This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2023. For the original video go to https://www.youtube.com/watch?v=Ooiy5DxAPfg
Brad: As we age, particularly after age 50, we become more unstable. It happens to everyone. I noticed it at about 55 and I work on my stability all the time. The big problem with being unstable is the risk of falls which is a big thing we want to avoid.
Mike: However, if you understand the reasons why you’re falling, you can help prevent them from happening. And the best part is we’re going to show you how to do that. And it doesn’t take much time or effort to fix these problems.
Brad: As therapists, Mike, Bob, and myself, over the last many years have worked with countless individuals with their balance in keeping them upright and safe.
Mike: Falls can occur for many different reasons, and we’re gonna talk about 7 common reasons they happen, and figure out how to prevent them from happening, or what you should do to fix this problem.
Brad: We’re also gonna discuss some of the other benefits of working on your balance, some things that you probably aren’t aware of. For example, you’re going to have less joint pain and less muscle pain, and you’re actually going to be taller and look better. It’ll all be explained very clearly in the next few minutes.
Mike: So these 7 balance issues are not in any particular order and they might not all pertain to everyone. Just pick which ones that pertain to you and hopefully, it’ll help.
Brad: That’s right it’s going to be very clear, let’s go to the first one Mike.
Mike: The first one is vision declining. Obviously, if you can’t see where you’re going, or your surroundings, you’re more likely to have a fall.
Brad: And this doesn’t mean just blatantly not seeing, but if your vision changes over time, and you need new glasses, or if you don’t have glasses and you need them, it can make a significant difference to your balance. Once you get your glasses, things can change a lot for you. In many ways.
Mike: So the solution is, you have to go see your eye doctor because we are not licensed to give advice on this.
Brad: That’s for sure. I can hardly see, myself. I need cheaters, that’s all I need. Anyway, let’s go to number two. This is something many people are not aware of, it's your ear health. What’s in your ear is the vestibular system. It houses a little balancing system that talks to your brain and lets you know if you’re upright. It controls a lot of your balance. So if you’ve had a history or recently had an ear infection, if you’ve had anything related to your ear, even an ear impaction (your ears get plugged up), get that checked out by the doctor. Make sure your ears are in good health. It can make a big difference in your balance.
Mike: So, a good solution to this, as Brad said, is to go visit your doctor to make sure that isn’t causing your falls. Typically there’s dizziness associated with this problem. We do have a video, much more in-depth with another physical therapist, called “Understanding Causes of Dizziness and Vertigo: All You Need to Know”. Check it out if you want to find out more information about this problem.
Brad: Right and that actually is with Sherry, right? She is an expert on this and she does an excellent job describing the problem and how to work with it.
Mike: Reason number three for falls, is typically poor posture when you’re standing. Now this happens commonly as we age, we begin to lean forward with rounded shoulders. This will shift the center of gravity and make you more likely to fall over, causing imbalances in your muscles, and can even cause some back pain. So we want to try to straighten you up.
Brad: Right, this is so critical, and I want to emphasize this forward-flexed posture as we age, you notice it with a lot of people. They start walking this way, gravity takes over, and everything starts pulling down. The muscles in the back are particularly stressed, as well as the joints in the knees and the hips. That stresses everything, causing pain associated with tippy balance. So we’re going to show you one quick simple exercise to improve this.
Mike: So the solution for this, if you have a rounded posture like this, is to do a simple posture check against the wall. So what you’re going to do is put your buttock against the wall. If you’re forward like this, it might be hard just to try to get your shoulder blades back. The goal is to try to touch the back of your shoulder blades to get a better posture. Once you can do this comfortably, try to bring your chin back and touch your head to the wall. So you want to try to get nice, flat, and upright. Your feet can be out further, they don’t have to be touching the wall. That’s going to possibly cause you to fall if you have poor balance. So, remember the buttock first, try to bring the shoulder blades back for good posture, and then the head.
Brad: Now, I’m going to mention some people who have been forward slouched for a long time may not be able to touch the back. Oftentimes I’ve seen patients be able to touch their buttocks and shoulders, but touching the head is difficult. The neck has become so contracted or tightened up over time, that it takes some time, even weeks to see improvement. You can take your hand and do some gentle chin tucks, gently stretch it out to get that head to come back. Sometimes I’ve had people make progress all the way to touch. If they’re older, you know, 70s and 80s, and had bad habits, that may never come back. But you still work with it.
