A fall has the potential to be a serious health setback, posing the threat of injury or even fatality – especially when we consider the aging population. With that being said, falls need not be a normal, “inevitable” part of aging! There are many fall prevention initiatives that work to improve balance and balance confidence thus reducing fall risk. A bit of awareness, exercise, and education could truly make all the difference.
National Public Radio (NPR) released an interview series this past month with Dr. Elizabeth Eckstrom -- professor and chief of geriatrics at Oregon Health & Science University. Link below:
The article discusses fall risk and the importance of integrating fall prevention initiatives for older adults into our health system as a rule. As a clinic dedicated to treating balance, we are experts on identifying fall risk and implementing balance-specific, fall prevention exercise plans -- so let’s unpack Dr. Eckstrom’s insight together!
How does balance work? What are our bodies doing to keep us balanced?
Our ability to balance is integrated so fundamentally into our lifestyles that we often don’t realize the amount of coordination and work that the highly complex systems in our bodies produce in order to keep us stable, upright, and involuntarily aware of our surroundings. Balance is truly more than meets the eye.
At first glance, we tend to look at the body the same way we do a car - surface level, from the exterior. The wheels turn, the engine roars, the brakes make for stop and the pedal makes for go; but internally there are a multitude of intertwined systems that allow the operation to run smoothly! Sometimes, we need to remind ourselves to think about our bodies in that same way. We have a whole network of balance-specific systems that keep us on track. Understanding how these systems work can be a stepping stone in helping us all to improve.
There are a few dozen factors that contribute to overall balance success (some are listed below -- see "risk factors"); however, there are three balance systems in the body that are primary players when it comes to balance. Here they are, the "BIG 3:"
The Somatosensory System - A part of the sensory nervous system that is responsible for the communication between the brain and the body. Information from your skin, joints, feet is sent to the brain to detect your body position.
The Visual System - Sight! Vision plays a huge role in our ability to balance. With sight we can better detect our surroundings and orient ourselves in space.
The Vestibular System - Also known as “the inner ear.” This system coordinates movement and balance. It works hard to keep us balanced while we are mobile. More information about the vestibular system can be found here: https://www.mainestrongbalancecenter.com/single-post/2018/07/14/The-Inner-Ear-Anatomy-of-the-Vestibular-System.
So why is it that older adults are more prone to having a fall?
These BIG 3 balance systems are all subject to the hands of time -- meaning that with age, we will all experience a series of changes to each of these systems to one degree or another. These changes can cause some functional restrictions and thus balance challenges.
In addition to the changes that impact the body's balance systems over time, there are a number of other factors that may predispose an individual for having a fall. These are called “risk factors," listed below:
Having had a previous fall
Requiring help with activities of daily living
Difficulty walking without support (using a device or using hands on surrounding surfaces like walls and furniture)
Difficulty maintaining balance while standing still or when walking
Medication use (the NPR article elaborates on this)
Pins & needles, numbness, or tingling in hands and/or feet
Urinary incontinence (having to rush to the restroom)
Identifying these risk factors can be the very first step when it comes to fall prevention. Awareness of risk factors can help to avoid a fall. Education regarding the BIG 3 balance systems can make us better suited to strengthen and protect these systems.
How can we work towards preventing falls in the older population?
One of the most poignant statements that Eckstrom makes during the interview is about specificity, “In order to really reduce your risk for falls, you've got to do something specific to balance.”
Engaging regularly in a form of exercise like walking is hugely valuable from a cardiovascular health, brain health, mental health, and more standpoint; however, it is not balance specific. This means that walking, although host to an abundance of health-related benefits, doesn’t directly improve the body’s balance systems in the same way that a targeted balance exercise program will. Imagine a tennis player who is looking to perfect her swing. If she went for a jog everyday it should certainly enhance her cardiovascular health and maybe provide some changes muscularly to her anatomy; however, her tennis swing would likely not improve much without directly addressing it through strategy and agility drills specific to training her swing. Ultimately, the best way to improve balance is to utilize an exercise program that works directly to strengthen muscle groups designated for balance and train those systems in the body that are balance-oriented.
Eckstrom also indicates that an issue with balance is often and likely due to a number of overlapping factors. We agree! Remember that your body is a unit of intertwined systems. Be it vision, medication use, or finding an assistive walking device that suits your needs -- "It's really important to tend to all of those little details to really get your fall risk as low as possible. I encourage people to just work on that really, really hard. It's worth the trouble."
And what are some balance-specific programs that will help to improve balance and prevent falls?
Tai Chi is a program that has gained increasingly more recognition as a balance improving exercise program especially as of late. Eckstrom alludes to the function of Tai Chi to “increase the size of [our] postural stability.” This, along with components of mindfulness and inward attention, has made Tai Chi highly successful among the older population as an engaging and powerful exercise tool. One of our community colleagues, The Southern Maine Agency on Aging, offers a number of Tai Chi classes in the Southern Maine Region. They are a wonderful organization and we think very highly of them!
Aside from Tai Chi, there are numerous other programs targeted towards improving balance. Here, at the Balance Center, we employ a variety of physical therapy driven exercises into our practice. Our practice challenges and addresses directly the BIG 3 systems described above. We call this targeted balance exercise of which we know has the potential to improve balance by 25-40%! We also prioritize strengthening and conditioning because any area of weakness in the body is correlated with being 2.5x more likely to have a fall. We offer classes to the public as well as one-on-one therapy sessions at our clinic. Feel free to contact us if you are curious about any further details or need some guidance getting started with a balance program of your own.
Check out the NPR article for more information about fall prevention (link above). And as always... Stay balanced!