Aging & ArthritisInjury

Fall Prevention

You have to stay off the ground after 60. I’m not quite there, but I’ve been working on staying clear of the ground for years. I’m really focusing on falling down to the ground in this blog. That’s a fast and dangerous way to get down there and you’re all doing it way to often! Once you start to fall then anything goes. When you land you might break a bone, and depending on which bone, it can totally alter the quality of your life! But at best you’re going to bruise something that’s going to take a while to heal. In my practice I see a bunch of fallers every day. All ages. So I make some of my living off your poor balance or your failure to pay attention to your environment. And I wish it wasn’t so!

Kids are going to fall and there’s not much I can accomplish by giving them a lecture on watching where they’re going or fall prevention exercises. So I’m mainly talking to those over 40 because I think that’s an age when some folks start getting clumsy and when some women start getting osteopenia. It’s a good age to start developing some fall-prevention strategies.

Start getting in the habit of doing single leg standing exercises. I can tell you I’m not going to take 5 minutes out of my busy to stand on one leg. But being the multi-tasker that I am, I will do single leg standing exercises when I’m…waiting for the microwave to boil water, waiting for something to cook on the stove, brushing my teeth or standing in an elevator. I’ve been doing it for so long that it’s now a habit and honestly, though I’ve come close, I haven’t fallen to the ground in a long time…knock on wood.

So start out by going to your kitchen and standing by your kitchen counter, since they’re taller than most counter tops. Rest your hand on the counter and lift one leg. Some of you might not feel comfortable going any further than this, but if you do, then continue to work on this over the next several days to weeks, until you can stand on one leg for one minute at a time. Now you’re ready to move away from the counter and graduate to doing this exercise at will. You honestly can’t do this exercise too much, unless you’ve got an injury or arthritis or something that causes you to have pain or weakness when you try it. If that’s you…do it less or not at all if it’s too painful or too difficult. Sorry.

The rest of you can get better and better at it, until you’re easily able to do it when standing in a line or filling your car with gas. Now I’m trying to do it with my eyes closed and believe me, that’s not easy.

But baby steps first. Start lifting your hand off the countertop, leaving it lifted off for longer and longer periods of time, until you can finally stand on one leg, independent of the countertop.

Once you’re comfortable with standing a hands-free minute on each leg, the next step would be to make it harder by writing the alphabet with the toes of your non-weight bearing foot. Raise the leg to the side or flex it forward. Do anything to make it harder to do! Once you are good at doing this exercise, you can do it almost anywhere and no one will even know you’re in the middle of preventing injury to yourself! You can do it in an elevator. While you’re standing on a long line. While you’re getting chewed out by your boss. Wouldn’t it feel good at the end of a beat down, to know that you had accomplished something positive for yourself at the same time? Guys, you can do it while you’re going to the bathroom. Now that would be some serious multi-tasking. Girls, don’t try this at home.

People often ask me, “Doc, are there any other exercises?” As if I’m holding back or something. Not really. Any exercise which makes you stronger and more conditioned, and doesn’t hurt you in the process, is always a good thing, but I think the single leg stand is the best and easiest for fall prevention. You get some leg and core strengthening, and some increased weight bearing along with it, so there’s a big bang for your buck.

But there are other things you can do to better ensure that you don’t do a face plant on the street or in your house.

Pick up after yourself and make others pick up too. Don’t leave random shoes, purses, boxes, etc., lying around the house on the floor. If you find them with your foot before you find them with your eyes, you’re going down. Unless that is, you’ve been doing your single leg standing and are quickly able to fight gravity and catch yourself before breaking your wrist…or something worse.

Don’t take your stairs for granted. I can’t tell you how often I see patients for injuries they sustained because they thought they were at the end of their staircase and stumbled down the last step. First of all, just put your hand on the bannister any time you’re on a stair case. Better yet, just hold on to that bannister. Secondly, turn the lights on when you go up or down stairs at night. Nighttime is usually when people miss that last step. But they also miss it when they’re carrying a bunch of bulky stuff down the stairs and the stuff just blocks their vision. Hello one more step!

If you have rugs in your house, make sure they stay in place. You can get special tape to secure the corners. Make sure you have rubber mats under the rugs so they don’t slip.

Train your pets! Pets cause about 87,000 falls a year which result in emergency room visits. So that number doesn’t include the injuries which don’t require ER treatment! Teach your pets to stay out from under foot! People with small pets are often guilty of too much tolerance when it comes to pets who get under foot. Your little tea cup Chihuahua is just as likely to cause you to fall as a Labrador retriever. Large, poorly trained dogs are likely to yank you off your feet when you’re walking them and they go, “squirrel?” And no matter what size, when you don’t train your dog to heal, they often run circles around your legs, causing you to get tripped up by a loop of leash. But not to give all the blame to dogs; sweet little kitties rubbing up against your leg can result in a fall when you try to keep from stepping on them. I wouldn’t know how to teach a cat not to do that, but just be very aware of their presence as you move away from the refrigerator.

Watch your step! Your response to this might be, “duh.” But I would then reply that I see a huge number of patients who simply trip on things; stuff lying around on the floor, curbs, parking lot barriers and speed bumps, uneven places on the sidewalk. Make it your habit to scan your surroundings, and to both look up and down as you walk to your destination. Ofttimes we look to where we are going and make a beeline there, forgetting about the obstacles between us and our destination.

