Hello everybody. In this blog we take a look at how we can avoid Trips and Falls, why they happen, the signs to look out for and how to prevent them.
Why do trips and falls occur?
Anyone can trip or fall at any age, but there are a number reasons why trips and falls can become more frequent and how you or your friends and relations react to a trip or fall, can often lead to some unintended consequences. Let's take a short look at how trips can happen and try to simplify what is really a very complex area.
Does age affect Trips and falls?
By and large, when a person below the age of sixty trips over and falls, most of the time, they simply look rather embarrassed, get back up, brush themselves down, and go home to nurse their bruises. But as we get older, we tend to spend less time on the floor! We spend lots of money on decent sofas and chairs and we are darn well going to use them.😀 Anyway, sitting on the floor, it's just not the done thing for a respectable adult! So we tend to lose both the specific strength and balance needed to get up from the floor.
How do I get off the floor if I fall?
When we lose that skill of rising from the floor, what happens if you find you can’t get up? Normally, it takes several well meaning people to pick you up. Great people these, completely restores your faith in humanity, but now a subtle but rapid downward spiral can begin. You may begin to become fearful of falling again. Thoughts start to take the form of "What if no one is around to help", "what if I hurt myself badly?" One way of dealing with this is (if possible) to make a point of getting on and off the floor every day, just for the sake of it. A physiotherapist can also help you re learn how to do this.
I have a fear of falling?
Once you realise you may be susceptible to falls and that you struggle to get back to your feet, you may begin to avoid going out, or severely restrict where you are willing to travel. This can start to lead to reduced confidence, as well as reduced fitness levels from decreasing activity.
This problem of reduced fitness brings many other issues with it, all of which can lead into a vicious circle.
Do I need a stick?
You, the doctor or the family, in an act of good intent, decide a stick will give more security and here a new problem can emerge. Using a stick changes our balance senses, we are now walking with three points of contact, not two. This works until the stick is abandoned, possibly just for a few seconds to open a door or step over a threshold, at his point there is now an increasing likelihood that loss of balance and a fall will occur.
Is a stick a good idea?
When used for support, a stick tends to be used in front of the body rather than the side and this leads to a forward lean, which over time can become fixed stoop. This stoop moves the centre of gravity forward of our centre of mass, which significantly increases the likelihood of tripping or loss of balance. That same forward lean also compresses the ribs together, giving rise to a multitude of issues related to a limited ability to deep breath. The direct results of this include reduced fitness, resulting in reduced distance walked, resulting in less leg strength, making falls more likely, recurring chest infection and quite a few others. It can be very easy to become stuck in this cycle without being aware that this is happening, or assuming it is due to other causes. 🙁
Should I not use my stick?
In a word, NO.
Not without seeking to address, understand and correct the issues that lead to using a stick in the first place. If you are used to a stick, you will have reset your movement and balance pattern to stick use. A careful weening off of a stick is necessary, whilst addressing the background causes.
What can I do to reduce the chances of a trip or fall?
Of course, what we have just highlighted is the long term result of a few falls, the original cause of which still needs to be established. Whatever that cause is, it will ultimately lead to the mechanical issues we have explored which can turn something that was very simple into something that suddenly the therapy and medical professions can fail to get hold of.
Here are a few known causes of trips, falls and balance issues
Eyesight: We rely on our peripheral vision to inform our brain were we are in relation to fixed objects. This accounts for up to 80 percent of the way we balance. Any issues that affect eyesight will have a direct effect on balance and is a common cause of trips.
Vari and bifocal glasses: In relation to the above issue, when our eyes move between lenses there is a brief moment when they are out of focus. A classic trip can occur crossing a road, at the point when looking up into the distance lens, having just looked down to check were the kerb is.
Vestibular issues (ears): The inner ear provides us with important balance mechanisms that can become affected by anything from the natural thickening of the fluid in the inner ear, to ear blockage and infection. There are specific physiotherapy tests to establish if this is an issue and to rehabilitate the inner ear senses. Dizziness and feelings of motion sickness are often associated with problems in the ear.
Interactions of medications: Sometimes a simple change of medication can create an interaction with another medication that can lead to anything from faintness, dizziness, fatigue and sudden drops in blood pressure. All of which can result in a fall. One of the characteristics of this kind of fall, is no awareness that you were falling or recollection of how it happened.
Biomechanical issues: By this we mean issues regarding strength, the ability to lift your feet and move your legs readily, how the rest of your body moves over your feet and whether you shuffle at all. The stiffness, effort of moving and reduced strength that can come with age, are completely reversible, although this was not fully understood or appreciated until quite recently.
Postural issues affecting our centre of gravity: Our head position dictates where our centre of gravity falls, this should be through the middle of our pelvis. If our head and shoulders come forward through, weakness, posture problems or constant use of a stick in front of us then the centre of gravity can come forward of the pelvis. This a very unstable position for the human body to be in.
Arthritis: The pain and stiffness that can come with arthritis can lead to poor movement of the feet and legs, short steps or a shuffling gait. All of which can increase the chances of a trip or fall. There is so much that can be done to manage arthritis that this need not be a factor if tackled correctly.
Gait (the way you walk): Gait can be affected by the condition of your feet. There are many foot issues that can affect the way you place your foot on the ground. Our feet are designed to load and balance us in a certain way, anything that makes us avoid loading our feet correctly can lead to loss of balance, turning ankles or tripping. Bunions, corns, plantar fasciitis, heel spurs and painful areas of hard or cracked skin can all affect the way we place and load our feet.
Who should I see to help with falls and balance issues?
All this can be stopped in its tracks and even reversed. The art of dealing with these issue successfully, is to acknowledge that, with so many multi-factorial and interrelated issues, no singular profession can truly provide all the answers. In an ideal world, the different health professions would combine their skills and knowledge. Fortuitously, that’s exactly what we do here at The Reinge Clinic, our unique skills base allows us to tackle most of these issues directly.
Physiotherapists have specific tests for eye, vestibular, strength, co ordination and medication issues. Bio mechanists can target posture and movement based issues and there are multiple exercises to help deal with eyesight, vestibular and mechanical issues. At The Reinge Clinic we are of course all of these things. Chiropody and Podiatry can also work with the often missing link of foot care and we know some great local Chiropodists and Podiatrists too. 😀
Ian is doing a talk on this subject in Kenilworth this month (January 2020), please get in touch if you would like more information.