August 2010

Older adults who fall, even those who are not injured, often develop a fear of falling. This fear often leads to limiting of activities, leading to reduced mobility and physical fitness.  It is important to understand that reduced mobility and physical fitness is actually shown to increase the risk of falling (Vellas et al. 1997).   Therefore, it is important to be physically active with an end goal of increased strength, flexibility and a better awareness of ourselves and our surroundings. 

So…how does the ROM of the various joints fit affect physical balance?  Overall ROM is important, but the ROM of the shoulder/neck region, the hips and the ankles are particularly important.  So…let’s ponder each area, and consider options for improvements:

Neck & shoulder region: The shoulders tend to lose ROM over a period of years due to the forward patterns of our activities of daily living (e.g. driving, typing, opening cupboards, picking up objects, etc.).  When we want something behind us…we turn around and get it in a forward fashion.  As a result, we eventually lose the ability to take the shoulders through their full ROM.  Do a quick test of your shoulder flexibility by reaching over your right shoulder with your right hand, and reaching down-and-under with your left hand.  Try to touch your fingers behind your back.  This tells you about the flexibility of your left shoulder.  Now, do the same for the right.  The closer your fingertips are to one another, the better.  Being able to touch your fingertips indicates good ROM, and one side is likely to be tighter than the other.  ROM of the shoulders and neck is particularly important for static balance / our balance when we’re standing still.  This is due to the fact that as this area becomes increasingly tight…we begin to round the upper back and carry the head forward of the shoulders.  The average human head weighs in the neighborhood of 10#.  When considering the idea of holding 10# forward of one’s center of gravity, you can see where this is an issue.  Activities that serve to increase the ROM of the neck & shoulder region include daily 1) chin tucks for the purpose of pulling the head back and bringing the neck into line with the spine 2) reverse shoulder rolls / elbow circles in an effort to increase shoulder ROM 3) head turns / vertical rotation of the vertebrae of the neck (good to precede with chin tucks for proper alignment).

Hip region: When we sit for long periods of time, whether this is due to age or our occupation, our hips tend to stiffen up.  Stiff hips affect physical balance as our gait / walking patterns become compromised.  Stiff hips compromise gait as the movement in the act of walking comes from the hip joint.  Dynamic balance /our balance when we’re walking then becomes an issue.  Indications of an issue include shuffling, walking flat-footed and walking with the toes pointed out.  Activities that can serve to increase the ROM of the hip region include daily movement of this area, with the best activity being to do a slow, exaggerated hula while keeping the head and shoulders stationary.  The hips move purposefully…forward, side, back, side while the head and shoulders stay put.  If the shoulders and head move during the hula, this is a definite indication the hips are tight and need work.

Ankle region: Again, lack of movement forces the ankles to become weak and tight.  The ankles and feet communicate with the brain in terms of our exact position in space and the type of terrain that is underfoot, which is critical in terms of maintaining an upright position.  Tightness in this area affects both static and dynamic balance, and activities that can serve to increase the ROM of the ankle region include slow ankle rotation, pointing and flexing the foot repeatedly and coming up onto the ball of the foot and stirring around repeatedly with the heel.  Options are performed on one side…and then on the other and should be done slowly and purposefully.  Massaging the feet is shown to be effective in stimulating circulation; key in terms of being able to sense the surface underfoot and stay upright. 

Aging alone does not cause falls.  Falls seldom "just happen" and most falls happen in the home.  Be empowered, and understand the various determinants for falls, and know what you can do to prevent a fall before it happens.  Among the things you can do…be physically active, get regular eye exams / ear exams / physicals, take calcium and vitamin D, slow down…avoid rushing, eliminate clutter, use assistive devices (e.g. grab bars, cane, walker, etc), wear enclosed nonskid shoes and practice a high level of awareness of the self and the surroundings.