Just say “NO” to ladders when at all possible. I really do think there’s a certain point at which you should probably just stay off ladders. Let someone else do the job. If you’re unsure, always ask someone else to stand by the bottom of the ladder, just in case. Use sturdy ladders with a handle on top so you have something to hold on to when you’re climbing and when you get to the top. Use ladders with a shelf on top, on which to put your supplies before climbing up. Don’t carry them up there and then put them on the shelf. You can’t begin to know how many terrible accidents I see as a result of someone putting those extension ladders into soft dirt on the side of their house. As they ascend, the ladder starts to lean and you’ve got nowhere to go but down. The severity of your injury is in the hands of God at that point, and based on my professional experience, I’m pretty sure there is often something more important going on in the world. It’s a slow motion movie on the way down as you reach helplessly for sunbeams. If you need to use an extension ladder, you MUST:

1)      have someone below standing guard,

2)      have health insurance, and last but not least…

3)      have your power of attorney and will updated.

‘Nuf said.

Don’t text and walk. Been there. Done that. And if I hadn’t been doing my single leg standing exercises, I really think I would have ended up doing a face-plant on the ground after I tripped on the fluorescent yellow, cross-hatched painted speed bump. As it was, I just ended up a little embarrassed. That was my wake up call. No more texting and walking.

Shoes. High heels, flip flops, and mules have all contributed to my kids’ education fund in their own special way. How’s that for putting something in perspective? If y’all would quit wearing these categories of shoes, I would have to work overtime to pay for this luxury. I think the high heels are obvious. Flip flops speak for themselves. Flip. Flop. Sometimes these cheap, easy on and off shoes actually suck down to a wet floor! They start to slide off your foot. But not quite. And you fall down. You also have to hold them on with your toes, which just puts your foot at a disadvantage when they flip and flop. Mules might not be so obvious, but again, you have to hold them on with your toes, and so again, your foot is already at a disadvantage when you start to go down! Secondly, your heel slips out of them, so with uncanny, but predictable regularity they cause people to sprain their ankles.

And I’m sure I don’t even need to mention the effect this bizarre trend of wearing these 6 inch platform high heels has had on the orthopedic industry. But I’m going to anyway, even though I’m sure it will have no effect on those who wish to wear them. A lethal combination, but one which I have seen many times: 6 inch platforms on a drunk girl who is texting while walking to her car, which is parked in some back alley off Austin’s 6th St. Parents! Teach your children. They can, and they most likely will, get drunk. They can (hopefully just the girls) and they will wear six inch heels. They can and they will text while walking. They can and they will park their cars in dark alleys. But please…just not all at once!

Drugs and alcohol by themselves and in conjunction with all of the above…you-fall-down-go-boom.

And last but not least…Slow down. Give yourself time to get somewhere. We’re a society of people going everywhere at a fevered pitch. Just slow down and pay attention.

How do you know if you’re at risk for falling? Do a simple test; the Get-Up-And-Go test. Stand up from a seated position without using your hands. Take 3-4 steps forward, then turn around and return to your chair. Sit without using your hands. If you can’t do this; if you have to get yourself situated, and gain your balance before you can take a step, then you are at risk for falling. It might be hard to analyze this test if you have bad arthritis or some painful condition in your legs or back, and can’t get out of a chair because of the pain. But a case could be made for that pain resulting in an increased likelihood of falling as well. Just an FYI.

This also reminds me of one last fall prevention suggestion. Don’t get up and go! As we age our bodies stiffen and become more painful. Our balance and our vision deteriorate. After you’ve been sitting for a while or sleeping, it gets harder and harder to just jump up out of our chairs or beds. So do me a favor (actually you won’t be doing me a favor since I see plenty of people who injure themselves jumping up from beds and chairs), and prepare yourself to sit up from bed or get up from chairs.

Briefly stretch. If you’re getting out of bed, do a couple of leg and foot stretches, turn on your side and push yourself up into the seated position on the side of your bed.  If you’ve been sitting for a while, bend and straighten your knees. Make sure they’re not getting ready to lock or cramp.

Make sure you can see your surroundings. If you’re in bed and it’s dark, turn on a light or wait a moment until your eyes get used to the darkness.

Make sure you’re not dizzy. Just sit there a moment. Slow down! Don’t be in such a hurry.

If you know you have pain in your back or lower extremities, think ahead and put a cane or walker by your chair or bedside to help you get up and go.

Now you’re ready to stand up. Do so, but before you take a step, take a moment to make sure you’re not dizzy or hurting in some place that’s going to make you cringe and thereby make you take a bad step.

Now you’re as ready as you’re going to be to start walking.

I know this sounds like a big ordeal, but really, it’s only going to take a minute or so, and isn’t your health and ability to live independently worth it?

For more on stiffness and pain when going from bed or chair to standing, see my blog; STIFFNESS. https://drbarbarabergin.com/a-common-complaint/

I’ve listed a lot of things which can cause falls and therefore cause injuries. There’s a lot of information here, and it might seem like it’s too much to accomplish. But most of this can just become a habit. It simply becomes the way you do things, and therefore takes very little extra time to accomplish each day. Preventing falls is one way to improve the potential quality of your life without altering much in the way you do things. Start today! Do a single leg stand!



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