Preventing Falls

Some new recommendations regarding fall prevention (meaning “falling down” rather than the season Fall) have recently been published in the Journal of the American Medical Association (JAMA).  This has been a topic of previous blog posts here and elsewhere, but new guidelines were issued in April 2018 by the U.S. Preventive Services Task Force (USPSTF) so it seems worth revisiting.  The USPSTF is a group of nationally recognized experts on evidence-based medicine and primary care appointed by the government’s Agency for Health Care Research and Quality (AHRQ).

The USPSTF conducted a review of 62 studies evaluating various interventions among older adults at risk for falls.  They found that of the interventions studied, exercise tops the list by “significantly reducing the risk for experiencing a fall”.  Although specific types of exercise were not highlighted, group exercise was included in the majority of the studies reviewed.  According to the review, “initial, exploratory analyses suggest that group-based exercise (vs individual-based exercise), [including] multiple exercise components (vs single exercise component), and . . . strength or resistance exercises . . . were more likely to be associated with a greater reduction in falls and number of persons experiencing a fall.”

The reason for the effectiveness seems to be the strengthening effects of exercise.  But I would add some additional possibilities, particularly relevant to yoga, Pilates, Tai Chi and other practices which focus on connecting mind to body.   These include an emphasis on training your mind as well as your body to pay attention to what’s happening right now in this moment.  Practitioners are encouraged to learn how their bodies work and to gain greater awareness of their surroundings as they move through space.  We call that “proprioception.” Balance training is also inherent in all of these practices in addition to strength training.  Also, group exercise has the added benefit of a social component.  This may seem like it would not be relevant to fall prevention, but I would contend that it has an impact on all aspects of one’s life, including continued mobility both physical and mental.

Falls are something we all worry about, especially as we age, but they can be devastating at any age.  According to USPSTF

“Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. In 2014, nearly 29% of community-dwelling adults 65 and older reported falling, for a total of 29 million falls. Of these, more than one-third necessitated medical treatment or restricted activity. There were an estimated 33,000 fall-related deaths in 2015”

Anything we can do to strengthen our resources against this danger is certainly worthy of our attention.  This provides just another piece of evidence to recommend regular exercise for everyone.  It’s never too late to start.  No matter how inflexible or out-of-shape you think you are, if you can move and breathe, there is some form of exercise that you can do.  Starting is the hardest part.  That requires a decision.  Every journey begins with the first step.  Take that first step and then add to it.  Gradually.  Start slowly and keep moving.  You’ll improve if you stick with it.  You might still experience a fall, but by building your strength, you may also find that you recover that much more quickly.  That’s certainly worth the effort.

 

Advertisements

Simple Strategies for Improving Movement

This week I was inspired by two resources that I want to share with all of you.  The first comes from Mindful Strength founder and instructor Kathryn Bruni-Young.  Her practice “combines mindful attention with strength, mobility and functional movement”.  I learned about her from movement specialist Jenni Rawlings, who I have been following for some time.  Those of you who know me recognize that I have long been interested in functional movement and how to improve our capacity for movement at all ages and skill levels.  In my opinion the outward shape of a yoga pose is not as important as the internal feel of that pose for the person holding it.  Can you sense your movement through space?  Do you know where your body’s parts are in relation to other parts and to the external world?  As a result of injury, trauma, or just plain lack of attention many of us have lost touch with our bodies.  Images in the media to which none of us can possibly measure up have given some of us a less than optimum opinion of our bodies.  This further contributes to detachment.  The goal of mind-body disciplines as I teach them is to put practitioners back in touch with their own bodies. Then, perhaps, we can see them for the miracles they are rather than focussing on perceived faults and failings.

On Kathryn Bruni-Young’s website, I was delighted to discover her podcast.  Many of you know I am a podcast devotee so I began listening immediately.  I am now working my way through her archives and have so far been extremely impressed.  The one I wanted to point out to you today features an interview with Nicholas St. Louis, a Physical Therapist and founder of The Foot Collective, which is on a self-described “mission to reclaim the human foot.”  I highly recommend this podcast and also suggest a visit to The Foot Collective website.  In his blog post “An Introduction to Feet and Footwear”, Nick describes our feet as “a magically well engineered body part and yet despite the massive role they play and how robust they are, most people neglect foot health.”  That is, until those feet start to hurt and become a problem.

