Let’s Prevent Falls This Winter!
From Your Friends at Parkway Physiotherapy

Accidental falls pose a huge health risk to all people and these injuries are often some of the worst we see in the clinic over any given year. Not surprisingly, older adults are the most at risk for falls and the consequence of a fall in an older adult can be very debilitating, life-changing and even fatal.

We decided to write this piece on falls prevention due to the winter season being upon us and because the frost and ice can make for slippery conditions that can take down even the most athletic and agile of individuals.

When it comes to falls either outside or inside the home,  this paper will outline 4 primary places where risks may be identified and where answers might be obtained:

1. Risk factors that your family doctor will help with

Frailty:  As we get older it is natural to lose muscle mass and this of course leads to less strength and balance. Less strength and balance leads to increased risk of falls and we will speak to this specifically a bit later in this article. This is an important area where we collaborate with our physicians to ensure that patients have a plan in place to combat frailty and the many negative impacts it can have on human health, including of course an increased risk of falls.

Decreased Sensation: If we cannot feel where our feet are and the type of terrain we’re walking on, then fall risk will increase significantly. Some of you may have heard of the term neuropathy and this is primarily what we’re speaking to here. This is another area where physiotherapy and other health professionals can work with you and your doctor to ensure that we are doing everything we can to ensure the nerves to your legs and feet are working as well as possible. There are conditions such as diabetes where sensation is often affected in the feet yet even here there are both exercise and medication based interventions that we can take on in order to keep the sensation to your lower body intact.

Polypharmacy:  Medications are well known to increase the risk of falls and in some people there are multiple medications prescribed which can lead to drug-drug interactions. Sometimes we see patients who have been prescribed multiple medications from multiple doctors and specialists. Please ensure your family doc and pharmacist are aware of all your medications so that they can consider the interactions and global effects on your body.

Vitamin D Deficiency: Vitamin D status relates directly to both bone density and also to muscle strength. Since we make vitamin D based on sunshine exposure, all of us who live away from the equator have increased risks of this type of deficiency. Your doctor or naturopath can help you to understand whether you might be at risk for this type of vitamin need.

Co-Morbidities: These are health conditions such as arthritis and blood pressure regulation (both high and low blood pressure) that can pose increased risks for falls. Arthritis as an example can lead to weakness around specific joints as well as decreased range of motion and reaction time all of which can lead to a slip or fall.

In a different example a person might experience a drop in blood pressure when changing postures and this can lead to becoming lightheaded or dizzy which in turn can lead to a fall. Once again, these risk factors are often addressed in conjunction with your doctor and your Parkway team. Strength and balance exercises will be addressed below but cardiovascular training is also an important goal for some patients, and we can help you safely achieve these goals as well.

2. Risk factors that your optometrist or ophthalmologist will help with:

Impaired visual function such as decreased acuity, decreased depth perception, and contrast sensitivity have all been associated with increased risk of falls

Recent studies have also demonstrated that falls can be reduced following cataract surgery as a visual intervention. Your optometrist will be aware of these associations and through appropriate treatment, referral and/or education, they can play a major role in fall prevention.

A study is also being completed right now to look at a combination of home based strength and conditioning exercises with people with visual impairments and hopefully this will provide some great processes to help a particularly vulnerable group of people.

Here’s a quote from Dr. Nicole Hewitt, a Doctor of Ophthalmology at Sooke Eyecare

“Several eye conditions and diseases, such as cataracts and diabetic retinopathy, can cause visual impairments that can lead to an increased fall risk. Your optometrist can diagnose and, through appropriate treatment, referral and/or education, can play a major role in fall prevention.

Visual correction plays a major role in falls and fall prevention. Multifocal lenses, while quite convenient, have been shown to increase the risk of falls.  Some people, like those with vertigo, should not be wearing a multifocal lens. To ensure that you or a loved one is in the safest and most effective pair of glasses, it is important to discuss your ophthalmic lens choice with an eye care professional.”

3. Risk factors that your Parkway therapist will help with

There is a huge body of evidence that relates an increased risk of falls with poor balance and with poor lower body strength. Since we are a community of physiotherapists, chiropractors, kinesiologists, athletic therapists and massage therapists, it makes sense that we are especially concerned with this type of approach to fall and injury prevention.

For this reason, the best fall prevention program will combine strength and balance exercises together. At Parkway Physiotherapy and Performance Centre we use a program that came to be called our Pillar Training series.

This series of exercises has been used for elite athletes, for post-operative care, and for balance and strength training for a wide variety of individuals. These pictures are to help illustrate the basics of the Pillar Training series but you will probably want to check in with your Parkway team to get the right resistance of band, to ensure that your exercise form and alignment are good, and to ensure that your starting point is right for you.

The exercises are typically started as isometric exercises which means you try to hold still in the posture shown for up to 30 seconds. Balance assist may be used but the ideal progression has each of us trying to perform this pillar exercise without any balance assist. The initial goal for most people is to go twice through the entire series where each leg acts as both the standing leg and the moving leg. The theraband you use for this series should be anchored to something solid such as a sofa leg. Hopefully the pictures will help make the exercise series clear.

Pillar 1 – Hip Flexion

Pillar 2 – Hip Adduction

Pillar 3 – Hip Extension

Pillar 4 – Hip Abduction

4. Risk factors to consider around your home

These 4 factors can contribute to a fall inside our own home. Once again, a fall can lead to a hip fracture and a host of other injuries that can diminish our quality of life and our independence. Each of the factors noted here can be addressed by observing and making changes where appropriate.

  1. Slippery floors or rugs
  2. Poor lighting
  3. Unstable furniture
  4. Blocked walkways

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