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Published on October 31, 2012

Are you at risk for a fall?

By Michael Donner, MPT
Avera Sacred Heart Hospital Physical Therapy

October is National Physical Therapy Month. One of the common areas physical therapists work with is decreased balance and falls. Today we will discuss and provide some information regarding physical therapy and the prevention of falls.

A fall may lead to a hospitalization or ER visit for stitches, or worse yet, a fracture.  It can change your life forever like any accident or injury. For example, if you fall and break a hip, you may need surgery and hospitalization until you are strong enough to return home.  Some patients need a swing bed, or nursing home care for more assistance to get stronger in order to return home. Worse yet, some patients require additional assistance and are unable to return home from the nursing facility.  The question we should ask ourselves is, “Is there anything we can do to decrease our chance of falling?” The answer is YES!

Some of the risk factors (1) for falls include:

  • Muscle Weakness 
  • Arthritis
  • History of Falls 
  • Impaired ADLS’s 
  • Gait Deficit 
  • Depression 
  • Balance Deficit
  • Cognitive Impairment
  • Use of assistive devise
  • Age > 80 years
  •  Visual Deficits
  • Medications
  • Neurologic Deficits
  • Cardiovascular Deficits

Physical therapists look at what may be affecting your balance through a thorough evaluation and history. We look at any muscle weaknesses you may have or compensation techniques utilized by the patient while walking. This can show a lot. We also may assess if the patient is on more than four medications, or if the patient is having any blood pressure issues that may be contributing to his or her balance issues. Finally, another common topic that needs to be assessed is vision, which we will discuss next.

In regards to balance, we have three different areas that contribute to our balance.  If any of the three areas are not functioning correctly it can make balance worse. The three areas include the vestibular system, proprioception, and vision. As patients get older, many patients tend to rely more on their vision to assist with balance. The problem is we all know what often happens with our vision as we age. Yes, it gets worse. So that means as we age, we are relying more and more on vision to help with balance, even though our vision is often times getting worse.

Many of the patients I see for balance issues have already experienced a fall. Some were fortunate enough to have only bruised muscles or their ego, while others suffered a fracture.  Many people notice early on that their balance is getting worse. People often figure out if they don’t walk as much or leave their home as much, they are less likely to fall.  This sounds like a great fix for safety, but it isn’t a long term fix.  This person will not only miss out on valuable socialization in the community with others, they will also start to get weaker from a decrease in their activity.  This quick fix initiated by the person will eventually increase his or her chance of falls due to the decrease strength and endurance with walking that developed as a result of the decrease activity level.

This leads to the next question, “What can physical therapy do for you?”  Physical therapy can be a valuable source of information and insight to assist patients with balance problems to get back to walking in their home and in the community.  This is completed by increasing their strength and balance, but more importantly by assisting them in regaining their confidence in themselves in regards to their balance.  Physical therapy will utilize strengthening principles, balance exercises, education in proper walking technique, stretching and activity modification if needed.

 If you feel your balance is getting worse or don’t feel as confident going out of your home due to a fear of falling, visit with your physician and discuss if physical therapy may benefit you.  The physical therapists here at Avera Sacred Heart Hospital would be happy to assist you in getting back to the activities you enjoy.   

(1)  American Geriatric Society, British Geriatrics Society, and American Academy of Orthopedic Surgeons.  Guideline for the Prevention of Falls in Older Persons.  J Am Geriatr Soc.  2001;49:664-672.