Nick reminds us that although we take our ability to walk upright on 2 feet for granted, this trait is unique to humans.  The feet, he emphasizes, are “the only part of your body that touch the ground as you navigate the world and because of that they have a rich and extensive network of nerves . . . that relay vital information to your brain”.  In fact, each foot “contains 25% of the bones in our body, has 33 joints and over 100 muscles/tendons/ligaments.”  What could possibly go wrong?  No wonder we have foot problems!

Yet our feet are also incredibly resilient and designed to take lots of abuse.  But we abuse them at our own peril.  According to Nick, a major source of that abuse is the footwear to which we subject our feet.  He details how our footwear choices have allowed our muscles to weaken and even atrophy.  The modern shoe, he states, “numbs the sensory network in your feet and without the input from the ground, the muscles of your foot stop working like they were designed . . . [shoes become] a foot binding contraption that systematically shortens our heel cords” among other issues.  Furthermore, as a result of this “contraption” the absent or misleading information coming from the foot “gets translated upstream to your shins, knee, hip, low back and all the way to your neck.”  Nick even goes so far as to suggest that many of our knee, hip and back issues are really foot issues.  Of course, there are likely other contributing factors that accumulate along the way, but I believe there is great deal of merit to this argument.  It certainly makes sense to include this concept into any strategy for addressing other problems.

In the podcast, Nick also states that many of our problems with balance are also related to our limited ability to translate signals from our feet to our brain and, consequently, other parts of our body.  He suggests some simple practices to help address this problem.  Among them is simply gradually incorporating more barefoot walking.  Also heel-to-toe walking a straight line both forward and backward, without looking down, on a slightly raised surface like a 2 x 4.  This helps to retrain your proprioceptive ability to gauge your body’s place in space.  The height of the surface can gradually be increased as mastery develops.  He also suggests walking on a variety of surfaces, like grass and sand, even rocks.  As with any new or renewed effort, “gradual” means just that!  Start slow and increase equally slowly.  You’re not going to undo a lifetime of poor habits in a day or even a week or month.  But as with any practice, if you stick with it you’ll improve.

The second piece of information I wanted to pass on to you is an article from NPR this past week called “The Lost Art of Bending Over: How Other Cultures Spare Their Spines”. This article describes the “hip hinge”, the process of leaning forward from the hip crease instead of the waist.  Your hip crease is that place where your legs meet your torso.  When you bend from the waist, you round your spine.  For those of us with weak abdominal (or “core”) muscles, this creates stress on your spine which ultimately invites back pain.   As Jean Couch, from The Balance Center, states in the article, bending from the waist makes us “all look like really folded cashews.”  Do you really want to look like some kind of nut??

Of course, in Pilates we try to train practitioners to strengthen and engage their core muscles when creating a “C-curve”, but that does not negate the benefits of the hip hinge.  Core strength also helps with hip hinging.  I often hear prospective yogis lament the fact that they can’t touch their toes.  Touching one’s toes is certainly not the be-all and end-all of any yoga practice.  But one of the reasons why many people have so much trouble reaching for their feet is because of chronically tight hamstrings.  “Bending at the hip takes the pressure off the back muscles,” says Liza Shapiro, who studies primate locomotion at the University of Texas, Austin. “Instead, you engage your hamstring muscles.”  That simply means stretching your hamstrings.  People often think of reaching for their toes as a back stretch, but it is really a hamstring stretch.  As the article states, “when you hip hinge, your spine can stay in a neutral position, while the hips and upper legs support your body weight. When you bend at the waist, the back curves, putting stress on the spine.”

The article also advises that “whether or not hip hinging will prevent back pain or injuries, doctors don’t know yet” but it’s one more practice that is worth a try.  If nothing else it might help relieve those chronically tight hamstrings.  I have certainly seen the evidence in my classes that hinging at the hip improves the ability to reach toward one’s toes without back pain.  There is a great little video in the article that demonstrates using the hip-hinge technique to pick something up off the floor.  I highly recommend it.

None of our movement problems have easy solutions, but the more tools we can try in our practices the more we information we can gather.  If you’re reading this you probably already know that each part of our body is inextricably connected to every other part, brain included.  Learning how our bodies work is an endlessly fascinating journey.  Each of us needs to explore lots of ideas to find what works for us.