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01
09
2017

Pride goes before the fall

There are six things the physical therapist hates,

seven that are detestable to him:
inflexible hips,
       worn out shoes,

a recliner chair that encourages kyphotic posture,
       a forward head with no recourse

a person with poor balance
          yet goes to the gym and sits on machines.

 

Humans are generally poor at risk assessment. We tend to over emphasize areas with strong emotional connection whether or not harm is probable. For example, 30,000 Americans die per year in car accidents. But we fear shark attacks. The early death rate and costs associated with metabolic diseases (obesity, high blood pressure, and diabetes) are astronomical, with many of the causes being modifiable behaviors. But we fret about the opposing political party “taking over” healthcare.  Falls are the most common cause of visits to the emergency room. The 8 million fall-related visits per year compromise 1/3rd of all visits to the emergency room. Yet we spend hours debating whether we should be drinking coffee or tea.

Here are a few more statistics:

Every year there are 115 falls per 1000 adults over the age of 65 (and these are only the ones reported).
Forty percent of people over age 65 fall once per year, with ten percent of those landing in the hospital. Fifty percent of those admitted to the hospital are still alive one year later.
Most falls occur in the home and in older individuals with chronic illness or failing senses.

We should think more about having a resilient body. We should remember that age-related decline is inevitable. Avoiding falls is not only an issue of being careful. Ironically, there is good evidence that being too careful makes us more likely to become frail and suffer a severe fall-related injury.

As we age, we typically move less. A little at a time, over many seasons, we lose flexibility, strength, and sense of balance. We get banged up and the old injuries catch up with us. We usually do not think about losing our movement quality until very late in the game. Improving our ability to move well should be a top priority. What are the best ways to recoup what we can, and make our bodies more resilient for the inevitable fall?down stairs

Preparation is good. But I want you to exercise smarter. Here are the top 5 concerns for fall prevention and body maintenance.

  1. Make it happen.  Do something. The most commonly cited barriers to maintaining a regular exercise program is time and cost. But you’re not going to use those excuses, because this does not require a lot of time or special equipment! But it does require consistent effort and a willingness to be uncomfortable. So write 15 or 30-minutes into your schedule and treat it like an important meeting that your life depends on.
  2. Get off the exercise machines. Most gyms are packed full of various machines that have you sitting and guiding the movement for you. There is a time for these. But the far majority of us sit for too long, too often. Driving to the gym to sit on various exercise contraptions seems quite misguided, especially in light of the typical excuses (time and cost) for not exercising. Instead, try to perform exercises and activities that demand that you control the movement. Start with small movements and light resistance, and progress gradually. A little resistance and gravity is all it takes! We have all the gizmos and gadgets and apps, but at the end of the day we’re always still dealing with gravity, load, distance and time. You truly need knowledge more than fancy gadgets!
  3. Limit “dumb” exercise. By dumb exercise, I’m referring to activities that do not demand your attention and focus. Dumb exercise is sitting on a recumbent bike while reading a magazine, or using an elliptical trainer for an hour while watching television. These activities do have some benefit to our cardiovascular system, but they are limited in the extent that they help us train our balance sense, reactive abilities, strength and range of motion required in everyday living. So instead of 40 minutes churning away on an elliptical trainer, try 20 minutes with 20 more of total body strengthening and balance exercise. Sign up for yoga, tai chi, or a recreational sport or activity that demands body control, balance, and careful attention to learning something new.
  4. Don’t hide from your problems. If you are strong and stiff, you may want to find a safe and effective stretching program. If you are flexible and thin but frail, hit the weights or at least bodyweight calisthenics. If you have shoulder, back, knee or foot pain, don’t push through. But don’t quit! Find a professional who can evaluate and guide you through the problems before they get worse, limiting your function even more.
  5. Try this balance “sampler”. Here are a few of our favorite simple but effective beginner exercises that will help improve range of motion, balance, and functional strength. I did these in my home in order to show that they do not require a lot of equipment!

 

“Step-to balance” Stand a few feet from a wall or counter top, feet side by side. Practice stepping out and stopping, maintaining your balance on one leg. Try to stay tall and keep your hands near a wall or counter-top to “spot” yourself. Step back, feet together, then step out with the other foot. Repeat 5 to 10 repetitions stepping out onto each leg. IMG_9452

IMG_9454

 

 

 

 

 

 

 

March march down and back near a wall our counter top, focus on driving one leg high and keeping the “down leg” hip straight and heel pressed into the ground. Pause with each step, front knee up and back heel down. When this is easy, try marching backwards or while holding some weight in each hand.IMG_9449

 

 

 

 

 

 

 

Nose Lean IMG_9446 Balance on one foot, approximately 8″ from a wall. Stay tall but lean your nose out toward the wall. Spot yourself with your hands near but not touching the wall. Reach your nose “out and up” but don’t face-plant! Return to tall standing on one leg. Do 5 to 10 repetitions on each leg. IMG_9448

 

 

 

 

 

 

 

Single leg hip hingeIMG_9439IMG_9440 Stand on one leg near a bench or chair. Stay on one leg as you push both hips back, folding at the waist but not rounding our back, to lightly touch the surface in front of you, then return to the tall posture (still on one leg). Progress this exercise by holding a light resistance in your hands to touch the surface in front of you, or reach to a lower target such as an 8″ step.

 

 

 

 

Side step over and under fence Step sideways down a hallway or along a countertop (somewhere that you can touch to lightly spot yourself from falling). As you step sideways, imagine that you literally have to pick up both feet over a fence, then step sideways while ducking under a fence. With each step you go over the fence, then the next step duck under the fence. Repeat this 5 to 10 times stepping to the right, then back to the left.

Poor balance and falling are usually not something that just happen, but comes from unaddressed injuries and years of accumulated loss of flexibility, strength, body awareness. So do not neglect the maintenance and repair of your body. Get to it. Feel free to email me if you have any questions or suggestions.

 

 

References:

 

Fall Risk Awareness and Safety Precautions Taken by Older Community-Dwelling Women and Men: A Qualitative Study Using Focus Group Discussions

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363490/

 

National Council on Aging Fall Prevention Facts

http://ncoa.org/news/fall-prevention-facts

 

Falls in the Elderly by American Family Physicians

http://www.aafp.org/afp/2000/0401/p2159.html

Falls among Adult Patients Hospitalized in the United States: Prevalence and Trends

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572247/

 

 

author: Bob Gorinski