This was a line made famous by a commercial for senior alert necklaces over a decade ago. 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 as my article this month because in the past two weeks I worked with two clients, both in their 80s and very active. They walk, exercise, mow the lawn and lead fun productive lives. Both fell unexpectedly and could not get up. It was a scary several hour ordeal of being on the ground until help arrived. They were amazed and confused because once someone helped them to a chair they could instantly stand up and walk. WHY?
First let’s address the falls themselves. The circumstances were quite typical and could send any of us off balance: a wet floor and wet grass. Why do seniors fall more than younger folks in these instances? Having good joint range of motion and the muscle strength to react quickly are extremely important. If we’re not continually challenging ourselves with activities or exercise that helps to maintain these as well as challenging our balance, we put ourselves at risk. Often, we don’t know it is gone until we need it. However, this is NOT enough.
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) and 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 than a seated position such as what it takes to get 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 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 start to 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-aides. We must address the greater issue of loss of motion! How do we do this?
Here are some ideas. In the photos you see Dwight and Pam (both provided their permission to share their photos). It is important not to just dive into a big exercise routine. It is important to grade the movements in a safe progression for each person. 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.
I’ll explain the photos and add some detail.
In the first photo, Dwight is positioned in a chair that is lower 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. My suggestion was that 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 not quite enough strength throughout the full motion to control the lowering motion into the chair. At the lower end, strength gives out and we plop into the chair. I instructed him to use less and less assistance from his arms as his legs gain 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 begins to mimic 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 in a low stool with the 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 provides 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 throughout the range builds. 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, you see Pam touching her knee all the way 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 an 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, 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 being able to get up and down easily as well as maintain our balance in an upright position. My other client who was very active but couldn’t get up was completely lacking in this motion which prevented her from being able to get up from the floor. She’s currently working on this skill. Pam’s motion is excellent! Yeah Pam!
Finally, we have not addressed going from the position of being completely flat on the floor. This is another important 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 get yourself safe.
The key points: • Get up and down regularly as part of your exercise plan at every age. If you have hip or back pain, you may be lacking in strength and motion. 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 that 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 was able to do about 15 get ups from the chair without the use of 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 futher increase his range of motion. 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 split stance. He was able to improve with significantly in just a few weeks! We’ll see how he does with this challenge. His plan is 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 goals is to use less and 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.
We commonly refer to clavicles as collar bones. The clavicle bones are the two long thin bones beneath your shoulders on the front of your body. You can easily feel them with your fingertips. The clavicles connect the sternum (breastbone) to each scapula (shoulder blade). They are far more important than you might think. Five muscles (pectoralis major, sternocleidomastoid, subclavius, deltoid and trapezius) attach to each clavicle supporting complex three-dimensional motion. The clavicles and the attached muscles supply the support and motion required for complex shoulder and arm function. If one or both of your clavicles are not in proper alignment, your shoulders and arms are likely unable to achieve their full range of motion. This misalignment is very likely to lead to an injury or pain that seems to come out of nowhere.
If it wasn’t very intense, you could try moving an inch or more toward the wall. You can do this by placing your feet on the floor and walking your hips toward the wall.
But, let’s dissect this a bit more because teens are NOT going to stop using technology and devices are getting into the hands of younger and younger children all the time. As a mom, grandma, and occupational therapist I must implore parents to do the best they can to balance tech time with lots of outdoor and indoor free whole-body play.
When I asked them to describe how to do the tasks safely, it was quite superficial and, in most cases, included how to protect your back. This is good, but it assumes the exerciser is starting with a body in proper alignment and know how to keep their back safe.
Typically, if our bodies were in proper alignment, it would be no big deal to grab a couple of 5-pound weights and start pressing them to the ceiling. But, if our shoulders are stuck in a rounded forward position with muscles that are tightened in either a short or elongated position (even just a few millimeters), and we lift those weights, we are asking for trouble. Our complex shoulder joints are designed for complex movement and need to be moved through their full range of motion regularly to function best. Regularly doesn’t mean 3 times per week for 20 minutes. Regularly means daily, several times per day. Instead, the position our neck and shoulders see most is rounded forward grasping a phone or typing on a computer. This idea applies to our feet, ankles, knees, hips, ribs, neck, elbows, wrists and fingers, too.
Every fitness program, regardless of age, should begin with an assessment of your body alignment no matter how young (or old) you are. If you find details of alignment that need to be corrected, every program should begin with exercises that focus on bringing the body back into alignment. Once proper alignment is achieved, full-speed ahead.
I don’t know about their spouse, if they have one, or their savings account, or if they have a health savings account. (I do make sure to tell them if they have a health savings account, they can use it since I am an occupational therapist.) With high deductible plans becoming common, more clients are expecting to pay out of pocket. Most of my clients don’t question this arrangement. It is on my website, and I don’t proceed with my evaluation until it is clear that I don’t process insurance. I don’t want any suprises. I also never pressure clients to return. It is up to them if they find value in my services and want to continue. If they do, they decide when and how often. I also volunteer my services to be sure I am helping people who can use my skills but can’t afford them. I do think it is essential to give back to the community and I am working with a local non-profit to do this regularly.
Insurance companies want objective information. They want proof that a person has pain. They demand objective reproducible, measurable information to prove a person actually has pain, and proof that the therapy being provided is making progress toward an objective, measurable goal. There is not always a clear measurable deficit that accompanies pain. Most of my clients can do all their daily tasks. They go to work every day. They take care of their families. They are happy and interesting people. They have normal range of motion and functional strength. Many have had imaging tests that do not show a problem. …and yet they have pain. Sometimes the pain is mild and intermittent and sometimes it is severe and chronic. But, they are still functional. They must be. Life won’t allow less. It is the quality of their experience that brings them to therapy. My therapist friends might ask, “don’t you use a pain scale?”. I used to. It just doesn’t work for many of my clients.
I don’t waste any time collecting information I don’t need to help them. I spend 100% of my time collecting data that will help me help them. The information I collect is often subjective, and part of the person’s lived experience and not a standardized assessment. Each follow-up session is 100% problem solving and treatment. I don’t need to spend time repeating assessments to prove change is happening. I simply ask my clients how they are doing, and we go from there.
Even when we know what better alignment is, our brain easily settles into what feels the most familiar. This is true even when misalignment may be contributing to the pain we feel. Our brain and our body need repetition and deliberate practice to change.
Since you are probably in front of a mirror right now, see if you can identify any of these common issues I see in many of my clients.
When you come to the standing part of the squat turn your palms up and move your hands behind you, leading with the thumbs. Gently pull the shoulder blades together keeping the shoulders down away from your ears. Bring your thumbs and fingers as close together as possible behind you. Be sure not to thrust the bottom of your ribs forward. The breastbone should remain perpendicular to the ground. Don’t compromise this alignment trying to reach your hands together. When you move back into the squat, let the arms move into a relaxed position or a position to help you balance always trying to keep the palms facing forward or up. Once you have this perfected, add the head. As you come up to standing, gently tuck the chin and lift the ears straight up while noticing the weight in your heels.