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Falling
Hampstead Heath this morning was beautiful but treacherous and all of a sudden, as is usual with such things, I fell over on the ice. One minute I was walking along chatting and the next minute I was on my bottom as my wrist, forearm, shoulder and buttock took a bash. I slid sideways fast in the fall, thereby distributing the blow to several parts of my body and reducing its impact, entirely by luck. So I escaped joining the legions of people who, over the UK Christmas festivities, suffered a fall as the weather managed to concoct a particularly tricky combination of sub-zero temperatures and sharp showers.
As the populations of many countries continue to age quickly the matter of falls increases in importance and not just in icy weather. The skill of maintaining our balance is taken for granted by us since we first learned to walk securely in childhood but the ability depends on complicated skills and functions which commonly, as in many other areas, deteriorate with age. Falls are a large and increasing problem in elderly people, with the increasing cost of surgical and medical care and the threat of loss of independence a continuing concern. The clinical workload and expense of falls related injury is felt in many worldwide medical systems.
There are a series of physical and mental abilities which contribute towards our keeping our equilibrium in physically challenging conditions. The joints and muscles of the legs suffer from reduced function as joint ranges of motion decrease and muscle power reduces with time, leading towards the gait of an elderly person where their step length becomes smaller and more frequent. If they are then called upon to make a much greater movement they may not have the joint range to do so or may not have done so for so long that they cannot accomplish the movement in time.
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.
There are several central nervous system capabilities which impact strongly on the ability to keep balance during movement, including the balance organs, vision, mental abilities such as logical thought and awareness and vision. The ability to see well makes us aware of the alterations in the surfaces we face and allows a judgment about which way to move and then to monitor the movement for effectiveness in achieving what we desire. Our balance is greatly worsened by closing our eyes and if we have poor vision and loss of some position sense then this may allow us to be vulnerable to falls.
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.
Being aware of our environment and being able to make rapid and mostly accurate judgments is key in balance maintenance. If we are aware of our surroundings we can plan early for what difficulties present themselves such as slippery or wet surfaces, other people getting in the way or obstacles suddenly apparent. The maintenance of an alert and mentally active mind permits us to pull all these complex aspects together and allow us to make the right decisions for our balance.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, Leeds Physiotherapy, 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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Filed under back pain by on Mar 23rd, 2010. 
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