Over a decade ago, this line was made famous by a commercial for senior alert necklaces. According to the CDC, our risk of falls is continuing to rise, and by 2030, we’ll have 7 fall-related deaths per HOUR if the trend continues. If you are in your 50s and up or have loved ones in their 50s and up, you MUST read this.
I chose this topic because, in the past two weeks, I have worked with two clients in their 80s who were very active and fell unexpectedly and could not get up. They walk, exercise, mow the lawn, and lead fun, productive lives. It was a scary several-hour ordeal of being on the ground until help arrived. They were amazed and confused because they could instantly stand up and walk once someone helped them to a chair. Why?
Why is falling synonymous with aging?
The circumstances of my clients’ falls were typical and could send anyone off balance: a wet floor and wet grass. Why do seniors fall more than younger folks in these instances? Good joint range of motion and muscle strength to react quickly are extremely important. If we’re not continually challenging ourselves with activities or exercises that help maintain these and challenge our balance, we put ourselves at risk. Often, we don’t know it is gone until we need it.
Let’s examine why someone who can mow their entire lawn with a push mower can’t get up from the ground.
- He has plenty of strength but only within a small range of motion of his hip joints.
- He has functional hip and leg strength from a sitting position to a standing position (meaning it isn’t great, but he can get up).
- He has great strength in a walking range of motion (meaning he can walk a long time comfortably).
- He has poor or no strength at a greater range of motion that is used when getting up from a low chair/couch or the floor.
How does this loss happen without us even realizing it? We sit and sit and sit. All this sitting leads to a loss of motion and strength. This leads to poor postural habits and tight fascia. It creates a downward spiral of problems with balance and overall health. To make matters worse, when older adults have trouble getting up from chairs, we buy them lift chairs, raised toilets, and install grab bars. Now, they can get up independently. Yeah! These tools are fine, but we avoid the underlying problem. We cannot just apply these band-aids. We must address the greater issue of loss of motion! How do we do this?
Increasing range of motion and strength
Before I share exercises to improve your range of motion and strength, I want to talk about how to approach this process. If you’re excited to start improving your health, it is tempting to jump right in but grading these exercises to your own unique abilities is the key to success. Occupational therapists (OT) are trained to expertly grade activities to the individual based on their skills and health history. OTs also put exercise in context, so the developing skills directly apply to the desired activity.
Let’s take a closer look at the photos below as I go into detail about how to improve your range of motion and strength.
In the first photo, Dwight is positioned in a lower chair than he typically sits in at home. When trying to rise, he cannot get himself up without the assistance of his arms pulling him up. This was surprising to him. I suggested he position a chair about this height at his kitchen sink and practice getting up and down slowly without “plopping.” Plopping happens when there is insufficient strength throughout the full motion to control the lowering movement into the chair. Strength gives out at the lower end, and we plop into the chair. I instructed him to use less and less assistance from his arms as his legs gained strength in this new range of motion.
In photo number two, I asked Dwight to change his leg position in the chair. Dropping one leg back mimics the position he’ll eventually need to get up from the floor. He found this position even more challenging. He should start with assistance from his arms and gradually reduce this assistance as he gains strength in this new range of motion.
In the third photo, we see Pam, who admits getting up from the floor is not easy for her, and anyone who has seen Pam for a massage knows she is STRONG! Pam is positioned on a low stool with a split stance. Dwight isn’t ready for this position, but it is what he’ll transition to next. Pam is using her arms to assist as she moves through the lowest part of the motion. She reduces her arm pull as she finds the strength in her legs. The stool provides a sense of safety while practicing challenging movements and a safe place to land and rest if she fatigues too quickly.
The next phase (photo four) is switching to a lower target. Lower the knee to touch the target and come back up. The target might be three pillows or the stool at first, then gradually lower the target as strength builds throughout the range of motion. You may also notice Pam is doing the movement at a door. This is another good option for grading the support. Starting at the kitchen sink provides excellent stability and support. A door offers support but not as much stability.
In the fifth photo, Pam is touching her knee to the floor. Excellent! She’s built enough strength to get down and back up again. However, she’s not done yet.
In photo five, she is learning not to rely on any external support to get up. This increases stability and balance in this lower range of motion. You may not fall in a place where you will have external support to assist you in getting up. Continue to do the exercise in a place where support is available if needed. You should do the movements until your muscles fatigue, or you will not get stronger.
In the final photo (seven), we see Pam’s foot. As we age, we also tend to lose range of motion in our feet, ankles, and calves. This is NOT simply due to aging. It is due to lack of use. When adults have foot pain, we are often offered immobilization as an option to protect them. This creates a spiral of decreased motion and strength. Our feet must also be strong and flexible and are a key element to getting up and down easily and maintaining our balance in an upright position. My other client, who was very active but couldn’t get up, was completely lacking in this motion, preventing her from getting up from the floor. She’s currently working on this skill. Pam’s motion is excellent! Yay, Pam!
Finally, we have not addressed going from the position of being completely flat on the floor. This is another crucial progression I’ll address in another article. Just remember that if you fall, you are not guaranteed to fall in a place that will be easy to wiggle out of. Many falls happen in the bathroom where you might be on your back, front, or side with very little room to maneuver. It is important to have strength available at all ranges of motion to keep yourself safe.
The key points:
- Get up and down regularly as part of your exercise plan at every age. You may lack strength and motion if you have hip or back pain. This is an early sign!
- Grade your exercise with the help of an expert if you are very weak or have other health conditions.
- Don’t forget your feet, ankles, and calves.
- Provide older adults with assistive devices as needed, but don’t be fooled into thinking they are the answer to the problem. Your loved one is still at risk if they can’t get up. Connect them with a health professional that can get them moving safely.
- Create a body that is prepared to get up from any position.
UPDATE! At his last wellness session, Dwight reported he could do about 15 get-ups from the chair without using his hands and was ready for the next challenge. In the photo, you can see that we’ve given him a bolster as a target to increase his range of motion further. He could not get to the bolster without using his hands to lower himself down and pull himself up. However, this was true with his last challenge of getting up from the chair with a split stance. He was able to improve significantly in just a few weeks! We’ll see how he does with this challenge. He plans to do the exercise at his kitchen sink with a couple pillows as his target. The pillows will also keep him safe if he does need to rest. The goal is to use less arm strength as the legs gain strength in this range of motion. Go, Dwight!
Need help getting started? Make an appointment for a New Client: Natural Movement Evaluation and Consultation. Or Join a MovNat class on Schedulicity.
Check out my online course, Move Better to Feel Better and Live Your Best Life for an in-depth guide to healthy aging. It is full of tips and exercises to keep you living your best life for years to come.
Updated January 29, 2024