But what about Frequency and Severity?
On a glorious autumn day with colors bright and 75 degree temperatures, I forsook the temptation to bask in the sun and attend a community lecture. I wasn’t alone. While held mid-day and with outside conditions as I descripted, the theater was packed, with only a handful of vacant spots when a friend and I walked down the aisle to find our seats. The audience was mostly gray-haired, which might not be surprising for a weekday afternoon. But it wasn’t just the timing that found all these seniors in their seats; it was the subject – SLIPS and FALLS.
When I was in high school I was quite athletic, but took many stumbles and falls. Some were during activities, but many more were on ice-covered sidewalks heading for the 5:30 pm late bus (a dark time during New York winters). My instant recovery was always spectacular. But that was then, this is now. We all know what the first severe fall and possible hip fracture can mean as we age: the rapid decline that can escalate almost beyond reason. I believe my Neuro-Muscular-Skeletal training has taught me solid basics, but I am not too proud to learn wherever I can. So off I trotted, giving up the lovely autumn day, to discover any new tips on avoiding falls.
The speaker started with a mini lecture, condensed to:
Falls.
They are Bad.
Avoid them.
That of course brought a laugh or two. Not unexpectedly, he had more to say. I have attended considerable academic continuing education about balance and have written on it previously, so it won’t shock anyone that I was interested in this. Admittedly, I have found other courses a bit clearer and more helpful in practical advice for patients; nevertheless, there were good ‘takeaways’ here. The information was recent, well documented and covered the most vital (and some of the more obscure) issues related to slips and falls.
The emphasized theme was strength. The lecture didn’t cover origins involving situations like medication reactions, low blood pressure or severe vision problems. These are always conditions to rule out, but more often than not the precipitating factor for a fall lies elsewhere. For this post we are sticking to weaknesses common with aging. You can’t have balance without strength and you can’t avoid falls without strength and balance. Based on the speaker’s point that strength is the more dominant issue, I am adjusting the graphic below (similar to the one which he used). Without strength you can’t develop necessary confidence – meaning confidence in your movements, and not constantly fearing you might fall. Eliminating fear doesn’t mean you throw caution to the wind and heed nothing. We still need to watch where we walk and make sure we have sufficient light. Keep in mind that the side-effects of trepidation and hesitation can make matters more precarious. In this context, fear isn’t simply a psychological issue but can cause strange gait, muscle hesitancy and inhibition as well as poor biomechanics. Here is the idea in one picture:
These 3 factors equate to what the speaker summed up as the anatomy of a fall. The factors being: loss of strength (resulting from age-related muscle atrophy) reduced ROM (range of motion) and decreased confidence. Diminished ROM and lack of flexibility reduce strength. As the circle continues both of these problematic situations reduce confidence and in turn are reduced by the increased apprehension. And if either weakness or reduced range of motion causes pain, the cycle of fear is increased and the confidence diminished again. If this circle of words makes your head spin, I think the graphic circle gives you the general idea.
The lecturer, Andy Baxter is not just a dabbler in senior self-help. He is a Medical Exercise Specialist, world champion master rower and designer / evaluator of exercise equipment. He is the founder of Beyond 50 Fitness and Baxter Fitness Centers. He consults national firms on both the scientific and practical implications of gym equipment. While I can’t reference all his remarks, his disdain for certain equipment (like upright stair steppers) was clear.
The Technical Stuff
Truthfully, I may have enjoyed this lecture more than some listening as he expounded on gait kinematics, muscle firing, lateral extension and muscular power factors with arcane terminology not everyone is comfortable deciphering. His knowledge about strength training was obvious and he made an effort to explain his claims with studies and science. The audience mostly just wanted to know ‘how do I avoid falling’ or ‘why does it happen.’ I hope they got their answers. The imperative information was there (even if hidden a bit in the jargon).
Momentarily, I will get to the practical application, but on the technical side, here is a quotation on ‘Balance Dysfunction, Lateral Stability and Falls’ that he uses from the Department of Physical Therapy and Human Movement Sciences from Northwestern University:
“An impaired ability to control postural balance stability in the lateral plane of motion appears to be particularly relevant to the problem of falling among older people. Moreover, falls often involve lateral body motion, and hip fractures occur most frequently in association with lateral falls. “ [Emphasis mine.]
Baxter’s in-depth answer to solving this problem is a movement with the unique description of ‘closed-chain, non-concussive and compound (or bi-directional).’ However, for the information that I am sharing below you really don’t need to know this; the key point is weight lifting (but don’t think ‘he-man’). I promise to explain these terms about movement in English, but the reason Baxter points to it as the solution is that so many forms of lifting weight in our lives (especially as we age) are dangerous and risky. We need strength to lift weight even to get out of a chair, lift a grandkid or put the dishes away on a high shelf. These actions are known as the infamous ‘ADLs’ (Activities of Daily Living). We need to lift ‘things’ (translate that as ‘weight’) everyday. It’s best if we do it correctly.
So whether you are having a professional senior’s trainer evaluate your movements or are trying new stuff at the gym or home, these points can be helpful.
closed-chain – basically means the feet (or sometimes hands) are in full contact with the ground (or a machine in some cases);
non-concussive – smooth, not jerking or jarring movements;
compound (or bi-directional) – movements involving two or more joints and their muscles.
[Examples of these compound movements or activities include cycling, rowing, squats, high pulls etc. There are oodles of examples. Think of it like this, if you were rowing, whether in a row boat on the lake or on a gym machine, both the muscles of your shoulder and elbows are working together. So 2 joints (elbow and shoulder) comprise the compound movement.]
