Falls cause 2/3rds of deaths due to unintentional injury in the elderly, which is the 5th leading cause of death of people over 65 years of age.
A fall by an elderly person can be defined as “a situation in which the older adult falls to the ground or is found lying on the ground” or “any unintended contact with a supporting surface, such as a chair, counter or wall”. (Shumway-Cook & Woollacott 2017)
We have your health in mind, and the prevention of such an adverse event, in our best interest and priority. We have decided to write a blog post to provide you with information to help minimise your risk of falling and increase your chances to lead a fit and healthy aging process.
The following list presents risk factors that are relevant to individual factors that increase the chance of falling:
History of falling
Walk with a limp
Poor balance (feel wobbly when walking)
Use of a walking aid (e.g. walking stick or frame)
Poor cognition (e.g. memory/ ability to problem solve)
Age greater than 80 years old
Are any of the symptoms listed above relevant to you?
It is difficult to attribute ageing as the sole reason for the development of the traits listed above, as older adults of the same age can demonstrate physical function ranging from physically elite to entirely dependent on others for all activities of daily living. However, there are some common trends of declining function to do with the neuromuscular system which occur in older adults, and although age may not be the main cause for these changes in the systems of postural control, it is likely, increasing age has a detrimental effect.
The aspects of the systems of postural control potentially detrimentally affected by age include:
Range of motion
Static balance (ability to remain stable when you are not moving)
Dynamic balance (ability to remain stable with movement)
Reactive balance control (ability to sequence movement, time muscle activation and adapt to changing tasks and environmental demands
Anticipatory balance control (the ability to stabilise the body before performing a movement)
Sensation (the ability to detect change in the external environment through vision, hearing, touch, ability to sense vibration, and proprioception, or the ability to sense where your body is in space)
It is also necessary to comment on the loss of bone density associated with increased age (>50 years old). A loss of bone density increases your risk of fracture when falling and is something everyone can and should actively work to minimise.
Our Physiotherapists are pleased to guide you and minimise your risk of falling. Therefore, we have developed a very simple home exercise program for all readers, using equipment all should have access to, to enable you to take action to reduce your risk of developing risk factors of falling and consequently your overall risk of falling, immediately!!:
Sit to stand (to increase muscle strength)
Sitting upright in a chair
Lean forward with hands on chair
Push through arms and heels keeping back straight
Squeeze your buttocks to stand as tall as possible
Repeat 15 squats
Perform 3 x daily
Thoracic extension (to increase range of motion)
Sitting on a chair which has a high back
Place a rolled towel horizontally behind your shoulder blades
Place both hands behind your neck and interlock your fingers
Touch elbows together
Bend backward to a comfortable position and hold for 30seconds
Perform 3 x daily
SLS (to increase static postural control)
Standing next to a stable object
Place one hand on the stable object
Lift one leg off of the floor to form a L-shape
If you are confident and safe, take your hand off of the chair
Hold for 30 seconds
Repeat on the opposite leg
Perform 3 x daily
SLS – Eyes closed (to enhance sensation especially proprioception)
As above, however once stable, close your eyes and hold for 30 seconds
Tandem stance (to increase static postural control)
Standing next to a stable object
Place one hand on the stable object
Place one foot directly in front of the other, so that your toes of the back foot are touching the heel of the front foot, forming in a straight line
If you are confident and safe, take your hand off of the chair
Hold for 30 seconds
Repeat with the opposite leg in front
Perform 3 x daily
Tandem walking (to increase dynamic postural control)
Continue to get into the position as above, however, continue walking – like you are walking on a tightrope! (We recommend alongside the kitchen bench for safety precautions)
30 minutes of walking daily (to increase bone density, dynamic postural control anticipatory balance and importantly cardiovascular fitness – or heart and lung health!!)
This program is very basic and does not cover all of the aspects of postural control. Please make an appointment with one of our physiotherapists to extend your exercise program, so that we can make it more tailored to your needs and more interesting. We will use modern, exciting equipment and more fun movements!!
Finally, the following listed items are external factors that also increase one’s likelihood of falling. They are known as secondary factors and are easily controlled:
Clutter in the home
Please take a moment to consider how you can minimise your risk of falling through controlling these listed items, for example placing non-slip mats in the shower, reducing clutter in frequently used walkways, having a bedside lamp to use when going to the bathroom in the middle of the night.
