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
In the April 2018 issue, Mike O’Hara discusses the benefits of the farmer’s walk exercise. Jeff Tirrell tells you how to reduce injury to your ligaments and tendons, and tips are given for getting back out into the garden.
Getting up and down off the ground is a movement skill we need to maintain. It is the functional exercise activity that keeps us safe and independent for a lifetime. Developing proficiency in getting up and down off the ground has multiple benefits. It takes away fear, builds confidence, and increases activity in other areas of life. Your fitness training should involve activity that makes you better at moving gracefully in and out of the positions necessary to get up and down off the ground.
Getting up and down off the ground is largely a neural activity. Nearly everyone has enough strength, range of motion, and balance—you just need some practice. Physiologically, we know that movement practice makes transmission of neural signals more efficient. Research on motor learning has taught us that repetition, ascending challenge levels, and coaching produces the best results. The reach and roll exercise is a good starting point for improving from the ground up movement skills.
Reach and Roll Performance
You need some open space. Lay on your back. Bend the right leg up and keep the left leg straight. Reach the left arm out at 45 degrees in relationship to the body. Brace the abdominal muscles. Reach across the body with the right arm and then let the head follow as you rotate over to the left. Roll the right leg across the body and turn over onto your left side. Return back to the supine position and then repeat the exercise to the right. Perform five times on each side.
One direction may be much easier than the other. Try starting with that side and add in some extra repetitions to the weaker direction. A common mistake is leading with the head instead of with the reaching arm. Some coaching can make ground up movement skills much easier to master. As you get better at the reach and roll, add in a lift up onto the elbow and then hand.
View video demonstration of reach and roll here: https://www.youtube.com/watch?v=n4B8A8rnzsQ
Michael S. O’Hara, PT, OCS, CSCS
How To Make Stress Urinary Incontinence Go Away
Stress Urinary Incontinence (SUI) is a common problem in the female population. SUI responds very well to a proper rehabilitation exercise program and modification of behavior. Unfortunately, most women are either not directed or do not seek care for this problem.
SUI problems are happening to more women at younger ages. The overall fitness level of younger women has dropped and problems with SUI are happening sooner. Obesity, surgical interventions through the abdominal wall, and pelvic floor and systemic diseases such as diabetes all contribute to an earlier onset of SUI.
Women in the fitness population often suffer from what I call Permanently Contracted Abdominal Muscles (PCAM). They hold their abdominal muscles in a perpetually pulled in position and their pelvis tilted backward. They are unable to relax their abdominal muscles and properly inhale and exhale. PCAM creates hypertonicity and weakness in the muscles of the pelvic floor. It is also the reason many postpartum women develop a chronic diastasis recti hernia.
Modification of fitness activity is often necessary to resolve SUI in female fitness clients. Many exercises overload the pelvic floor and impair the motor control necessary to prevent leakage. You may have to temporarily give up the crunches, leave the yoga and lose the lifting belt in order to ditch the dribble. Once SUI problems have resolved you will be able to go back to all activities. My experience has been that most female fitness clients find they function so much better that they never return to those activities.
Physical therapy patients treated for SUI are often surprised by how simple changes in behavior and consistent training quickly resolves their leakage issues. It is unfortunate that many of these women suffer with SUI for years before receiving some help. I had a patient tell me that she thought SUI was just part of being a mom. Her mother had SUI, and after delivering two children of her own, she developed symptoms. All of her problems with SUI were eliminated with three months of simple exercise and some alteration of fitness activity.
Take a few minutes and read the article by physical therapist Ann Wendel on the Girls Gone Strong web site. She does an excellent job of covering all areas of physical therapy for SUI. You can view the articles here: https://www.girlsgonestrong.com/blog/injury-prevention/strong-pelvic-floor-isnt-enough/
-Michael O’Hara, P.T., OCS, CSCS