Context: Falls, many of which are caused by balance problems, are a leading cause of injuries in elderly persons. Few studies have investigated osteopathic manipulative treatment (OMT) for patients with balance problems. Objective: To test whether an OMT protocol with an emphasis on cranial manipulation can improve vestibular balance control structures and postural stability in a healthy elderly population. Design: A pilot prospective clinical trial. Setting: Research laboratories of the University of North Texas Health Science Center Texas College of Osteopathic Medicine in Fort Worth. Patients: Forty healthy elderly patients aged 65 or older were enrolled and separated into an OMT group and a control group. Owing to the recruitment process and limited time for the study, the first 20 patients to enroll were in the OMT group, and the next 20 were in the control group. Patients were excluded if they had a condition that could impair balance. Intervention: The OMT protocol comprised 7 OMT techniques applied weekly by the same osteopathic physician before balance tests. Patients in the control group received no treatment. Main Outcome Measures: Patients were asked to stand on a force plate and to perform 3 balance tests: (1) eyes open, (2) eyes closed, and (3) a modified Romberg test. The center of pressure between their feet was recorded for 30 seconds. The average center of pressure displacement for each test was used to determine anteroposterior (AP) sway and mediolateral (ML) sway. Balance tests were performed each week for 4 weeks. Tests were performed at the same time of day as the first test. Results: Changes in AP sway values between visits 1 and 4 were as follows: eyes open, -0.72 and 0.75 mm for the control and OMT groups, respectively; eyes closed, -0.49 and 0.44 mm; and Romberg test, -0.17 and 0.52 mm. The changes in ML sway values between visits 1 and 4 were as follows: eyes open, -0.58 and 0.07 mm for the control and OMT groups, respectively; eyes closed, -0.21 and 0.03 mm; and Romberg test, -0.15 and 0.39 mm. The OMT group had significantly reduced sway for the eyes-open test after 4 visits (P=.001). Conclusion: The OMT protocol used in the present study improved the postural stability of healthy elderly patients, as measured by changes in sway values.