We hope you have found this blog helpful and please do call us for any questions or comments.
Chapter 9 Shumway-Cook, A & Woollacott MH 2017, ‘Aging and Postural Control’, in M Nobel (ed.)Motor Control: Translating Research into Clinical Practice, 5th edition, Wolters Kluwer, Philadelphia, pp. 206- 228.
Some reflections on concussion from the author below. We can help if you do have concussion.
A Carolina Panthers player left the Super Bowl and was found to have a concussion.
By David L. Katz
Fortunately for me and the others gathered at the Katz home, we enjoyed a fabulous, Cuisinicity.com meal for the Big Game. No surprise there; my wife is the culinary genius behind the site.
Thank goodness for the wonderful dinner, because the game itself was rather disappointing. There was, I trust my fellow spectators will agree, an unusual bumper crop of penalties, some egregiously bad calls by the referees, some truly strange mistakes by players and a disquieting bounty of poor sportsmanship into the bargain. Congratulations to the Broncos and Peyton just the same, but seriously, weird game.
Alas, it also featured an announcement all fans of the game should now know is a reason for a collective wince: concussion protocol. Corey Brown, of the Carolina Panthers, left the game after a head injury, underwent neurological evaluation and was found to have a concussion.
I trust everyone now knows the ominous implications of that kind of injury if repeated periodically over the course of a career. The media attention to Chronic Traumatic Encephalopathy, or CTE, is considerable and rising. The movie “Concussion,” starring Will Smith, raises the profile further. I highly recommend the movie if you haven’t seen it, by the way. It is very well done, and beautifully acted, and entertaining even as it educates.
I have no particular expertise in CTE beyond any doctor’s basic understanding of it, and others have said plenty already. If you are interested, as every football fan should be, and certainly as every parent of a child inclined to play football must be, the relevant information is readily available. I will take the opportunity to make a different point, about the cultural malleability of “normal,” and thus, “acceptable.”
While I have no claim to the football-fan hall of fame, I like the game as much as the next guy. I am wondering more and more, though, if my entertainment is worth the price the players are paying.
Football is part of our culture, and thus normal. We might thus think that if it has occasional consequences, those, too, are normal. That may make them seem acceptable. But that’s the real danger here: complacency. We can perhaps only see it looking across cultures, rather than from corner to corner within the box that is our own.
Consider, for instance, the Gladiatorial Games of Roman times. Those were, infamously, contests to the death, whether between people, or people and wild, half-starved animals. The only vague approximations of any such barbaric entertainment in the modern world are, so far as I know, bull fighting, and the generally illegal contests between fighting dogs or roosters. There is no longer any mainstream interest in watching bloody death for entertainment.
But that’s simply because sensibilities and culture have evolved. The Romans were people just like us. Their society, too, was made up of mothers and fathers, aunts and uncles. They, too, knew love and compassion. But they cheered while watching young men, literally, kill one another. In their culture, it was normal, and thus acceptable; but I trust we agree history has reached a different verdict.
I happen to be a fan of both the late Heath Ledger, and Paul Bettany, and was thus predisposed to love the movie “A Knight’s Tale.” I’m no movie critic – I can’t say whether or not it’s a great movie – I can only say I like it.
The movie is especially noteworthy for how it handles anachronism. More than once, it features period elements, like music, and then transitions them to the modern analog, such as a rousing rendition of “The Boys Are Back in Town” by Thin Lizzy. More memorable still is a scene at a dance. Heath Ledger’s character is dancing with his love interest in the stylized manner of medieval folk dance. The music then transitions to the late, great David Bowie – “Golden Years,” to be exact – and the dancing keeps pace, morphing into what one would expect, more or less, in any given club on any given Saturday.
The director, I think, was telling us something important: The old-fashioned music and dance of medieval times would not have felt old-fashioned then. It was, simply, the music and dance of its day. It was normal. Showing medieval folk dancing to a modern audience says: this was an old-fashioned party. The director substituted “current” music and dance to show us how it felt to the participants. It was current and normal then, and no matter how it feels to us now, that’s how it would have felt to them.
