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For Your Patients – Falls Revisited: How to Stay on Your Feet

by Dr. Sheri Colberg, Ph.D., FACSM

Prevention of falls is such an important topic that it’s worth revisiting once in a while.

Just last week when I was traveling back from the American Diabetes Association meeting, an older woman near me in the airport tripped over a bag and fell down in the gate waiting area. Alerted by an airline agent, the airport paramedics arrived a short time later to check her out and give her an ice pack for her arm, which she had hurt trying to catch herself when she hit the floor. Fortunately, she did not appear to be seriously injured.

Even if you have been fortunate enough to stay on your feet or to fall and not get injured, there’s no guarantee that your good fortunate will continue as you age. If you do experience a hip fracture related to falling, you may not be able to get up on your own (like my aunt who fell last December due to neuropathy in her feet making her unsteady and who required a partial hip replacement to repair her broken hip and months of living in a rehab facility afterward).

Falling down occasionally is inevitable at any age, especially if you’re active and even if you’re currently in good shape with excellent balance, so it’s best to try to minimize the impact of falls (both the number and the potential injuries) rather than to ineffectively attempt to lower the risk of falling by becoming more physically inactive (which is extremely counterproductive).

How can you tell how good your balance is? Poor balance is readily apparent if you stand on one leg and shut your eyes. (Don’t try doing this without holding onto something.) You may be surprised how much worse your balance is with your eyes closed. To balance effectively, you need adequate strength in your ankle and hip muscles, good feedback from the nerves in your feet (to help your brain with its position sense), and a functioning cerebellum. Most of us rely more heavily on our eyes for balance to compensate for negative changes in our ability to balance over time. If you can’t stand steadily on one leg for at least 15 seconds — with or without your eyes closed — start practicing as soon as possible to improve your balance.

One-Legged Balance Exercise

The easiest balance exercise is to hold onto a table with both hands while standing on one leg. Once you feel stable in this position, you should slowly release one hand. This exercise needs only to be done two to three times a day on alternating feet. Within a couple of weeks or months, your balance will rapidly improve.

This easy exercise can improve your balance further by (1) holding on with only one fingertip while standing on one leg; (2) not holding on at all; and (3) if you are very steady on your feet, closing your eyes (still without holding on). Have someone stand close by in case you ever feel unsteady, though, particularly when your eyes are closed. Switch legs and repeat often.

Anytime Balance Exercises

These exercises also improve your balance. Do them as often as you like, but make sure you have something sturdy nearby to hold onto if needed.

  • Grab a towel with your toes. Place a towel on the floor and practice grabbing it with the toes of both of your feet, alternately, while both sitting and standing.
  • Stand on a cushion. Using cushions or pillows of varying firmness, stand on them with your legs alternately together and apart.
  • Stand with a changed position. Stand under different conditions: with your eyes open or closed, your head tilted to one side or straight, your mouth talking or silent, and your hands at your sides or out from your body.
  • Walk heel-to-toe. Position your heel just in front of the toes of the opposite foot each time you take a step. Your heel and toes should touch or come close. You may want to start first going along hand rails or with a wall next to you.
  • Walk backwards. Walk backwards along a wall or a kitchen counter without looking back, using the wall or counter to steady yourself infrequently.

Tai chi is also an excellent exercise for improving balance, and yoga can also increase strength and core stability. Lower-body resistance training also doubles as balance exercise. When you do your regular strength exercises, your balance should improve at the same time.

In summary, you can minimize falls and their potential impact by keeping yourself healthy, strong, stable, and physically active, particularly by doing daily balance and strength exercises. Whatever you do, never stop being physically active due to fear or falling or it will become a self-fulfilling prophecy!

As a leading expert on diabetes and exercise, I recently put my extensive knowledge to use in founding a new information web site called Diabetes Motion (www.diabetesmotion.com), the mission of which is to provide practical guidance about blood glucose management to anyone who wants or needs to be active with diabetes as an added variable. Please visit that site and my own (www.shericolberg.com) for more useful information about being active with diabetes.

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