NY Times Article on Fall Prevention
When discussing fitness goals, most people never mention fall prevention, but I suggest that it is more important than fat loss or improving your cardiovascular capacity. Please take the time to read Gretchen Reynolds excellent article; Falls Can Kill You. Here’s How to Minimize the Risk. In the article, Ms. Reynolds presents several good lifestyle modifications and medication precautions that will help prevent a fall. Try adding some of my long standing fall prevention training tips.
Exercise in a standing position.
If your goal is to move better and remain free of injury, then 90% of your exercise activity should be performed in standing. Developing better kinesthetic awareness, strength, and coordination in a standing posture is the crucial component of training that prevents a fall. During my visits to commercial gyms, most of the exercise activity I witness is performed in a supine, seated, or supported position.
Practice moving in all directions.
Fall prevention training involves improving multi-directional movement skills. Most falls happen from an unexpected disruption of your equilibrium. You get pushed to one side, twisted off center, or a foot slides from under the body. Most gym activities are predominantly sagittal plane- forward and backward. We need to be able to move well in all directions.
Practice moving faster.
Fall reaction training should focus on exercise activities that make you quicker. Research on falls has shown that a gait pattern (how you walk) that starts to slow down is the best predictor for a future fall. Agility ladder footwork, medicine ball throws, and hurdle drills are examples of faster paced training activities. Yoga, Pilates, recumbent bicycle riding, and muscle isolation exercises will not make you better at moving faster.
Stand on one leg.
A simple and proven fall prevention activity is single leg stance balance training. Single leg balance is a skill that tends to deteriorate with age, injury, and a sedentary lifestyle. Stand on one leg for twenty seconds. Stand on one leg and turn your head side to side. Stand on one leg and then close your eyes.
Practice getting up and down off the floor.
One of the best anti fall training activities is consistent practice of getting up and down off the floor. Moving gracefully from standing to the floor and back up again is a life skill that keeps you independent and safe. As a Physical Therapist, I frequently find people who are very impaired in this basic task of mobility. They crawl to a piece of furniture for an assist and transition from the floor in an unsteady and unsafe manner. Most of these patients are not elderly, they are tight, weak, and deconditioned.
Perform single leg strength training.
We are monopods. We absorb and then create force one leg at a time. During activities of daily living, one leg is loaded more than the other. It only makes sense that we train our legs the same way we use them. Work with a trainer and learn how to perform step ups, single leg squats, rear foot elevated split squats, single leg deadlifts…
Become a better shock absorber.
Fall events often occur because of an impact. The force of the impact causes our body to give in to gravity and down we go. Just like any other physical attribute, impact resilience can be trained. Mat work, medicine ball throws, and rope drills are some of the activities that can be used to improve impact resilience.
Make balance practice a daily event.
Integrate anti-fall training into your lifestyle. Stand on one leg while you brush your teeth–right leg thirty seconds then left leg thirty seconds. Perform multi directional exercise as movement preparation before a bike ride or run. Get some instruction on a program of exercise that improves agility, single leg strength, and power production.
Someday, somehow, and when you least expect it, you are going to have an unplanned interaction with gravity. Your fitness program should make you more responsive to a fall event and less likely to be injured.
Link to article: here
Michael S. O’Hara, PT, OCS, CSCS
Bad Man Break
Men Need To Be More Aware Of Bone Density
Allen was getting out of his fishing boat when he twisted his left leg and fractured two bones in his ankle. Six weeks after ankle surgery, he landed in our clinic with considerable pain and a very limited lifestyle. Allen reported lower back pain that he attributed to his limping and use of the boot on his left leg. On recommendation from his physical therapist, Allen had further medical assessment of his lower back pain. An x- ray of his lumbar spine revealed two lumbar vertebrae fractures.
On a recent vacation, Mike went on a horseback ride with his grandchildren. During the ride, he developed pain in his upper back that “took his breath away”. A visit to the emergency room with what he thought was a cardiac issue revealed a three-level compression fracture in his thoracic spine. Further assessment showed significant osteoporosis in his hips, pelvis, and lumbar regions. Allen started on some bone rebuilding medications and physical therapy. It took over four months to fully recover from this injury.