That’s relevant to football. We are not willing to entertain ourselves by watching young men bash one another’s heads in with maces, as the Romans did. But we do entertain ourselves as young men bash their helmeted heads into one another repeatedly over a span of years, with all-too-often calamitous consequences.
Our gridiron heroes are latter-day gladiators. And their house – the house of football – inspires almost religious devotion in our culture. But that may be only because it is part of our culture. Imagine if football did not yet exist, and we were thinking of introducing it, and knew about CTE from the start. Would we add such a game and such a liability to our cultural entertainments?
The one-time editor of the Journal of the American Medical Association, and later Medscape, Dr. George Lundberg, reflected along similar lines in the New York Times recently. He discusses cultural evolution over a much shorter period than the Middle Ages to now, noting a marked change in his personal – and our societal – enthusiasm for the brutalities of boxing. Both the sport and its following have changed dramatically in recent years, and he conjectures that football is in that same queue.
My principal mission here is to point out the inevitability of culturally induced blindness to the unacceptable elements of what is currently normal. We live in a time of epidemic obesity and its complications in our children, yet continue to market multicolored marshmallows to them as “part of a complete breakfast.” This is absurd, and history will judge us accordingly, but it’s normal now – and so we overlook the hypocrisy. Cultures around the world justify practices as heinous as female genital mutilation. What passes for “normal” is self-defining, and to some extent, self-perpetuating.
Until, that is, we evolve beyond it. Looking back, what was normal yesterday often proves repulsive and contemptible today.
We speak routinely about “thinking outside the box,” but when the box is culture, that is much easier said than done. Everything we know is inside the box, as are we. The contents of the box at any given time are normal.
History turns the years into a ladder. Out of the box we all climb, into a bigger box presumably, as we gain the perspective of altitude, and roll our eyes at the mess we’ve left behind.
I love watching football. The Romans presumably loved their gladiatorial games. Both are normal in context. That doesn’t guarantee that either is right.
For the sake of today’s players, and our sons inclined to take their places, I hope we reform the game of football sooner than later. It’s a great game, but not when paid for with brains scrambled, and lives cut short.
In general, we need to recognize how readily we follow the gospel of any given culture telling us what’s normal. We need to recognize that normal is simply what we do now, and that it isn’t necessarily right. Perhaps the true measure of cultural enlightenment is how ably we judge ourselves in real time as history is sure to do in the fullness of time.
“Tension headaches” are often talked about and we see a lot of patients with these headaches. In our diagnosis of these conditions, about eighty five percent of all headaches arise from the neck, or cervical spine, which refers pain into the head through the nerves which go to both areas. Neck problems cause head pain because some of the nerves which come from the spinal cord have branches which go to the upper neck joints and other branches which spread over the back of the head, with still others going to the front of the head. When one area is sore the brain interprets the pain as coming from all the areas the nerve branches go to.
CAUSES OF TENSION HEADACHES
Patients who have “Tension Headaches” or “stress headaches’’, are often very busy and have work related problems, a tough boss, urgent deadlines, problems with managing work flow and they often have trouble sleeping because of work problems and their worries. This causes the patient to be mentally and emotionally stressed and their relationships at work and with their families suffer.
They develop a headache which they cannot shake and they feel helpless, tired, tense, anxious and in pain. We have seen many cases where the headaches have continued for weeks and frequently kept recurring, sometimes over many years.
It is important to understand that a Tension Headache is due to “physical tension” in the tissues, often from a poor working position and the damage it has caused, not the other mental “tensions” listed above. Once full neck movement has been restored with treatment, the tissues have healed and the postural strains have been removed, patients often cope better with the other aspects of their lives. This is where Physiotherapy can help by breaking the vicious “Physical Tension” cycle. It is better to think of these as “structural headaches”.
Our neck is made of seven vertebrae stacked one above another. They support the head and they are joined together at the front by discs and at the back by facet joints. When we bend forward, the vertebra above tilts and slides forward, compressing the disc and stretching the facet joints which join the back of the vertebrae. When we bend backward, the disc compression is reduced at the front and the facet joints are compressed at the back. The junction of the first vertebra and the head does not have a disc and the joints there are particularly susceptible to leaning forward which causes the weight of the head to strain the joints, ligaments and muscles as gravity causes a shearing force as the head slides downward.
