Every year throughout the months of November and December, there is a spike in the number of falls or near falls reported by my class participants. In the spirit of hopefully reducing the chances of falling, here are the most common reported causes gathered from the many stories I have heard.

Moving Fast:

Moving quickly is a very common cause of falling. When moving quickly we tend to miss things like tripping hazards and other subtle sensory cues that tell us that we are unstable. Also, when we move fast, it takes more strength and control to stop or change direction, especially if it happens suddenly.

No Free Hand:

When both hands are occupied, it is more difficult to balance and often impossible to grab on to something for stability. Holding bulky objects may also limit the visual field.

When a person loses balance while holding objects, the dominant tendency is to hold on  to the objects rather than to release them.

Low levels of Light:

It gets dark earlier in the winter, especially with the end of daylight savings time. Due to the holidays, we may find ourselves out more at night.

Visual information is a very important part of our balance control. With less visual information in dark surroundings, we are more at risk for a loss of balance. Slowing down can help increase balance control in the dark.

Distractions and Hazards:

Distractions alter concentration and sensory perception which in turn alters balance. All of the following factors can increase the risk of falling:

• Strong emotions such as grief, anger, depression, and anxiety may distract our attention.
• Impetuous behaviors, often inspired by celebratory substances, can alter judgment and cause a person to exceed physical limits for control.
• FATIGUE – this is a big factor for increasing the risk of falling, especially combined with rushing.
• Poor sleep alters balance.
• Clutter in stores, especially items close to the ground. Crowded aisles and loud startling sounds can catch us unaware.
• Glare from bright lights and reflections off of shiny surfaces can distract the eyes.
• Unfamiliar surroundings which require more concentration and visual attention in order to avoid tripping hazards can increase fatigue.
• Rambunctious kids and animals can catch us off guard.
• Liquid spills on hard surfaces such as tile and wood can be difficult to see.
• Clothing that limits visibility (hats) and shoes that alter balance (high heels), can interfere with normal movement and balance control.
• Exposed electrical cords for holiday displays are a big tripping hazard.

WHAT CAN WE DO?

• Be aware of the surroundings, Be conscious of our bodies, and Be sensitive to limits.

• Slow down.

• Be assertive. Ask for help if needed. Be extra cautious when tired, sleepy, or experiencing strong emotions.

Happy Holidays!

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Our purpose in creating this podcast is to help a person lower the risk of falling. The information on this page and in the demonstration video is simple and powerful. You can put the demonstrated ideas below into practice; they will strengthen your balance control and lower your risk of falling.

Balance loss is a normal part of movement. Falling is the abnormality, especially a pattern of falls or near falls where no obvious accident or unusual circumstance can be identified as the cause. Two or more falls in the space of a year would be considered a pattern that might indicate some weakness in the balance system.

The fear of falling creates high levels of anxiety and tension which seriously erodes one’s sense of independence and quality of life. We hope that this information helps to guide you toward safer movement practices and ultimately helps you to feel better about the quality of your life.

Below, is a very simple bit of advice that a professor from my college days gave me about conveying information to an audience. It never seems to lose it’s potency:

First, tell your audience in simple terms what you intend to say.

“In order to lower the risk of falling,

Be Aware, Slow Down, and Widen and Lengthen your base of support (the distance between your feet)”

Second, say it again in more detail.

“Be Aware.

• • • • • Be conscious of distractions.
        • Watch out for tripping hazards.
        • Pay attention to your surroundings.

Slow Down. Slowing down allows MORE TIME for our senses to gather information about the environment, MORE TIME for the brain to process the sensory information, and MORE TIME to make decisions about safe movement.

Widen your base of support. Put more distance between your feet in order to make it easier to shift the weight from one leg to the other. Shifting the weight is one of the primary keys to better balance control and safer movement. When watching the video demonstration, observe how the weight is quite clearly shifting from one leg to the other. Notice how a wider and deeper/longer base makes movement more relaxed and balance control more reliable, especially when moving on soft surfaces such as grass.
+ Keep calm and stay relaxed.
Make a conscious effort to be as calm and relaxed as possible when moving, especially on an unfamiliar surface or in situations where there are multiple obstacles and other distractions.”

