Falls are a major burden on society and the most common cause of injury when looking at the statistics from 2012-13. In fact, falls made up 40% of all hospitalised injury cases as per the statistics from the Australian Institute of Health and Welfare website with the scary reality that these numbers are increasing. This growing rate of fall-related hospital admissions reflects our ageing population which strengthens the argument that we should prepare appropriately to reduce our risk of falling and thus reduce our risk of significant injury in the future. From my experience, in the rehabilitation setting, I have found that patients seem to leave or put things off until it is too late. The patients who appear to seek assistance are those who already have a significant falls history and or history of injuries as a result of falls. I feel this trend needs to change, and the earlier intervention can be implemented the better chance there is of maintaining a better baseline level of function. The intervention program you choose does not always have to be complex as a simple program performed regularly will produce superior results when compared to a complex, detailed program performed sporadically. I feel the most important point to consider when implementing an exercise program is how it is going to fit into your day. If it is excessively time-consuming or mind numbing naturally, it will be difficult to complete. Where possible if exercises can be incorporated into everyday tasks I find adherence to be greatest.
Balance is a complex motor function which is influenced by many factors. No individual system provides us with all the sensory information we require to determine our position in space rather each system contributes in its unique way to allow our body to determine its position in space. To simplify it the three primary systems which provide feedback to help us maintain equilibrium and thus balance are:
Vision –The visual system directly responds to light. Visual input helps us negotiate obstacles, avoid harmful situations and provides visual cues identifying the orientation of a person in relation to other objects allowing appropriate balance strategies to be implemented when required.
Somatosensory – Feedback is provided to the brain by sensory receptors that are sensitive to touch, vibration and pain. These sensory cues assist the brain in determining its position in space and the movement of our body relative to the support surface beneath us. This sensory feedback allows us to implement the desired strategy to maintain balance/safety.
Vestibular – Utilises a collection of structures in the inner ear which provides your brain with feedback regarding your heads spatial orientation. This information allows your brain to determine your position in space. When combined with visual input your vestibular system enables your body to determine whether the world or you are moving. Your brain ultimately uses this information with other sensory information to coordinate the appropriate strategies to avoid harm. The vestibular system is even more important to maintain your balance when the sensory information usually received from the visual, and somatosensory systems are not available.
It is extremely difficult to design an exercise program which is suitable to all. Therefore if you are looking for something that specifically meets your needs I would recommend you visit Body Fit Physiotherapy or your local Physiotherapist. A program that could get you started could be as follows:
1. Sit to stand (not using hands where possible)
2. Calf raise
3. Sitting Planta Flexion and Dorsi Flexion
4. Feet shoulder width apart
5. Feet together
6. Stride Stance
7. Heel toe
8. Side stepping
9. Walking forwards and backwards
10. Walking heel toe
When we look at improving your balance we naturally have to challenge your balance to enable your body to adapt. In many cases, we need to take you close to the point of falling and sometimes this boundary may be broken. To reduce the chance of falling / injury I recommend you perform these exercises with a stable object that you can use to regain your balance if required. Often I advise patients to do this at the kitchen sink as they can grab onto the sink if they find themselves falling back and push on the bench if they stumble to the left or right. A safety first mentality should always be taken when commencing a balance program especially independently so don’t take yourself past the point of no return rather play it safe.
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