Health Matters Blog

Slip Sliding Away

By Eileen Casey, PT

Snow, rain, sleet, polar vortexes, yikes! The freezing and thawing can lead to frost heaves, potholes and uneven ground in many places. Even with the most diligent shoveling, plowing, sanding and salting, patches of ice or potholes can still be lurking, just waiting for you to step on them and fall. Just ask any of the folks treated this winter at the BMH Emergency Department for hip, wrist or arm fractures due to falls on the ice.

As children, most of us had no fear of falling; you got up, brushed yourself off and kept going. It was no big deal. As a child you did many things that helped keep your balance system working in tip top shape. Play and exercise kept bones and muscles strong and flexible, helped keep reaction times quick and challenges you gave to your balance system on the playground actually made it work even better.

Eileen Casey

Eileen Casey

But, as we get older, falling can become much more serious. Injuries such as fractures and head injuries can result from a fall. These injuries can result in a loss of one’s independence. As we age, the things that make up our balance system –vision, inner ear (or vestibular system) and sensors in your feet and legs, may not be working in that same tip top shape as when you were younger. And all the sitting that we do as adults doesn’t help challenge the balance system either.

As we age, many of us may need glasses to see well. For some people, that may mean bifocals which can throw off your vision when walking, especially on uneven ground. Difficulty seeing in low lighting or vision problems due to cataracts or macular degeneration can also limit how well we see our surroundings and can impact balance.

The tiny bones and hairs in the inner ear that make up the vestibular system tell your brain about where your head is in space. But as we age, we can lose some of those tiny hairs and the bones may become stiffer and don’t react as quickly. All of that can lead to feeling just a little off kilter with your balance even when on secure footing. Other inner ear issues can cause outright dizziness when you move. Many medications or combination of medicines can also cause a side effect of dizziness or throw your vestibular system off.

Feet and legs may become less flexible over time and arthritis may limit motion in joints. Your sensation may not be as keen as it once was due to diabetes or neuropathy. These things can decrease the reliability of the sensors in your feet and legs giving your brain faulty information about where your body is in space.

Any one or combination of these things can cause people to become fearful of falling and decrease confidence when you are out and about. Some people can become so fearful of falling that they limit their activity level. This, in turn, can lead to a loss in muscle strength and decreased balance which can lead to an even greater fear of falling, and the cycle is repeated in a vicious downward spiral.

Spending the long New England winter sitting on your couch waiting for better weather is not the answer. In fact the answer is just the opposite. In order to improve your balance you must challenge it. There are numerous ways to do this.

Simple things such as practicing standing with your feet together and holding your arms across your chest can help. To make that more challenging, try moving your head right and left or up and down while in that position. If that exercise isn’t challenging enough, close your eyes while holding that position and maintain your balance as long as possible. If that is easy for you try standing on one leg for as long as you can. Have a spotter available for your safety.

There are published normal values for a number of activities that can tell you how well your balance compares to others. For example, you should be able to get up and down from a firm chair, without using your arms, at least eight times in 30 seconds. Inability to do that often indicates a lack of leg strength and is a predictor for falls. People in the age range of 50 to 59 years old should be able to maintain their balance without arm support, standing on one leg for 29 seconds; for ages 60-69 you should be able to hold that position for 22 seconds. How do you compare?

If you want to start exercising to increase strength and balance, Bone Builders or Strong Living classes may be a good start. For more of a challenge try a Tai Chi or Yoga class. There are numerous offerings in and around the Brattleboro area to help improve strength, flexibility and balance.

If you have concerns about your balance speak with your health care provider. Referral to a physical therapist may be in order. A physical therapist can evaluate and identify particular areas you are having trouble with and can work with you to create a treatment program. The treatment may include eye exercises, strengthening your leg or core muscles, stretching and working on flexibility of your ankles and, of course, challenging your balance!

We can’t always prevent every fall and we know that we can’t eliminate ice and snow from a New England winter but we can reduce the chances of falling by doing a few simple things:

  1. Talk to your doctor about your medications – taking more than eight different medications increases your risk for falls.
  2. Get your vision checked. If you wear glasses make sure your prescription is correct.
  3. If you use an assistive device like a cane or walker, make sure you use them. Special ice grips on the tips can help ensure you get proper traction when outdoors.
  4. If you don’t already have them, install railings on your stairs.
  5. Make sure you wear appropriate footwear.
  6. And most important – maintain or improve your fitness and balance with regular exercise!

Eileen Casey, PT is Director of Rehab Services at Brattleboro Memorial Hospital. She can be reached by calling 802-257-8255.

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