Brad: All right number four, we’re going to talk about lack of sensation in the feet. In other words, numbness and tingling. If you’re diabetic and you have neuropathy in your feet you know exactly what I’m talking about. I’ve worked with a lot of patients who have that. They don’t feel or have sensations in their feet. When that happens there’s no feedback from your feet to your brain in the balance centers and your balance becomes much more difficult. Now you can also have similar problems, just by the shoes you wear. If you have thick shoes, your feet are not going to sense and feel the ground particularly if it’s unsteady ground. If you have shoes, like Mike and I have these really thin-soled shoes. They’re called zero drop and barefoot shoes, minimalist shoes. That can help, however, we understand that for certain people, these are just not comfortable. Perhaps you have foot problems and you need the support, so that’s okay. We’re going to show you some exercises that you can do very simply to improve your balance and proprioception. Did I mention proprioception?
Thick Soled Shoe
Zero Drop/ Minimalist Shoes
Mike: You maybe did. I wasn’t listening.
Brad: Anyways, that is what it’s called technically, proprioception, and we’re going get right with that. OK, we’re gonna show you the option to do some exercises. Now if you have neuropathy this is something you definitely want to do. If you decide that you don’t want to go with these thin shoes to get a more feel of the ground or proprioception, you’re going to stick with your comfortable soft-soled shoes, and that’s okay. You’re going to wear those when you do this exercise. You can do it barefoot as well. So the thing that you want to do is go to a corner like this. Now the reason we’re using the corner is because this is going to make you a little unstable and we obviously do not want you to fall. So when the corners are there, you have all these directions that you’re stabilized by the wall. Going forward, you are not stable, so Mike has a cane. You could use a walking stick, you could use your stretch stick or Booyah Stik, whatever you have. You could actually put a chair in front of you, so you can grab onto the back of it.
Mike: So to work on this in the corner, make sure you have your cane or if you want a chair like this just position it in front of you and you can hold onto this as well for more support. So to start, just stand with your feet wide apart as long as you feel safe this way. You can bring your feet closer together. Eventually, try to touch them, and stand like this for 30 seconds. You can repeat it 3 times. Once this becomes easy, another progression to do is to stand on one leg. The higher this leg is up, the more it will challenge the balance. Make sure to work both legs, 3 times for 30 seconds as well. Now if all this is too easy for you, you can also take some type of cushion, pillow, balance pad, whatever you have laying around, something soft. Put it on the ground and you can stand on that. Again, start with a wide base of support, feet further apart. Then bring your feet closer together for a narrow base of support and you can progress to one leg as well.
Brad: Let’s look at this a little bit closer. Let’s use Pete’s Choice balance pad. This is what we use in the clinic. They work very well. The black cushion is from my ottoman seat at home, so whatever works for you. If you zoom in on this ankle, now, watch as he stands on one foot. This ankle is working back and forth and is really focusing a lot of energy to stabilize Mike. This is a type of thing we want to work on for that proprioception. That’s critical for your balance. This little thing is what you will not get without a cushion to unstabilize your support, so that’s why we use it. If you don’t feel comfortable with it, don’t use it.
Brad: Alright, number 5, this happens with a lot of people as we age in their 50s and 60s is simply a decline in strength, in our hips, legs, feet, and ankles. Oftentimes because we become a little more sedentary, we don’t get out and exercise as much, those things weaken as a result. Weaker legs, hips, etc. result in being a little more unsteady. The body just cannot control itself as well, particularly walking on uneven terrain.
Mike: So the solution for this is to strengthen your legs. You can do this in a variety of ways but we have a video we’ve done in the past. It’s called “Three Best Beginner, Senior Leg Exercises, Using a Kitchen Chair, Improve Balance, and Walking.” That is a long title. You’ll need a chair for it, the video explains how to do the exercises. So if you want to start strengthening your legs, just watch that video. So reason number 6 that your balance isn’t improving or reasons you can fall is because you’re not challenging your balance enough. So that means standing up, doing standing activities, going for walks outside, maybe not just on the sidewalk, but maybe some hikes in the grass or gravel, or even going for a hike. Challenging your balance through everyday activities is going to help improve it.
