, and general health can all matter too.
Speaker 2:
That’s why the best evaluation looks at the whole person.
And remember:
The MRI shows anatomy. Your symptoms, neurologic examination, and daily function show what that anatomy means for you.
Speaker 1:
The nervous system is also remarkably good at adapting and compensating. Sometimes subtle changes in gait or dexterity become noticeable only when those compensatory strategies are no longer enough.
Speaker 2:
Which is another reason gradual changes in function are worth paying attention to.
Stay curious about how you move. Track meaningful changes and near-misses. Keep moving safely. And if your hands, legs, balance, or walking are becoming less reliable, bring that pattern to your medical team.
Speaker 1:
Thanks for joining us on this Vertrae® 360 Deep Dive.
Bring the Pattern Back to the Team
If you have started falling, nearly falling, dropping things, dragging a foot, or feeling less steady, write down what happens before the episode and which symptoms occur with it. Bring that pattern to your medical team. The details help distinguish a cervical spinal cord problem, a lumbar nerve-root problem, a peripheral nerve condition, and other common contributors to falls.
If spine symptoms are affecting your walking, balance, hand function, or independence, request an evaluation with Dr. Kamal Woods and the Vertrae® team at vertrae.com. The goal is to identify which part of the pattern may come from the spine, which factors may have another cause, and which next step best protects function. In Blog 9, we will focus more closely on cervical myelopathy and the specific combination of hand clumsiness, gait change, and falls.
References
Centers for Disease Control and Prevention. (2026). Older adult falls data. https://www.cdc.gov/falls/data-research/index.html
Centers for Disease Control and Prevention. (2026). Preventing falls and hip fractures. https://www.cdc.gov/falls/prevention/index.html
Fehlings, M. G., Tetreault, L. A., Riew, K. D., Middleton, J. W., & Wang, J. C. (2017). A clinical practice guideline for the management of degenerative cervical myelopathy: Introduction, rationale, and scope. Global Spine Journal, 7(3 Suppl), 21S-27S. https://doi.org/10.1177/2192568217703088
Florence, C. S., Bergen, G., Atherly, A., Burns, E. R., Stevens, J. A., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698. https://doi.org/10.1111/jgs.15304
Ge, L., Wang, C., Zhou, H., Yu, Q., & Li, X. (2021). Effects of low back pain on balance performance in elderly people: A systematic review and meta-analysis. European Review of Aging and Physical Activity, 18, 8. https://doi.org/10.1186/s11556-021-00263-z
Kakara, R., Bergen, G., Burns, E., & Stevens, M. (2023). Nonfatal and fatal falls among adults aged 65 years and older – United States, 2020-2021. MMWR Morbidity and Mortality Weekly Report, 72(35), 938-943. https://doi.org/10.15585/mmwr.mm7235a1
Katz, J. N., Zimmerman, Z. E., Mass, H., & Makhni, M. C. (2022). Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 327(17), 1688-1699. https://doi.org/10.1001/jama.2022.5921
National Council on Aging. (2026). Falls Prevention Awareness Week. Sept. 21-25, 2026. https://www.ncoa.org/page/falls-prevention-awareness-week-public-relations-toolkit/
Stubbs, B., Binnekade, T., Eggermont, L., Sepehry, A. A., Patchay, S., & Schofield, P. (2014). Pain and the risk for falls in community-dwelling older adults: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 95(1), 175-187. https://doi.org/10.1016/j.apmr.2013.08.241
