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Learning how to fall and conquering the fear

Jessica Neiss

Feb 8, 2023

You can do something to maintain activity and balance throughout your life: Prepare.

A common thread among the older adults I evaluate is that they are incredibly afraid of falling.

How can we forget that ominous commercial with the woman yelling, “I’ve fallen, and I can’t get up!” Many people perceive that, as they age, they lose control over their balance.

The reality is that you can do something to maintain activity and balance throughout your life: Prepare.

The truth is that everyone falls. Gravity doesn’t take a break, and sometimes we don’t see an obstacle in our path until it’s too late. Yes, it’s nice to prevent a fall from happening, but accidents are out of our control. For example, you might trip on a rock or slip on some ice.

Be prepared for any situation so that you do not get hurt when you fall and can get up on your own.

John came to physical therapy because he was afraid of falling. He had a minor fall while tripping over a grandchild’s toy. He didn’t want the “big one” to happen, and he didn’t want to “break a hip.” We spent weeks strengthening and challenging his balance while gradually adding more task demands. John joined a Tai Chi class once a week and practiced balance exercises at home.

Many studies prove that the body awareness and slow weight shifting in Tai Chi helps to sharpen your vestibular system and improve balance. Tai Chi originated in ancient China as martial arts training to cultivate physical strength and agility as well as mental clarity and emotional balance. Slow, gentle movement nurtures the body, protects and heals. Those coming to physical therapy for balance are referred to a weekly Tai Chi class as a complement to their therapy.

Balance should be treated as training for a sporting event. Falls preparedness involves strengthening, balance and coordination drills, falling techniques and reactive balance training. Tai Chi is cross-training and can be practiced and cultivated throughout one’s lifetime.

Strengthening is an important way to defy the aging process. According to the AMA, muscles naturally lose strength every decade, starting in our 40s. Lifting weights is vital to maintain the strength needed for everyday activities. To prevent frailty and bone loss, and to improve balance, lifting weights is an essential part of the puzzle.

Balance and coordination drills help to stimulate your vestibular system. The vestibular system is a combination of your visual system, the inner ear and sensation. It tells your brain where your head and your body are in space. If even one part of this system is disrupted, the entire brain feedback system becomes confused. This can make you feel off balance or as if you are going to fall every time you move.

Exercises geared specifically toward the vestibular system can help your response and build your confidence. Practicing balance by stepping over objects, walking on uneven surfaces, bending down and picking up items, reaching outside your base of support, multitasking and quick direction changes are just some ways you can practice.

It’s also important to practice falling techniques. I used to coach gymnastics, and one of the first things we taught was how to fall correctly. Most sports teach falling techniques. Why not teach falling to the aging population?

Falling techniques can be practiced in all directions: forward, backward and sideways. First, a physical therapist will get you to feel comfortable getting on and off the floor. Some people have not been on the floor (purposefully) in years and are afraid. John was one of those people. He had undergone two total knee replacements and laughed at me when I suggested that we practice getting on the floor.

Once comfortable on the floor, we practice rolling backward and sideways and falling forward from your knees. We emphasize protecting the head, tucking and rolling, and spreading out the force on your body. Then we gradually raise the fall height, so that eventually you can tuck and roll if you fall from a standing position.

Finally, and most critically, it is possible to simulate the experience and the dreaded feeling of falling. When you intentionally subject your body to a “real” fall, your brain learns how to react.

On specialized equipment called a slip/trip trainer, someone wearing a tethered safety harness can practice how to react when they slip or trip. As published in Archives of Physical Medicine and Rehab 2010, spending 25 minutes on the slip/trip trainer was enough to change balance reactions for up to a year. There are very few environments in which you can practice slipping and tripping in a safe, controlled way.

John had a love-hate relationship with slip/trip training. He said that it was both anxiety-provoking and empowering. He tolerated about 15 minutes at a time and sweated through his shirt but ultimately learned the proper reactions to slipping and tripping.

Ultimately, John graduated from PT with increased confidence, strength, the ability to navigate all surfaces, the knowledge of how to fall safely, and how to react with a slip or trip. He was able to get down on the floor to play with his grandchildren and even started hiking in the woods. He was no longer fearful of falling.

Jessica Neiss is a physical therapist with 20 years of experience. She owns To Life! Therapy & Wellness, a Center in Squirrel Hill that offers physical therapy, occupational therapy and exercise classes for older adults and people with neurological conditions such as Parkinson’s or multiple sclerosis.

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