Even the word ‘lateral’ may need a translation if it is not in the working vocabulary of your profession or your life. Here it simply means to the side (away from the midline of the body).
Adding to some of these directions about body movement is the point that muscles should support the skeleton, not the other way around. Adding weight to the end of our arms or legs is working the skeleton, and can irritate the joints. Yet we see this all the time, even from supervised gyms.
In the end, Baxter’s advice is honest and blunt, you avoid falls in an aging body by keeping the body strong and with good range of motion. It is “preserving FUNCTIONAL strength” that is crucial.
My Takeaway
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That brings me back to everyday applications. What was my takeaway, personally? And what would I share with you aside from that above?
Here are my 3 practical picks.
1. No grapevine(ing). If you find yourself starting to sway and on your way to falling over, according to Baxter you should shuffle your feet side-to-side, never ‘grapevine’ (my word, not his). Grapevine(ing) is from the old dance move – remember that? It means crossing our feet and legs, one foot behind the other. Most of us are rarely (in my opinion) ever going to have the time to make such a decision when falling; nevertheless, there is it. If you shuffle you have a chance at ‘righting’ yourself – in regard to your balance. The only problem with this
suggestion (which the speaker may not have had ample time to explore) is that when you are starting to sway to the right for example, you have no weight on the left leg. To accomplish a shuffle you need weight on both legs. The best way to undertake that movement is to think of ‘collapsing’ your weight down so the knees are slightly bent and you are able to get weight onto that left leg, and then shuffle. This is subtle and needs to be instantaneous, and perhaps the speaker would have had another solution to the technique of incorporating the air-bound leg.
Still, if you cross your feet in any way, stepping in front or behind, you are probably doomed to fall. It is rather like the old thought of ‘don’t trip over your own two feet.’
2. Those 2 beloved favorites won’t do it – but a less-loved one might. Surprising (or annoying) to many in the audience was his proclamation that neither walking nor swimming improve functional strength. Clearly, he thinks walking and swimming have many advantages both aerobically and mentally, but his point was that seniors are not going to actually improve their functional strength by either of these activities. They may ‘maintain’ their ability, but won’t ‘improve’ their lifting strength. I totally agree with him, and also find him a brave man to make this statement in a room full of silver haired golden-aged activity buffs. Those weren’t his only complaints. He also dislikes quite a few exercise machines, including some gym equipment he has evaluated as poorly designed and risky apparatus.
Most pleasing to me was that he DID advocate – as I often do – for the lowly 
squat. The much maligned and ill-appreciated home exercise (done correctly) is a superb gold-standard to help in later years with many of our daily living activities. Getting out of an armchair is just one example. My advice on form may be a bit simpler than his, but is basically the same: when squatting, keep your knees behind your toes.
—
3. Lateral Strength Exercise. Now this made my afternoon indoors worthwhile. It is a practical and helpful exercise which is not time consuming. I have seen it before, you may have too, but the context here is important, and elevated it in my personal tool box. Physical Therapists and others who deal with back pain, like Chiropractors or Osteopaths, will see that this is similar to a McKenzie exercise, a well-known standard. There is a slight difference here.
Specifically important to our standing balance is how far apart we can spread out our legs (this is a lateral movement – to the side) and how far we can do it with good power behind our muscles. Unsuspected by most people, when we walk it is the muscle in the opposite hip from motion that is stimulated to maintain our controlled movement. These muscles are the ones that are the source of our lateral (wide) stance and the power or strength we have to preform that action. As we age, we sometimes lose our confidence in both our range of motion (ROM) and our strength, especially of hip/leg/back muscles. When you see an older person shuffling along, who is otherwise healthy, it is often due to the relationship of strength – ROM – and Confidence as seen in our earlier graphic. That being said, to improve our own ability, (or maintain what we have if it is already fairly good), Baxter offered a specifically related exercise. Plus it is a great thing to do while watching TV, doing the ‘cool hang,’ or just walking from one room to another.
Lateral Strength Exercise 
1.) Stand next to wall or centered within a doorway and lean on the jam with your shoulder.
2.) Move your feet out sideways as far as you feel comfortable, feet together (not crossed), legs straight.
3.) Push upper hip out (may seem slightly up) away from wall or jam. Hold it.
4.) Bring that hip (currently sticking out) back and then closer to wall or door jam. Repeat several times.
5.) When feeling solid, with feet in the same position and your hips straight, lift outer leg up and straight out to side. Hold briefly. Return and repeat several times.
6.) Reverse and preform on the other side.
A doorway often feels more secure than the wall, but make sure you pick a wide enough doorway to allow your best work. You should feel the effort of this movement in the hip closest to wall / door jam – opposite the leg being raised.
Quick, Easy, Anywhere, Anytime, at No Cost. I like all that.
Final Thought
To be clear, Baxter feels that ‘dead-weigh’ lifting is the best way to build strength for balance or any other reason, but admits that people tend to need help doing it correctly. I am pleased he added that final thought as I would augment it to say they would require ‘much help.’ There are ways to build strength other than dead-weight lifting that have much less risk due to poor performance. Admittedly, the results of other approaches aren’t as quick, yet they are often equally as helpful and practical. At least #2 and #3 above are terrific and an easy start.
So, the question was “Are Falls Inevitable as We Age?” Probably yes. But the chances, risks and effects can be so drastically reduced as to have little (instead of catastrophic) consequence. Increase our strength and flexible ROM (range of motion) and we will increase our confidence over this dreaded fear. As Baxter proposed:
Less Fear, Less Falls.
Brando doing a Lateral Strengthening Exercise?
Probably not.
