I’ve Fallen and I Can’t Get Up!

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.

Over time, lots of sitting can reduce the range of motion and strength in our lower body.

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?

Progressive exercise for increasing leg range of motion and strength.

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.

Dwight’s next challenge!

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!

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