Third, tell your audience again in simple terms what you already told them.

“In order to lower the risk of falling,

Be Aware – Slow Down – Widen and Lengthen your base of support.”

Stay Upright and Keep Safe!

Dan Layne | Genevieve Shabandar

For more information on balance, balance classes, and balance training videos, follow the links below:

• Three Steps for Better Balance – Article  (provides a little more detail and serves as a companion to the video)
• More Balance & Mobility Articles
• Balance Training Videos

Some people are not attracted to structured exercise. The reasons may be tied to the residue of some past negative experience or alternatively, there may be no reason at all beyond personal preference. Many individuals maintain  themselves well enough through the daily necessities of living without a need to delegate extra time to making a special effort just to exercise.

Balance and movement are intrinsic skills that arise naturally during early childhood. A healthy balance system functions automatically and very reliably. Work, play, artistic expression, and other pursuits requiring specialized motor skills lead to a natural strengthening and diversification of balance and movement patterns. As long as one’s life proceeds well enough and movement satisfies demand, why fiddle with it?

But what if our balance is broken? What if an illness, injury, or change in lifestyle is no longer sufficient to sustain safe movement? Can impaired balance and mobility be restored? How do we make the repairs? How do we sustain adequate balance and movement skills for the future?

Fortunately, our capacity to adapt to changes in physical and cognitive function is powerful and broad. Balance and movement does not have to be perfect, it just needs to work well enough to allow us to feel confident in our movement.

Minimum Requirements for Functional Balance & Mobility

In order to maintain our balance and mobility skills, certain conditions must be present and sustained in the body. The conditions for healthy balance and movement are in turn a function of the specific nature of one’s physical life. As long as a person’s lifestyle includes enough diversity in movement to meet the requirements for safe balance and movement, the risk of falling is manageable, independence is maintained, and quality of life is acceptable.

Sustainable balance and mobility is built upon the following foundation:

• Movement in all three planes of motion: We must be able to move forward, backward, sideways, and vertically. We must be able to freely combine movement in different directions, including rotation.
• Adequate levels of muscular strength, flexibility, range of motion, and neuro-muscular control: For example, each leg must be able to support all of the body weight in order to control balance and walk normally. This includes the skillful use of devices such as canes or walkers to compensate when there is a deficit that cannot be corrected. Sequential movement patterns such as balancing while walking require precise and high levels of control.
• Physical fitness: fitness levels must be high enough to support physical activity without undo fatigue. Example, the cardiovascular and respiratory systems must be able to supply energy sufficient to meet the demands of our physical efforts, regardless of the specific nature of the activity.
• Sensory function: We must be able to gather information and transmit it to the brain. We require different kinds of information in order to determine position, control balance, plan, and coordinate movement patterns. Examples of sensory information are vision, spatial awareness, and touch. If there is a deficit such as visual impairment, other systems must be able to compensate.
• Cognitive function: The brain must be able to process sensory information quickly enough and with sufficient accuracy to maintain the flow of movement while adapting to changing conditions. That is a function of concentration and processing speed. Furthermore, the nervous system must be able to transmit signals throughout the body.

Solutions

If one’s lifestyle does not meet the minimum requirements for safe movement, balance and mobility may begin to erode. The root cause of most balance difficulties is loss of strength in the hips and legs due to a sedentary lifestyle. A major part of the solution, regardless of the specific causes, is to increase the strength in the hips and legs and to incorporate more movement in one’s life on a daily basis. There are many ways to increase our levels of activity in order to strengthen and restore balance control and movement.

The effectiveness of a corrective strategy, whether it is a do-it-yourself approach or involves engaging outside help, depends on doing the right things. Structured training can augment the process and improve efficiency by illuminating critical details and solutions, especially if the problem is acute.  Training can also provide the knowledge and tools to maintain balance and movement skills for the future.

Motivation

The effectiveness of balance and mobility training is connected to the level of receptivity to training. Receptivity is a function of motivation. Falling, loss of independence, fear, and pain are powerful motivators.

