Between diving for basketballs, rock climbing, and riding dirtbikes, I have had some hard landings, but none recently until last June. I was riding my bicycle, when a woman, with her infant in a papoose, decided to stop directly in front of me in a crowded crosswalk near the Museum of Science in Cambridge. It was hit her or hit the ground, and instinct bade me pull my bike down. The impact to the right hip was almost audible, however medical evaluation demonstrated no significant injuries except bumps and bruises. A sixty-three year old falling from bicycle height –about four feet – frequently produces fractures and concussions (even with a helmet on). My absence of serious injury motivated me to search the literature as to why.

A recent British Medical Journal article cast light on the topic. 4000 community dwelling 60+ year olds, performing daily balance exercises, had a reduced risk of falling, but also a reduced severity of injuries when they did fall. It is well established that many exercise programs, including gait training, bending and stooping, stability training with Bosu balls, balance/strength training with barbells, yoga-type exercises, or Tai-chi, all result in a 30% decrease in falls. This first-of-its-kind study considered outcomes among balance-trained patients that fell. Compared with non-trained citizens, there were 30% fewer falls resulting in medical care, 43% fewer falls resulting in serious injury, and 61% fewer falls resulting in fracture (some categories overlap, totals do not add up).

Since the laws of physics don’t change regardless if one has balance training or not – drop an adult from a certain height they will impact the ground with a certain momentum. So my tentative conclusion, as those in the martial arts know, is my collision with the ground was modified so the momentum was spread out. Not only does balance training prevent falls, but also helps one hit the ground with a less damaging impact.

Balance training can be as simple as standing on one foot for thirty seconds every day, or standing on one foot holding on to a chair. There are more complicated exercises such as yoga and Tai-Chi. Dr. Nadelberg and I teach all of our patients about appropriate balance exercise proportionate to their physical capabilities (our current oldest patient is 89). We practice them ourselves.

I have included some balance exercises below. Remember that all exercise – balance, aerobic, resistance, callisthenic – is good, and several five-minute sessions a day can be a good alternative when weather, darkness, and lack of exercise buddies keeps you from going to the gym for classes or workouts.

The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomized controlled trials BMJ 2013;347:f6234 doi: 10.1136/bmj.f6234 (Published 29 October 2013)

 

The Simplest Exercises

Standing on One Foot

In its simplest form, one holds on to a counter or a chair back, and stands on one foot. For those recovering or out of shape, one tries to hold the position for increasing amounts of time to build endurance. This is standard fare in the hospital – getting patients out of bed after illness or surgery.

For those in better shape, it is an exercise that can be done anywhere, even standing in the grocery checkout line. Simply lift one foot an inch off the floor and touch it to the opposite ankle.

Putting Your Socks On

Every morning try putting socks/stockings standing on one foot. Initially lean against the bed, so if you lose your balance, you land on something soft. DO NOT RUSH. Trying to jam on a sock while falling is NOT the goal. You want to be developing both flexibility and balance so that you can be deliberate. This balance exercise strengthens leg and core muscles, and the focused attention at avoiding falling is every bit as refreshing as meditation without the mantra.

Pick Up/Put Down

Put an item (coin, dollar bill, tennis ball) on the seat of a chair, or the side of your bed. Balance on one foot, lean forward, pick up the item, then straighten up, transfer it to the other hand, lean forward and put it back where you started. Repeat ten times. Next, do the same motion standing on the other foot. Then place the item at a lower height, such as a coffee table, and so on. Keep working lower till you can pick it up off the floor ten times on either foot. This exercise strengthens the back, hips, and legs as well.

James Katz MD

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