Randy was working on his garden and fell onto the lawn. He had right hip pain and was unable to stand. His wife called the ambulance and he was diagnosed with a hip fracture. Four days after the surgery to repair his hip, he suffered an embolism and at the age of seventy-one, he passed away.
All three of these older guys had testing that revealed a significant loss of bone density. Unfortunately, the tests occurred after and not before injury onset. We are getting better at keeping men alive longer–less smoking and better medications. As men get older, the need to monitor bone density becomes a crucial aspect of healthy aging. Men need fewer commercials for the latest in testosterone replacement and ED medication and more awareness of how brittle their bones can become.
The general public views osteoporosis as a “women’s health issue”, but management of osteoporosis is just as important for men. Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled or die from the fracture. Since 2008, the rate of osteoporosis related hip fracture in the American male population is going up at an alarming rate.
Osteoporosis is a silent disease. Most people do not realize they have a problem until something breaks and they are in the middle of a medical crisis. Even after a fracture, many physical therapy patients are reluctant to follow up with a bone density screening. Being proactive is the only method of managing osteoporosis.
We know that individuals that participate in consistent resistance training exercises are more likely to have better bone density. Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it. The best bone building exercise activities produce a stimulus through your skeleton. Bone building exercises are easy to understand, but they do require more effort than swallowing a pill or having an injection. Everyone can perform some form of bone reinforcing exercise. Proper exercise prescription and consistent progression can work wonders. See the trainers and physical therapists at Fenton Fitness.
Jane Brody of the New York Times wrote a helpful *article on bone density testing. It covers the latest medical guidelines for testing and the when and why of testing for both men and women.
Michael S. O’Hara, P.T., OCS, CSCS
*New York Times, July 16, 2018, Jane Brody, When to Get Your Bone Density (View Article:here)
Treadmills are found in virtually every gym. Read the six treadmill facts you need to know. Meet a Fenton Fitness member who learned how to manage her back pain, and read about the seven best TRX exercises. Do you have limited time to exercise? Be more efficient with HIIT.
The June newsletter brings information on side planks and bird dog exercises for core stability. Watch the video for demonstration of the exercises given. Mike O’Hara gives some practical advice on preventing falls in his article, Fall Recall. Read one person’s story about his transition from physical therapy patient to gym member, and be sure to check out sled rowing.
Mr. V had pain in his lower back and right hip. The problem had been present for over a year and he had been diagnosed with spinal stenosis. He was sent for physical therapy by his family physician because he was having difficulty climbing the stairs and walking in his home. Mr. V was 78 years old and lived with his wife Miriam. Miriam reported that her husband had mild dementia and had fallen three times over the last month. Mr. V stated that he often felt dizzy when he got out of bed, but he was not sure why the falls happened. Miriam stated that they did not bother to tell the doctors about these falls.
Every physical therapist gets these questions:
- My doctor told me to “just walk.” Why do I need to do resistance training?
- What can I do, so I don’t get a hump on my back?
- The trainer said I should do the elliptical because it is low impact. Will that help?
- Water aerobics is my favorite activity. Will it help my balance?
- I take Vitamin D. Will it help improve the strength in my legs?
Fitness clients and physical therapy patients are looking for assistance in the prevention of falls and reducing the risk of osteoporosis. It does not help when health care and fitness professionals give inappropriate answers. Health care and fitness professionals need to establish consensus on questions commonly asked by patients, so that we can give appropriate answers. In 2012, an international team of researchers and clinicians launched Too Fit to Fracture, an initiative aimed at synthesizing best evidence and developing recommendations for both exercise and physical activity for individuals with osteoporosis.
Two primary recommendations came out of their efforts:
1. Individuals with osteoporosis (with or without vertebral fractures) should engage in a multicomponent exercise program that includes resistance training in combination with balance training.
2. Individuals with osteoporosis should not engage in aerobic training to the exclusion of resistance and balance training.
Too Fit To Fracture Training Guidelines
- Encourage daily balance training.
- Include resistance training, twice a week, to improve strength.
- Teach spine sparing strategies, such as hip hinging and proper lifting mechanics.
- Encourage activities that increase back extensor muscle endurance.
- Encourage moderate to vigorous aerobic physical activity for individuals at moderate risk of fracture, but only moderate intensity for those at high risk.
The answers to the fall prevention / bone health questions should sound like this:
- Balance train for ten to twenty minutes every day of the week and strength train for 30 to 45 minutes twice a week.
