Falls. A perfectly preventable problem.
Key Takeaways
Falls are a significant cause of unintentional injuries and death, especially among people over the age of 65.
Falls are typically caused by poor eccentric contraction strength.
Eccentric contractions are crucial for controlling the body during physical activities such as lowering your body down from a curb or step.
Human anatomy can adapt and most people can pass physical tests of eccentric contraction strength at any age through disciplined exercise.
A well-designed exercise routine will define the proper frequency, intensity, and type of activities that can improve eccentric contraction strength and neuromuscular control.
Falls are preventable problems by adhering to an exercise routine that is the best way to reduce the risk of falls.
Note: These key takeaways summarize how skilled physical therapists can help most people develop and maintain healthy muscles to prevent falls. For more information about how to reduce the risk of falling, check out the recommended blog content.
In 2020, 42,116 people died from a fall; the incidence rose to 44,686 in 2021. For people over the age of 65, falling is the second leading cause of unintentional injuries leading to death. After one fall, there is an 80% chance that another fall will be experienced within 12 months. Falls usually occur when a leg muscle cannot sustain the contraction necessary to control the body and maintain equilibrium. Therefore, the answer to understanding why people fall and how to prevent them is found in the interaction between the musculoskeletal (bones & muscles) and neurological systems (brain & nerves).
Here are simplified, but essential, concepts of these physical systems: bones make up the joints that muscles move; muscles only pull, never push; muscles are the gas and the brakes to movement; skeletal muscles can perform three types of contractions; nerves are the batteries to power muscles; and, the brain controls everything - consciously and unconsciously. So, why are more than forty-four thousand people dying every year from a fall? The answer is (usually) poor eccentric contraction strength.
The three types of skeletal muscle contractions are concentric, eccentric, and isometric. A concentric contraction shortens the length of tissue (the gas); eccentric contraction elongates tissue as the muscle contracts (the breaks), and an isometric contraction does not change in length of muscle tissue (revving the engine). Most falls occur when the breaks (eccentric contractions) cannot stop a person from crashing to the ground. In medical jargon, this is known as a fall risk due to a lack of neuromuscular control and decreased eccentric strength.
Lowering the body down on a curb, step, or any elevated surface requires eccentric strength to control the body. That controlled force is much greater on the muscles than lifting up. Hence, falls usually happen while stepping down a curb rather than stepping up. When the body’s breaks are worn out, a potential fall is significantly more likely to occur. A fall down the stairs is much more common than up the stairs. That is, of course, unless you are a part of my family, which has an unusual tendency to trip going up the steps - in household jargon, we call that “a total klutz”.
For a variety of reasons, many people lose muscle mass, bone density, and nerve conduction speed (signal speed) as they age. Regardless of the reason for those physical deficiencies, the results are similar - falling. Think about some of the most memorable marketing campaigns to air on television, “Help! I’ve fallen and I can’t get up”. Does that ring a bell? Now it might seem like a commercial with bad acting, but that is a low-budget representation of a serious reality for many people across the world.
Instead of buying a reactionary device that calls for help, be proactive and take a few steps toward preventing that horrific event in the first place. There is not a lot of money to be made in fall prevention solutions, but the results are simple and amazing which makes everything worth it as a healer. Exercise, not a button on television, is the best way to prevent that event from happening. Just a few minutes every day, with the right guidance, can typically help any-body adapt to any-thing.
Humans frequently compare themselves to the most complicated machines made (e.g. cars, computers). These mechanical contraptions do not come close to any equivalent of human complexity because of a human’s greatest feature, biological adaptation. Adaptations are rooted in the interaction between bodily systems (e.g. nerves, muscles, blood, and so on) and the environment (i.e. houses, gyms, weather, relationship, and so on). The gift of adaptation allows humans to maneuver, inhabit, and thrive in any environment.
Regardless of age, given the correct training parameters, human anatomy will adapt to pass nearly any physical test. Age just changes the parameters, not the concept. Through specific training, people can unlock incredible things like throwing a ball >100 miles per hour; free dive 702 feet into the ocean; free solo El Capitan; and most importantly (least intensely), prevent falls.
We can, and do, regularly perform feats that no other life form can complete. Things that would send other creatures to their graves. In 2021, 255,318 people completed a marathon race (26.2 miles), the oldest person being a centurion (100 year old), Fauja Singh, with a finishing time of five hours and 40 minutes. As of January 2023, 6,338 different climbers have successfully summited Mount Everest - the oldest person, Yuichiro Miura, being 80 years old at the time of his summit. Over 750 people have swam around the heart of New York, the island of Manhattan - the oldest female, Pat Gallant-Charette, conquering the waters at age 67 and Dexter Woodford at age 77.
Although humans are masters of adaptation, the body becomes delicate if not challenged regularly - especially as it ages. Adaptive phenomenon typically happens gradually over generations due to challenges from the environment (e.g. Bajau water people). Through scientific discovery in physical therapy, however, adaptations can be accelerated to occur in a matter of weeks.
Regular challenges will significantly reduce the risk of falls. The key to selecting those regular challenges is through working smarter, not harder. Fall prevention programs should be safe, specific, challenging, and enjoyable. Here are some pointers that can get anyone started:
Safety: If it doesn’t feel safe, trust your gut. Walls, countertops, beds and tables all act as great guards if no one is around to catch you as you practice balancing. No one outranks General Safety.
Specific: If there is a specific task that makes you feel off balance, safely practice that task. The brain will make sure you perform better if you do exactly what makes you feel off balance. Practice makes perfect.
Challenging: Intensity can be gauged by how easy or hard it is to talk. If it is too difficulty to get a word out, it is too difficult. A light sweat is a good thing. Physical therapy can help provide medically directed challenges.
Enjoyable: Exercise is organized physical activity. Start moving more by doing things that are fun, engaging, and exciting. The most enjoyable will last the longest.
The blueprint for an adaptive program is a frequency of >3 times per week, intensity that is challenging yet achievable, 30-50 minutes of exercise each time, and the type of exercise is slow, controlled strength training using bodyweight, bands, or weights. Meaningful differences in your life can be achieved with body weight alone. A functional home gym is a chair, step, and timer.
Using the measures given in this article as a launch point and dedication to a new routine, a meaningful change in eccentric contraction strength and neuromuscular control should occur. Although there is no guarantee that a fall will not happen accidentally, exercise should result in a significant reduction in risk of falls. A fall is a preventable problem, and the best way to prevent it is by exercising.
Exercises Routine Example: Set the timer to thirty (30) seconds; sit, stand, repeat until the timer stops.* Reset the timer; sit as slowly as possible so the timer stops once seated; if the legs give before the butt lands in the seat, stand up and repeat until the initial timer stops. Exercises at the step can be taps, step ups, or heel taps - slow and controlled.
*Less than 8 repetitions indicate a risk for falls for men and women.
