Falling

I fell this morning on the ice on Hampstead Heath. It was quick and without warning. One second I was standing up and walking along, the next I had fallen rapidly on to my hand, elbow, shoulder and buttock. The sideways movement and the number of areas I hit meant the force was dissipated and I did not hit one area too hard. This was fortunate but not planned. I got away without fracturing anything or suffering from any of the many injuries which thousands of people have suffered over the Christmas period in the UK as the weather decided to provide a dangerous mix of rain and freezing temperatures.

As the populations of many countries continue to age quickly the matter of falls increases in importance and not just in icy weather. The skill of maintaining our balance is taken for granted by us since we first learned to walk securely in childhood but the ability depends on complicated skills and functions which commonly, as in many other areas, deteriorate with age. Falls are a large and increasing problem in elderly people, with the increasing cost of surgical and medical care and the threat of loss of independence a continuing concern. The clinical workload and expense of falls related injury is felt in many worldwide medical systems.

We need a variety of both physical and mental skills to manage to maintain our physical state of equilibrium when conditions become challenging. As we age our limb muscles gradually lose their strength and we use less and less of our potential joint movements as we walk. Older people gradually adopt a more restricted gait as they increase the number of shorter steps and decrease the amount of joint movement they employ in each gait cycle. If keeping balance suddenly needs a much bigger joint movement this may not be possible any longer or they may not be able to perform the movement in time to complete the required task.

Proprioception or joint position sense is a vital ability which continually informs our brains about where the limb and trunk segments are and if they are moving at what speed and in which direction. This unrecognised ability is vital in our holding postures and moving about accurately. Loss of proprioceptive input or more generalised feeling from the whole or part of a limb prevents the brain obtaining crucial information about where the limb is, making it unable to successfully plan moving it somewhere else. The loss of joint position sense or of sensation is of greater importance to function than muscle weakness as gait is possible with weakness as long as position sense is good.

There are several central nervous system capabilities which impact strongly on the ability to keep balance during movement, including the balance organs, vision, mental abilities such as logical thought and awareness and vision. The ability to see well makes us aware of the alterations in the surfaces we face and allows a judgment about which way to move and then to monitor the movement for effectiveness in achieving what we desire. Our balance is greatly worsened by closing our eyes and if we have poor vision and loss of some position sense then this may allow us to be vulnerable to falls.

The coordination and balance systems of the brain must work well if were are to cope effectively with balance, with our eyes contributing as well as the balance organs of the ears. If the ear balance organs are reduced in effectiveness they may be less accurate or engender feelings of dizziness when turning the head and this can make loss of balance more likely to occur. Our neurological abilities reduce in effectiveness as we age and this can impact the coordination systems of the cerebellar area of the brain.

Awareness of what is around us in our environment is vital in permitting us to make the quick and correct decisions to keep our balance. Being alert to what is going on means we can make early plans for managing the presenting circumstances such as other people’s actions, sudden obstacles and wet or slippery surfaces. Maintaining our minds in a mentally active and alert state allows integration of complex information and the formulation of plans to keep our balance.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapist Leeds visit his website.