As we age, our balance tends to decline. Falls among the elderly can have life changing consequences.
Two of the best predictors as to whether someone will fall are:
1. A history of falling in the past year.
2. A fear of falling, particularly if it stops someone from doing their normal activities.
There are many reasons why someone may have poor balance. One important reason to check is for medication side effects and interactions. A conversation with your pharmacist can prove helpful.
There are a variety of medical conditions that can cause someone to be unsteady, including vertigo and various neurological disorders. Also, a history of injury to one’s leg or back can lead to balance trouble.
Yogi Berra once said: “You can observe a lot by just watching.” I find that to be true when evaluating someone’s balance. Watching how someone moves gives several cues as to how good their balance is.
Two key movements to watch (and work on) are:
1. How someone walks and…
2. How they get in and out of a chair
In the first part of this blog series, we will focus on walking. In the second part, we will discuss the seemingly routine process of getting in and out of a chair, and some more specialized balance tests. These tests dovetail nicely into a balance training program that I have used with patients with excellent results.
Someone with poor balance will change how they walk in order to steady themselves. Here are some things to look for:
Do they rely on a walker or a cane? Do they reach out to touch walls or furniture to steady themselves?
How fast do they walk? People with poor balance will walk slowly in order to not challenge their balance.
Do their feet clear the floor?
Does one foot pass the other?
Are their feet close together or far apart?
How is their posture? People with poor balance will walk with a forward bent posture to accommodate for their lack of balance.
Often times, people are not aware of how they are walking. Paying attention to (or “being mindful of”) how one is walking can lead to better balance!
Now, I don’t recommend just ditching the cane or hurrying when you are walking. As your balance improves, which it often does with the proper training, those things improve as a consequence.
When someone takes a step forward to walk, the foot will normally not touch the ground until the knee has fully straightened, and the heel is the first part to make contact. People with balance trouble are often unaware that their foot touches the ground before it stops moving forward. (That is a “shuffling gait”.) You can practice being mindful that when you walk, your feet clear the floor. Practice something long enough and it becomes a habit.
Another sign of a normal walking pattern is that one foot passes the other. When the leg that is swinging forward touches the ground, the heel should touch the ground just past the toe of the foot that is on the ground. Someone with balance trouble will shorten their stride, as doing so will make it easier to balance.
Mindfully walk with one foot passing the other, with that heel being the first thing to touch the floor. This is another way to “walk as if” you had good balance.
The third thing I suggest people be mindful of when walking is how far apart their feet are. Think of the last time you walked on ice. A typical first response is to walking on a slippery surface is to walk with your feet wider apart. Why? It makes balancing easier. If you were building a table, you wouldn’t put all the legs in the center. You’d spread them apart to make the table steadier.
When walking, it is normal for the feet to be close together as one foot passes the other.
The last thing I want to point out is this: People with balance trouble tend to walk with a forward bent posture. This is for two reasons. It is easier to balance when we are slightly bent forwards. Bending forwards also allows us to watch where our feet are going. If we are not confident with our steps, then the tendency is to watch our feet.
When you walk, imagine that there is a string pulling you up by the top of your head. Stand tall. Look straight ahead. With your peripheral vision you should be able to see the ground ahead of you. If you know that you are walking on a level, unobstructed surface then there is little need to watch your feet. (I have had some people to note that bifocals can make this more difficult…many of us have a separate pair of glasses for reading. Why not have another pair for walking?!?)
If it sounds like I am suggesting that people who have balance trouble practice walking in a way that is harder for them to balance, that is correct. Our bodies respond to the demands that we place on them. If we walk in a way that mildly challenges our balance then our balance will improve. Practice it long enough and you won’t be “faking” that you have good balance…you will!!!