Such strong forces can either drive a person to move less, which compounds the problem, or motivate a person to seek a solution. Often, the need to restore balance function is such a high priority it will override fear and strong prejudices against structured exercise.

Definition of Exercise:

1. Bodily exertion for the sake of developing and maintaining physical fitness
2. The act of bringing into play or realizing in action
3. Regular or repeated use of a faculty or bodily organ
4. Something performed or practiced in order to develop, improve, or display a specific capability or skill.
5. A performance or activity having a strongly marked secondary or ulterior aspect

Common Hindrances to Exercise

Physical

• Pain and other uncomfortable sensations associated with movement
• The way the body responds to increases in heat production such as heavy perspiration
• Crowded exercise environment, uncomfortable spatial layout, mirrors on the walls
• Method of instruction, pacing and intensity are not right

Emotional

• Feeling that nothing can help
• Loss of privacy. “I don’t want anybody to know that I have fallen”
• Guilt, usually stemming from the notion that working on one’s self is selfish and takes time away from work or significant others.
• I might get hurt
• It’s boring
• The logistics of changing cloths and other tasks can seem overly complex
• Competition or the feeling that “everybody is looking at me”
• Perfectionism
• Time taken from other activities that have a higher personal value
• Disharmony with a partner due to differences in level of motivation or interest
• Exercise is narcissistic, often compounded by the presence of mirrors
• Worry that physical appearance or proportions will be altered in a way that is in conflict with self image
• Added complexity – another thing to do
• Uncomfortable with the instructor

Shifting Perspective

It can be helpful to see exercise as an integral part of movement. If we are moving we are exercising.

Movement implies balance, flow, harmony, and proportion. The marvelous inner workings of a fine hand crafted mechanical watch are called the movement. The different sections of a symphony are called movements.

• Movement evokes space, landscape, and freedom.
• An open road with infinite potential in contrast to a dead end.
• Balance and mobility rather than balance and exercise.
• Integration and wholeness rather that separation and fragmentation.
• Simplicity over complexity.
• Independence rather than dependence.

Suggestions

• Start slowly and accumulate training gradually, never force
• “No pain no gain” DOES NOT APPLY!
• Ask questions
• You are in control
• Define purpose and keep it simple – “I want to improve my balance so that I can enjoy traveling.”
• Proportionality, don’t over do
• Balance loss is normal, falling is the problem – “I will lower my risk of falling by educating myself and sustaining my strength and movement skills.”
• Trust your gut
• You don’t have to like it. Create a structure of thought and action that will get the job done.

Some risk factors can be eliminated as fall hazards by being more aware and making minor modifications in our living environments. The tendency to rush or environmental factors such as clutter are typical examples of risks that can be managed.

Health

• • Stay fit, especially leg and hip strength.

• • Vision is an integral part of the balance system. Have your vision checked if there is a change in your balance or ease of movement.

• Remember the safety triad:
  • • Practice Awareness
      • Be conscious of your surroundings and behavior (such as rushing).
  • • Widen Your Stance
      • Stand and walk with your feet further apart (about hip width).
  • Slow Down
    • Give your brain more time to process information.

Home

• • Clear obstacles and clutter that interferes with movement. Try to maintain unobstructed movement pathways.

• • Rugs: eliminate or try a different rug if you keep tripping, slipping, or hanging up

• • Wires: keep them out of the way

• • Clean spills as soon as possible

• • Thresholds: try to find a way to smooth transitions between rooms and surfaces, especially if there is an abrupt increase or decrease in floor level. It is the little changes that tend to trip us up. A one inch difference in floor height in transitioning from one room to another is just enough to trip a person, especially if there is a tendency to drag the feet.

• • Try to use chairs and couches that are easy to get out of. Use lifts such as bolsters or pillows to facilitate getting up.

• • Use railings or grab bars for steps or other hard to navigate areas.

• • Keep a chair or other objects that could be used to facilitate getting up in areas where getting up off the ground might a problem, especially outside.

