How to Avoid Falling: Start a Home Exercise Program

More than 30 percent of people 65 and older fall each year. This increases to 50 percent for those in their 80’s.  Two-thirds of those who fall will fall again within 6 months.  Those who fall are more likely to move into a nursing home.  Worse, falls are the leading cause of injury, deaths, and hospital admissions for traumatic injuries in people 65 and older.  Falls and problems with balance will not resolve on their own.  If you are feeling unsteady or you have already experienced a fall, the time is now to do something about it.

Falls in older adults

The Answer: An Exercise Program Proven to Reduce Falls

Researchers from New Zealand developed the Otago home exercise program to reduce falls in older adults.  This fall prevention program improves strength and balance and reduces falls and fall-related injuries among older adults.  Completing the exercise program has been proved to reduce falls by an astounding 46%!  Results have been even better in adults over the age of 80.   Besides these exercises being beneficial for reducing fall risk, most participants find them enjoyable.  In fact, 70% continued exercising after one year.  This is very important because any effective exercise program must be maintained in order to sustain any benefits.

Balance Exercises within Your Own Home

The Otago exercise program is composed of strengthening exercises, balance exercises, and a walking program.  The exercises are performed 3 times per week over course of a full year.  The strengthening and balance exercises take about 30 minutes total to complete.   These can be performed at once or spread over the course of the day.

The walking program includes 30 minutes of walking at least twice per week.  If needed, the walk can be broken up into 2 or 3 smaller walks.  For example, instead of walking continuously for 30 minutes, you could spread 3 10-minute walks out over the course of your day.

The program is very flexible but is designed to become more challenging as your strength and balance improve.  The following 5 videos show examples of some of the exercises included in the program.

The Role of Your Physical Therapist

 Your exercise program is prescribed after your physical therapist performs an assessment of your balance.  This includes evaluation of your walking, ability to stand from a chair, and a four-stage balance assessment.  It is important that you start with the most appropriate exercises.  Beginning with exercises that are too easy for you will result in little improvement.  Also, beginning with exercises that are too challenging may be dangerous.  An individualized assessment helps identify the exercises which are right for you.  A list of standardized exercises is rarely effective.

After the initial assessment, you are provided with instructions for your home exercise program.  You will follow up with your physical therapist every few weeks in order to assess your progress and advance your exercises.  Your physical therapist guides you in the right direction.  However, results are dependent on your ability to remain consistent with the program.

Get Started Right Away

The doctors of physical therapy at BSR have extensive experience working with older adults who have experienced falls in the past.  Many have benefited greatly.  Still, some people attempt to justify or explain away their fall.  Some say, “The curb was too high.”  Others say, “The floor was wet.”  Denial of your balance problem only magnifies the danger.  A fall is a fall.  Once you have experienced one, no matter what the cause, your risk for another rises exponentially.  Take charge of your own balance, your health, and your freedom.  Get started with an exercise program that is right for you.  Give us a call and your physical therapist will help you begin and stay on track.


Neck Pain and Dizziness

Each year many people suffer from neck pain and dizziness. The number of patients who visit their doctor and the emergency room for dizziness is on the rise.  Dizziness accounts for 7% of doctor visits for people over the age of 45 and is the leading reason to see a doctor in those over the age of 65.  Most people with dizziness are looking for a straightforward diagnosis.  However,  those who present to the emergency department only receive a confirmatory diagnosis in 49.2% of cases.  The purpose of this article is to describe how a physical therapist examines a person suffering from one particular form of dizziness called cervicogenic dizziness.

Cervicogenic dizziness occurs as a result of pain originating from the neck or cervical spine. This occurs because of faulty signaling from the neck to the brain about where your head is in space.  This faulty signaling results in the sensation of dizziness. There is no gold standard test for this type of dizziness.  Instead, the diagnosis is made by excluding other causes of dizziness ranging from cardiovascular causes to metabolic causes, and inner ear causes.