The neck muscles are often blamed as the cause of pain but this is rarely the whole story. Muscle pain often develops as the muscles contract to prevent further damage, as they protect the primary underlying structures. This pain is secondary to the underlying pathology and when the muscles are massaged, given acupuncture, etc, there is temporary relief but the pain will always comes back as the muscles resume their protective bracing. The most common sources of primary pain are the facet joints and their ligaments in the upper neck and the discs in the lower levels of the neck.
A facet joint strain is much like an ankle sprain, strained by excessive stretching or compressive forces. The joint ligaments, joint lining and even the joint surfaces can be damaged.
In the upper neck, facet joint strains typically occur during excessive bending or twisting movements and may follow trauma such as a car accident causing whiplash but generally, Tension Headaches occur with prolonged forces such as slouching, keying and reading.
There is often a previous history of pain coming and going as the damaged area became inflamed, was treated and settled for a while but as the underlying problem still remained, the pain flared up repeatedly every time it was strained. This type of injury, although often chronic, responds very well to specific Physiotherapy treatment.
There are many other sources of headaches and neck pain including arthritis, crush fractures and various disease processes. Your Physiotherapist will advise you should a more serious condition be suspected.
SYMPTOMS OF TENSION HEADACHES
Symptoms of “Tension Headaches” arising in the neck, are always affected by movement of the head and neck. This is important to understand. Symptoms are sometimes severe and may be sudden in onset but also may be mild and of gradual onset. There are other serious conditions which can produce headaches. If you have severe headache symptoms which are not affected by movement and a recent history of fever or nausea, you must consult a doctor urgently.
Facet joints, discs, muscles and other structures are affected by our neck positions and movements and when damaged, will respond very well to Physiotherapy treatment.
DIAGNOSIS OF TENSION HEADACHES
“Tension Headaches” often appear complex and require a full understanding of the history and a comprehensive physical examination. It is important for your Physiotherapist to establish a specific and accurate diagnosis to direct the choice of treatment. In some cases, the pain may arise from several tissues and these coexisting pathologies are treated individually as each is identified. Where the Physiotherapist requires further information or management may require injections or surgery, the appropriate x-rays, scans and a referral will be arranged.
TENSION HEADACHE RELIEF
Some of these cases will temporarily respond to a general non-specific treatment such as bed rest, ice and anti-inflammatories, however Musculoskeletal Physiotherapists have developed diagnostic skills and treatment techniques, targeted to stopping “Tension Headaches”. We will identify the reasons for the development of the pain and advise strategies to promote healing and to prevent further damage.
Specific techniques are chosen to correct the structural and mechanical problems. Among many choices, treatment may include joint mobilisation, stretching, ice, strengthening and education.
When normal function has been achieved, the inflammation and pain has settled and the structures have healed, using your new strategies will reduce the possibility of the headaches ever recurring. We use this approach to reduce or stop chronic pain. While we have the choice to manipulate or “click” joints, those with ongoing pain will seldom benefit from repeated “adjustment”. This is because our tissues are elastic and the benefit of the quick stretch of manipulation is lost as the tissues tighten up again. Potentially dangerous “adjustments” of this type have little long term benefit and can lead to an unhealthy dependence on the provider. Your Physiotherapist will choose a safe and appropriate treatment for you.
PROGNOSIS OF TENSION HEADACHES
Physiotherapy for “Tension Headaches” can provide outstanding results but it is a process, not magic. The damage which produces “Tension Headaches” takes time to develop and time to repair and heal. You will understand there are often several interacting factors to deal with and your compliance is necessary.
Okay. So you’ve decided to embark on a fitness regime in order to shed some kilo’s, get fit or just for fun. New gym membership. Check. New sparkling runners. Check. Gym gear (a bit tight at the moment). Check. Alright, let me at that treadmill/rower/crosstrainer/zumba class!
“Hold on a second – what about your warm-up!”
“Warm-up” you scoff, “you’ve got to be kidding. No time to waste on that”.
Sorry folks, but the warm-up is an important part of your exercise routine and plays a crucial role in preparing your body for exercise. Skimp on the warm-up and you run the risk of injury during exercise or sport, as well as reduced performance levels.
“But what’s so important about doing a few stretches?” I hear you ask.