Brad: That’s right, I’m gonna actually recommend you go out of your way to do this. Have good judgment, and make sure you’re not going on a trail that has rocks and 3-foot elevations to negotiate over. Good judgment, but things that you have to actually think about where you’re walking. You’re placing your feet to get around rocks, stumps, and uneven terrain like the lawn that is going to make you think. And when you do this, probably use a walking stick or a cane. Something that assures you’re going to be safe. Walking sticks are very popular. They look cool, everyone’s going to think you’re really cool. Get a fancy one if you’d like. Go out in the woods and go for a hike on the trail. The tranquility, the birds, the trees, and the fresh air will do more for your mind than for your balance walking on the trail, but keep your mind on the trail as well. Good luck with that.
Brad: Okay, and number seven, the last one is kind of similar to number six but it relates more to being in the house. Times when you have to walk sideways or walk backward. They call them perturbations, where things happen kind of quickly and you don’t expect it. Particularly if there’s a crowd of people around, those little things sideways and backward can lead to stumbles, which can lead to falls and it’s a real problem. So we’re gonna show you some quick little simple things you can do to practice on a daily basis, and it only takes a minute a day.
Mike: So the first activity to do is just sidestepping, just bring one foot out to the side and bring the other foot to touch it, going sideways like this. Make sure to do both directions. The distance will be determined by the length of your railing or countertop or whenever you get tired.
Brad: I want to emphasize Mike, when you do this, make sure you’re looking straight ahead too because when this happens in real life, you’re not looking at your feet often and that’s when falls happen. This is a very common reason for falls, with people in the kitchen and the bathroom, as with sidestepping. We know that from working with a lot of broken hips.
Mike: The next variation you’re going to march forward. Just lift your legs as high as you comfortably can. Once you get to one end, walk backward, and take your time. Make sure you feel controlled. If you really feel unsteady doing this, maybe hold off or have someone hold onto you with a gait belt as a good option as well. You’re just going to do this the length of your countertop or your railing as well.
Brad: So the reason we’re doing this is the marching forward simulates when you are going up steps, a rapid incline. If you’ve ever walked up a step and misjudged the steps or you didn’t lift high enough, it’s the perfect time to catch your toe on the edge of the step, causing a fall. Walking back into the chair that you’re gonna sit down on. Maybe you’re farther than you think and you’re stumbling. So these are great functional exercises to practice.
Mike: Again if you feel safe, try to keep your eyes looking ahead, not down at your feet. The next variation you can try, which is a little more challenging, is called the grapevine, or karaoke, it has a bunch of different names. I don’t know why it’s called karaoke. We’re going to cross one leg in front, bring the back leg back, and I’m going to go behind. So, right foot front, right foot behind. The opposite direction, you’re just going to do the same thing. Left foot in front then left foot behind. You want to make sure to take your time. If you start crossing your legs and feeling like you’re falling then you’re not ready for this exercise, it’s a little more advanced.
Brad: Yeah, I think Bob and Mike and I can all agree, when we work with people with this in the clinic, it’s one of those things that people oftentimes get confused on which foot goes in front or behind. If it’s a problem, don’t worry about it, you can just forget it and go work on the other ones.
Mike: The last one, another challenging one, is to try to walk heel to toe like you’re on a tightrope. And so you’re going to put one foot directly in front of the other, going forward like this. You can turn around and go forward and back. Or if you’re feeling advanced and feeling good and this is easy, you can do this backwards as well for more of a challenge.
Brad: I always emphasize, see if you can feel your toes touch your heel. Because when that happens, particularly going backward, you’re working your proprioception. In other words, you’re training your body to know where your feet are without visual contact. Very important to work on your proprioception, and it’s going to make you less resistant or less at risk for falls. Nice job, Mike. These are something that’s really important, but be careful with them. Be safe, and if you do not feel safe, do not do them by yourself. You’ll be okay without it. So, I don’t know, do we have some more to cover, Mike?
Mike: I think we covered everything. Let us know if they worked for you, or what we forgot because we don’t know everything.
Brad: Well, right, you’re right, we don’t. I thought maybe we did. I don’t know. But be careful and be safe.
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