Falling Over

This morning it was freezing and icy on Hampstead Heath and I fell over, suddenly and as is typical, with no warning. One moment I was walking and talking, the next my hand, forearm, shoulder and hip took a hit as I fell on the ice. Sliding down sideways and hitting several parts of me in turn helped spread the force although this was entirely by luck rather than judgment. I did manage to avoid joining the many thousands of people who fell over recently during the Christmas holiday in the UK as the weather unhappily conspired to deliver a risky mixture of freezing temperatures with short bursts of rain.

Falls are an increasing concern as the population of many countries gets older and not just in periods of cold and frosty weather. Our ability to maintain balance is something we take for granted since we learned to walk but it relies on a series of complex skills and abilities which are subject to the changes which come with age. In elderly people falls can become a significant problem, causing injuries and fractures which need costly medical and surgical care and eventually threatening independence. Medical systems all over the world are feeling the expense and the clinical load which results from falls.

We need a variety of both physical and mental skills to manage to maintain our physical state of equilibrium when conditions become challenging. As we age our limb muscles gradually lose their strength and we use less and less of our potential joint movements as we walk. Older people gradually adopt a more restricted gait as they increase the number of shorter steps and decrease the amount of joint movement they employ in each gait cycle. If keeping balance suddenly needs a much bigger joint movement this may not be possible any longer or they may not be able to perform the movement in time to complete the required task.

Joint position sense is an important sense which informs the brain continually of where each of our trunk and limb segments are and at what speed they are moving in which direction. This ability is also known as proprioception and is crucial in our being able to move about successfully. Losing the proprioception or the feeling in part or the whole of a limb deprives the brain of the essential information as to the location of the part so it is unable to plan to move the part to another location. Loss of sensibility or joint position sense is more important than losing muscle power to a great degree, as many people can walk with severe weakness as long as their proprioception is intact.

Several of our sensory organs and mental processing systems make important contributions to our ability to move whilst maintaining our balance including our awareness of the environment and our ability to think clearly, vision and balance organs. If we can see properly we can identify changes in the surfaces and so plan how we wish to deal with this and then follow our resulting movements to check they fit in with what we are trying to achieve. Closure of the eyes impairs our balance so if vision is not good and we have reduced position sense then we can be more at risk from falling.

The balance and coordination pathways in the brain also have to be working well if we are going to react appropriately, with the balance organs in the ears contributing as well as our eyes. If our organs of equilibrium in the ears are affected, perhaps reduced in accuracy or giving us feelings of giddiness when turning our head, then losing our balance can be more likely. A general age-related reduction in the effectiveness of our neural abilities can also affect the cerebellar pathways which deal with coordination.

Awareness of what is around us in our environment is vital in permitting us to make the quick and correct decisions to keep our balance. Being alert to what is going on means we can make early plans for managing the presenting circumstances such as other people's actions, sudden obstacles and wet or slippery surfaces. Maintaining our minds in a mentally active and alert state allows integration of complex information and the formulation of plans to keep our balance.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, Physiotherapy Leeds, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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