Rehabilitation guide
Each year, about one in three people over 65 has a fall. Falls can lead to fractures, a fear of moving and a loss of independence. The good news: regular balance and strengthening exercises reduce falls markedly.
A fall often has more than one cause; the likelihood rises when several risk factors come together. That is why assessing fall risk needs a broad view, from muscle strength to medication and from eyesight to the home environment.
Having fallen before is one of the strongest signs that you may fall again. Even a single fall is reason enough for an assessment.
In a Cochrane review of studies in older people living in the community, exercise reduced the number of falls by 23% and the number of people who fell by 15%. Exercises that train balance and everyday movements reduced the number of falls by 24%, and programmes combining these with strengthening exercises reduced it by 34%. Tai Chi can also reduce falls.
Fear of falling pushes people towards inactivity; inactivity weakens the muscles and raises the risk of falling even further. The way to break this vicious circle is to get moving gradually, in a safe setting. If you are curious about your leg strength and balance, take a look at the 2-minute quick test on the home page.
Exercises at home
Do all the standing exercises in front of something sturdy to hold on to, such as the kitchen counter; if possible, have someone with you at first. Stop if you feel dizzy or have chest pain or shortness of breath. As the exercises get easier, make them harder by relying less on the support.
Stand upright in front of the kitchen counter, holding on lightly with one or both hands. Lift one foot off the floor by bending the knee back, and keep your balance. As it gets easier, hold on with one hand, then with just your fingertips.
10–15 seconds, 3–5 times on each footWalk along the counter or a wall, keeping one hand ready to steady yourself. With each step, place the heel of your front foot just in front of the toes of your back foot, and keep your eyes looking ahead. Follow a straight line, as if walking a tightrope.
10–15 steps, 2–3 roundsHold on to the counter, facing it. Step sideways along the counter in one direction, then back the other way; keep your toes pointing forwards and do not let your feet knock together. This strengthens the muscles at the side of the hip.
10 steps to the right, 10 steps to the left, 2 roundsSitting on a sturdy chair with armrests, shuffle your hips forward and bring your feet back a little. Lean forward and stand up, straighten up fully, then sit back down with control. If it is hard, push up with your hands; as it gets easier, cross your arms over your chest.
10 reps, 1–2 times a dayStand upright holding on to the counter. Lift both heels together to rise onto your toes, hold for 2 seconds, then lower slowly. Your calf muscles are important for pushing off the floor as you walk and for regaining your balance.
10–15 repsHold on to the counter with both hands, with your feet shoulder-width apart. Slowly shift your weight onto one leg, then onto the other, keeping your body upright. As it gets easier, shift your weight forwards and backwards too.
10 reps in each directionA large share of falls happen at home. Small changes make a big difference.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
A balance workout you can do safely at home.
A safe, step-by-step way to get up from the floor.
First, stay calm and check whether anything hurts. If you are not injured, roll onto your side, slowly get onto your hands and knees, and crawl towards a sturdy chair or the stairs. Holding on to it, put one foot flat on the floor, push with your arms and legs, and slowly stand up or sit down; then rest. If you are injured or cannot get up, call for help, cover yourself to keep warm and move your legs gently until help arrives.
No. Inactivity weakens the muscles and upsets your balance, which increases the risk of falling. Moving gradually, with support and in a safe setting, helps you regain both strength and confidence.
In effective programmes, balance and strengthening exercises are done several times a week, regularly for months, and made gradually more challenging. Short-term or irregular exercise has only a limited effect.
Walking aids improve safety when they are chosen and adjusted correctly. A stick set at the wrong height or unsuited to your needs, however, can upset your balance. Decide with your physiotherapist which aid is right for you.
Yes. Tell your doctor that you have fallen, even if you were not hurt. Many of the underlying causes of falls, such as side effects of medication, drops in blood pressure or eyesight problems, can be treated or corrected.
After a fall, see a doctor without delay if you have any of the following:
Sources
İhsan Eren