Welcome everyone to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. This week I talked with Josh Davis, PT, DPT, CSCS (Tri Star Strength x Rehab) about the importance of GOOD BALANCE & STABILITY as it relates to the prevention of falls. I have had several people ask me to do a podcast on this subject and after talking to Josh, plus doing my own research, I know why.
Here are some stats from the CDC (Centers for Disease Control and Prevention) and NCOA (National Council on Aging):
- Falls are the leading cause of fatal and non fatal injuries among older adults.
- More than 1 out of 4 Americans age 65+ falls each year.
- Falls result in more than 3 million injuries treated in emergency rooms annually, including over 800,000 hospitalizations.
- For older adults in the U.S., fall death rates went up by 30% from 2007-2016, and researchers predict there will be 7 deadly falls every hour by 2030.
- People with mild hearing loss are nearly three times as likely to fall.
- More than 95% of hip fractures are caused by falling.
The list goes on, but we can stop there. You get the importance! Let’s dive into my takeaways from the conversation with Josh.
BALANCE 101
There are two types of balance: STATIC and DYNAMIC:
- STATIC balance is our ability to hold our body in a specific position and posture. The center of mass is over the base support at all times (ex. Standing, standing with eyes closed, standing on one leg, squatting). There are no external factors with static balance.
- DYNAMIC balance is our ability to maintain balance while moving. This type of balance mimics real life situations, such as walking, stepping over obstacles, going up or down stairs, etc. Both types of balance training are important.
There are three different systems in the body that are responsible for balance:
- VISION / the eyes,
- VESTIBULAR SYSTEM / the inner ear, and
- PROPRIOCEPTION / the body’s ability to sense movement, action, and location. Note: without proprioception you wouldn’t be able to move without thinking about your next step.
The vestibular system and visual system work together by sending signals from the eye muscles to the balance organs in the inner ear. If one of these systems is not functioning correctly a person can feel dizzy, off balance, or experience Vertigo. Note: Vertigo is a feeling of motion that is not actually present.
If you struggle with balance, or want to train your balance, you can take away one or two of these systems to isolate a problem area. For example, you’re most likely to fall with your eyes closed. This is everybody! Closing your eyes forces you to rely more on the vestibular system and your proprioception. This is good, unless you have diabetic neuropathy and can’t feel the ground underneath you. In this case, you may want to keep one eye open as you are working on balance.
Try to find out if it’s your vision, vestibular system (inner ear), or your proprioception. If we tease out which one of those you are limited in, then we can try to make corrections and/or adaptations to the body to help you reduce the risk of fall.
There are two types of muscle fibers:
- FAST TWITCH muscle fibers (type II)
- SLOW TWITCH muscle fibers (type I)
The fast twitch muscle fibers give us the ability to produce force quickly, helping to prevent falls. Unfortunately, this is the muscle fiber we lose as we get older, simply because we stop using them. Note: It’s rare to see older adults, like myself, outside sprinting on a track or jumping on a basketball court. I’d like to learn how to sprint again, without fear of injury!
The slow twitch muscle fibers focus on smaller movements and postural control. They are more efficient at using oxygen to generate ATP fuel (adenosine triphosphate) for continuous, extended muscle contractions. They fire more slowly than the fast twitch fibers and can go for a long time before they fatigue. Note: Good for long distance running and biking.
Tips and Exercises to help prevent falls:
TIP #1 – If you are walking around the house, and trip on the rug, you need to.
- Get your foot underneath you (make sure your knee is strong enough to support your weight), then
- Counteract to get upright again.
TIP #2 – Walk around barefoot as much as you can. As we get older, we lose the ability to feel our feet on the ground. Note: Everybody likes Hoka shoes, but if you have neuropathy, that’s like putting exercise balls on your feet (i.e. you can’t feel the ground). Also, because of the electrical currents of your body, you need to be able to connect to the earth. See my podcast on grounding.
TIP #3 – Try toe yoga, or “toga”. This is the ability to put all four outside toes on the ground, pick up your big toe, and then reverse it and put the big toe down, and pick up the other four. Think of your toes as an antenna. Feeling the ground and making those adjustments.
TIP #4 – If a person is falling, it typically will happen to one side or the other, or straight back. If you’re falling, get as much of your body to the ground as possible and try not to stiffen up. Hips down first, then roll. Note: By the way, on the day of this podcast my dog got underneath me, and I took a full fall. I literally did what Josh described in the podcast and came out unscathed.
TIP #5 – Get in a staggered stance with 80% of your weight on the front leg and 20% on the back leg (kickstand position). Get a dumbbell in one arm and do almost like a windmill, switching the weight from one hand to the other. Note: Demo in video.
TIP #6 – Hip hinges. This redirects our center of mass and base support to where we are stable. For example, this position is hip back, but chest forward. This is the deadlift position.
TIP #7 – Do one legged exercises once you master some of these movements on two legs.
Note: It’s best to start out with body weight exercises. You have to have mobility before stability, and then strength. Reminder: Most falls happen with dual tasking.
Two Tests For Balance:
The TINETTI BALANCE TEST and the BERG BALANCE TEST are two tests used to measure a patient’s gait and balance. Patients are scored on their ability to perform predetermined tasks.
Examples of some tasks: Note: Before trying any of these exercises, make sure someone is with you, preferably somebody like Josh or Zach.
- Stand still. Arms across chest. Narrow base of support. The closer your feet, the less balance you’re going to have. Shoes off. Eyes open at first. Once you achieve this, then close your eyes (start with one eye closed, then go to two eyes closed). Time yourself.
- After this, you can add external forces. This is when someone will be acting on you, such as pushing you backwards or sideways. Note: This should be unexpected.
- Then, you can add more dynamic movements like “reaching”. Put your hands together and reach out as far as you can. Measure that distance. Do this with a tandem stance (staggered footing).
Summary: Assess where you are with your static balance. Learn to stand on one foot. To make it more difficult, close one eye (and then both eyes).
Note: Can you get off the floor without using your arms? This is something I ask all of my patients, and it’s a good thing to practice. To practice, try sitting on the ground more.
CLOSING THOUGHTS
Balance is a good measure of your overall fitness. Take a look at the (3 legged) Barstool analogy: Mobility, Stability, and Strength. If you don’t have one, then the chair’s going to fall. Plain and simple. Therefore….
- Work on your mobility. Be able to get into end ranges (full range of motion on your joints).
- Work on your stability. Be stable at those end ranges, not losing your balance when your arms are fully extended on one foot.
- Work on your strength. Be able to exert force in the end ranges. For example, punching a heavy bag or lifting a weight while balancing on one leg. This is where one legged exercises become challenging!
Be careful. Be safe. In pickleball, a lot of the injuries occur when backpedaling. If you’re playing a lot of pickleball, don’t go after balls you’re not sure if you can reach, and be careful when running backwards. Watch the video of this podcast to see Josh working with me on a few balance techniques.
BALANCE and STABILITY can save your life.
Stay educated. Stay healthy.
Till next week.
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