A proper warm-up involves more than just standing around stretching and talking. It prepares your body for the exercise/sport it is about to undertake and should simulate the actions involved.
The benefits of a warm-up are:
1) Increase in core body temperature
2) Preparation of muscles, tendons and joints for the stresses/strains of activity
3) Increase in nerve impulse conduction to muscles
4) Increase in blood flow to muscles
5) Increase in respiratory (breathing) rate
Let’s have a closer look at each of these benefits.
1. Increased core body temperature – this is important as it prepares the body for the change in activity level from being sedentary to exercising and gets the body into a ‘ready’ state. This also results in an increase in muscle temperature which makes them more pliable, supple and loose.
2. Prepares muscles, tendons and joints for activity – each sporting activity stresses the body in different ways so it is vital to prepare in a way that simulates these activities. For example, if you are a basketballer you need to include in your warm-up the jumping, running and change of direction that occurs during the game. If you pump weights at the gym, it is vital to perform a warm-up set of each exercise at a lower weight to allow your body to adjust to each specific movement.
3. Increased nerve conduction – muscles that are in a ready or aroused state react quicker and more efficiently than muscles that aren’t prepared for activity.
4. Increased blood flow to muscles – through increased blood flow there is an increase in oxygen flow to muscles as well as nutrient flow. This increased flow allows for improved performance
5. Increased respiratory rate – prepares the lungs for an increase in activity level and improves oxygenation of the blood flowing to the muscles.
Okay, so now that we know why we are performing a warm-up, what should it involve?
One common misconception out there these days is the importance of stretching as part of a warm-up. Note I said part of a warm-up.
Stretching on its own does not constitute a warm-up – rather it forms a critical part of one.
An effective warm-up has a number of very important key elements, which work together to minimize the likelihood of sports injury and prepare the individual for physical activity.
These key elements are:
1) The general warm-up
2) Static stretching
3) Sport specific warm-up
4) Dynamic stretching
1. The general warm-up
This consists of light physical activity such as walking, jogging, easy swimming, stationary bike, skipping or easy aerobics. The intensity and duration of the general warm-up is dictated by the fitness level of the participating athlete. For the average person, this part of the warm-up should last between 5 and 10 minutes and result in a light sweat.
2. Static stretching
Yes! Static stretching. This is a very safe and effective form of basic stretching. There is a limited threat of injury and is beneficial for overall flexibility. All the major muscle groups should be included for a period of 5 to 10 minutes.
Debate has raged about whether static stretching should be part of a warm-up and some studies have shown that static stretching can have an adverse effect on muscle contraction speed and therefore performance. It is for this reason that static stretching is performed early in the warm-up and always followed by sports specific drills and dynamic stretching. It is important these first two elements are completed properly as it allows the more vigorous and specific activities of elements three and four to then be performed.
3. Sport specific warm-up
In this part, you are specifically preparing the body for the demands of your particular sport or activity. During this part of the warm-up, more vigorous activities should be employed. Activities should reflect the type of movements and actions which will be required during the activity.
4. Dynamic stretching
Finally the warm-up should finish with a series of dynamic stretches. Caution should be taken with this form of stretching as it involves controlled, soft bouncing or swinging motions to take a particular body part past it’s normal range of motion. The force or the bounce of the swing is gradually increased but should never become radical or uncontrolled. These exercises should also be specific to the sport or activity.
Another important factor to keep in mind when undertaking any new exercise regime, is the time it takes for the body to adapt to training. If you have had a period of time away from sport or activity, then your body won’t be used to the stresses and strains put on it from exercise. It can take up to 4 to 6 weeks for your muscles, tendons and joints to become adjusted to the movements involved in your sport or activity.
During this period it is advisable to start with low to moderate intensity exercise which gradually builds over time. Heading straight up the red or blue arrow as your first exercise session in 3 or 4 months isn’t a great idea. Starting out with flat walks or jogging and gradually increasing time and intensity is a better way to start. After 4 to 6 weeks you will be at the stage where you can tackle more intense sessions.
The same goes for weight training. Starting with lighter weights and more repetitions will allow your tendons and joints in particular, to adapt to lifting load. Going too heavy too soon can lead to tendon injuries or severe muscle and joint soreness.