• • Maintain balance safe pathways outside

• • Use a kneeling bench when working in gardens

• Storage: keep frequently used items within easy access.

Bathroom

• • Don’t use towel racks as hand holds in the bathroom. Have grab bars installed. Most home improvement centers have installation services.

• Get a raised toilet seat from the drugstore if sitting and standing are difficult.

Communication

• • If you were to fall would you be able to communicate?
    • Cell phone, life alert

• If you live alone do you have someone who checks in with you regularly?

Behaviors

• • Slow down rather than rushing to answer the telephone or doorbell.

• • Are you willing to ask for help with balance intense chores such as retrieving objects from difficult to reach areas? Can those objects be relocated?

• • Shoes – flip flops and slippers require a shuffling gait in order to keep them on the feet.

• Use canes, walking sticks and walkers to increase stability on unstable or compliant surfaces such as grass.

Hygiene

• • Foot Care
    • Keep nails trimmed to lower the risk of tripping

• • Braces and wraps offer support but also alter movement patterns – slow down

• Medications – be aware of any side effects which might reduce concentration or influence muscle control

If you are struggling with your balance, the information in this video will give you three powerful steps that can be taken right NOW to lower your risk of falling. Click on the image to view the video.
A fear of falling and the resulting inhibition of one’s sense of independence can be acutely uncomfortable. A desire for immediate relief is normal. Although balance and mobility training requires a committed investment of time and effort, right now, there are three steps that a person can take to improve balance and lower the risk of falling. Pay Attention and Be Aware Slow Down Widen The Space Between Your Feet When Standing And Walking
1. PAY ATTENTION AND BE AWARE! Balance requires concentration. In complex environments with distractions, pay closer attention to your surroundings and movements. Be conscious of your feet and the ground. Be aware of objects, people, and animals. Trust your intuition. If you do not feel safe or stable, do not ignore it. If you feel unsteady, simplify. Be assertive when necessary. If you feel pressured by someone to hurry, stay focused. Be willing to ask for help. When our balance systems are functioning normally, everything works automatically without much conscious attention on the process. Because of that, we can become freely absorbed in other activities. Sometimes, we are so involved we become unaware of sensations in other parts of the body or of changes in the surroundings that are critical to our safety.	Attention and Awareness – Essential to lowering the risk of falling. It is easy to ignore sensation (awareness) in one area of the body when absorbed (attention) in a task elsewhere.
2. SLOW DOWN! There are limits to how quickly the brain can process information. Balanced movement requires the processing of enormous quantities of information that is gathered through the senses. Slowing down allows the senses more time to gather critical balance information and gives the brain more time to process the information in order to orchestrate safe body movements. In addition to slowing down, it is also helpful to limit distractions such as trying to talk or listen when you feel that your balance is challenged. Slowing down is a behavioral modification. It can be challenging to alter the habit of moving quickly, especially if you have been a fast mover throughout your life. The faster we walk, the less we tend to lift the feet. Tripping is more common at faster walking speeds, especially when combined with the fact that there is less time to notice environmental hazards and make corrections in movement.	Slow Down – Complex tasks require concentration in order to process relevant sensory information.
3. WIDEN AND DEEPEN THE SPACE BETWEEN YOUR FEET WHEN STANDING AND WALKING! Develop a consistent habit of standing and walking with YOUR FEET AS WIDE AS YOUR HIPS – figure A. This creates a wider and deeper base of support. The wider base allows for a much greater capacity to shift the weight. Weight shifting is essential for balance control. A narrow stance is less stable and mobile – figure B. A narrow stance limits our range of motion and increases tension in the body. The result is higher muscle tension, increased fatigue, and less freedom of movement. It does not take long to develop the habit of maintaining more space between the feet. Begin by reminding yourself to Widen and Deepen your base before standing or walking. After a while it will become natural.	Wider Stance – Hip distance is more stable, mobile, and relaxed.

We have a Winning Combination for Increasing Stability and Lowering the Risk of Falling when a Larger Base of Support is combined with Attention, Awareness, and a Slower Pace!

Safe travels out there,