Examination of the Patient with Dizziness

When performing an examination for a person with dizziness there is a 5 step process.  Part 1 includes listening to the patient’s history and determining if their symptoms are consistent with cervicogenic dizziness . Next, part 2 includes testing to see if this patient is appropriate for physical therapy.  Part 3 includes testing the inner ear. The inner ear, or vestibular system, consists of structures connecting with your brain which tell your head where it is in space.  Finally, steps 4 and 5 involve testing the cervical spine.

Testing of the cervical spine may include testing range of motion of the neck, strength of deep neck muscles, and performing a variety of special tests. These tests may include tests for motor control, the neck’s awareness of position sense and the mobility of each vertebra in your neck.  Oftentimes, an examination of one spinal vertebra (shown below) will reproduce the person’s complaints of dizziness.  A treatment plan is developed based on the results of these tests.

neck pain

Treatment of Neck Pain and Dizziness

There are various research papers showing manual physical therapy and exercise reduces neck pain and dizziness. The videos below illustrate two of these exercises.  Thankfully, research shows a year after physical therapy patients who complete these programs are able to maintain their improvements.

Final Thoughts on Neck Pain and Dizziness

Cervicogenic Dizziness is a condition described as neck pain and dizziness originating from the cervical spine. The diagnosis is made by first ruling out other problems.  Successful treatment includes manual physical therapy and exercise.  Thankfully, when a proper diagnosis is made by your physical therapist, this simple approach significantly reduces neck pain and dizziness.  Contact us today if you have neck pain and dizziness or simply have questions about which treatments are right for you.

Afraid of Falling? Try These Balance Exercises

Almost 10 million Americans report problems with balance.  About 40% of people over the age of 60 years experience problems with their balance.  One-third of adults in this age group and over half of people over the age of 75 years fall each year. Men and women are affected about equally.  Loss of muscle and changes in the vestibular and nervous systems are partly responsible for increasing falls as with age.  Thankfully you can do things to improve your balance and reduce your risk of falls.

Your eyes, inner ear, joints, and muscles all relay information to your brain.  Your brain interprets all the incoming information to determine where you are in your environment.   The brain then coordinates your response in order to maintain balance.  This is accomplished through pathways from your brain to your nerves and on to your muscles.  Existing pathways can be strengthened and new one can be created.  Performing exercise which is at an appropriate level to challenge and develop these pathways will improve your balance.  Below are 3 examples of such exercises.

Step Taps

Stand in front of a step or small step stool.  Place your hands on your hips or across your chest.  Place one foot gently on top of the step.  It is best to alternate steps with each foot.  The aim is to place the foot on the step as softly and quietly as possible without looking at your feet.  Begin by performing 10 slow repetitions with each foot.  Progress the exercise by using a higher step.

4-Square Stepping

Make 4 squares on the floor with objects such as clothing, rope, or yard sticks.  Step forward then to the side, then backwards, and then back to the starting square.  After a brief pause, reverse the direction.  Alternate directions with each reach repetition.  It is best to perform the exercise without looking at your feet.  Your stability is compromised then they head is held down.  Perform 5 repetitions in each direction.

Tandem Walk

Stand with the arms across your chest.  Step with a narrow base of support as if walking on a tightrope.  The heel of one foot touches the toes of the other foot.  Take 5 to 10 steps then pause in the narrow stance position for 5 seconds.  For a greater challenge perform the exercise both forward and backwards.  It is best to perform this exercise in a narrow hallway or near a counter in case you begin to lose your balance.

Closing Thoughts on Balance Exercises

Balance exercises must be performed frequently in order to influence your nervous system.  With consistent practice over time, balance and reaction time will improve slowly.   Don’t expect a rapid change in a few days.  In order to continue to make improvements, the challenge of each exercise is progressed over time.  Balance exercises work best when performed in conjunction with strength training.  See your physical therapist to determine which exercises are best for you.