- Make sure your strength training teaches you how to move correctly and improves the endurance in your back muscles.
- If you have mild to moderate osteoporosis and you balance train and strength train first and foremost then spend the extra time on some cardio training.
- If you have been told you are high risk for fracture, keep the cardio training at a lower intensity.
This is what the latest and greatest research and clinical findings tell us about preventing fractures and improving bone health with exercise. Visit osteoporosis.ca for more information, and use their guidelines to determine your fitness plan of action.
-Michael O’Hara, P.T., OCS, CSCS
Falling In Love With Fitness
Fall Prevention And Intervention
Mrs. J. had pain in her lower back and left hip. The problem had been present for over a year, and she sought treatment in physical therapy because the pain was making it difficult to get in and out of her car and work in the garden. At 73 years of age, Mrs. J. lived in Michigan during the summers and traveled south for the winters. She enjoyed working in her garden, visiting with friends, and walking on the beach in Florida. On further discussion, Mrs. J. reported that she had fallen three times over the previous year. Two falls occurred while getting out of bed and once while working in her yard. She did not bother to tell her doctors about these falls because she had not been injured.
Mrs. J. had all of the factors that placed her at high risk for falling in the future. She was over 65 years of age. She took four medications, two of which had psychoactive effects. She had a prior history of falls in the past and she was weak.
Falls are the leading cause of accidental death for those 65 years and older. Just over a third of the population over 65 falls every year. One half of those falls happen to individuals who have fallen before. It is the most common injury related hospital admission. In 2012, we had over 340 thousand hip fractures from falls in this country.
Risk Factors For Falls
A prior history of falls. If you have fallen in the past you are more likely to fall again.
Balance impairment. If you are unable to balance on one leg or you lose your balance easily when you close your eyes, then you are at greater risk.
Strength deficits. The weaker you are, the more likely you are to fall.
Postural hypotension. A twenty point fall in systolic and/or a ten point drop in diastolic blood pressure on changing position from supine to standing places you at a greater risk of falling.
Visual impairment. If you are unable to see the dog, curb, or chair, you are more likely to have a collision and subsequent fall.
Multiple medications. Taking more than four medications is related to more frequent falls. The risk is amplified if the medications have a psychoactive component. Several studies have identified antiepileptic medications as more problematic.
Dementia. Cognitive impairment doubles the risk of falling.
Post hospital stay. For the two weeks after a hospital stay, you are four times more likely to fall.
What Definitely Helps
Home assessment and modification. In my experience, peace in the Middle East may be more readily attained than getting grandma to move her rug and install a grab bar in the bathroom, but it is what has been shown to reduce falls in higher risk individuals.
Exercise programs. Strength, balance, mobility, and power production activities. The activities should take place in a standing position and should be tailored to the specific needs of those at risk. These programs work–you just need to do them.
What is Likely to Be Beneficial
Vitamin D supplementation. Several studies have documented fewer falls in individuals that supplement with Vitamin D. The mechanism for the decrease in falls is not known, but it seems to work.
Medication review. If possible, minimize psychoactive medications and reduce the total number of medications. Discuss this with your physician before making any changes in your medications.
Assessment and awareness of postural hypotension. If blood pressure drops with transfer from supine to sit to stand, you are at higher risk for falls. A simple blood pressure test performed in the doctor’s office can determine if you have this problem and enable management of this risk factor.
Vision assessment and management program. Get your eyes checked and consult with your doctor on a treatment plan to keep your vision as healthy as possible.
Better footwear. This is the most common sense advice, but it gets the lowest level of compliance. Ladies those shoes look nice, but that pin in your wrist looks a lot worse.
Mrs. J. had a blood pressure assessment that showed her systolic pressure dropped twenty-two points with transfer from supine to standing. We contacted Mrs. Js’ family physician to alert her of her patient’s recent fall episodes and blood pressure findings. Mrs. J. was taken off one of her medications and her blood pressure improved. The pain in her hip and lower back resolved, and she was able to perform a program of exercise to improve balance, strength, and mobility. Mrs. J. completed five weeks of therapy and then continued with her exercise program at our fitness center. She has been exercising three times a week for the last two years and has not had another fall episode during that time.
Michael S. O’Hara, P.T., OCS, CSCS