One friend has started calling herself a “tippy old lady.” She fell recently getting up from a desk chair.
Another one has taken a couple spills on slushy but level pavement. A little slick spot that wouldn’t have even registered 20 years ago and whoosh, she was down.
No falls so far for me. But I have to admit that when I crouch to work in the garden or tie my shoe, I’m a little wobbly getting up.
I would have expected this in my mom and her friends, who are in their 80s. But we’re in our mid-50s, or just barely past 60. What is going on?
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Staying Strong is Key
Balance issues at this age often come down to systems that don’t fire as quickly as they used to and a few key muscles that most of us neglect, says Dr. Thomas Ripperda, a physical medicine and rehabilitation specialist in the Balance and Dizziness Clinic of South Dakota’s Avera Health.
“There are a couple of intrinsic things that happen with our muscles” as we age, Ripperda says. One is that muscle fiber gets replaced with fat, so muscles get weak unless we give them a regular workout.
The other change is in the ratio of fiber types in our muscles. We lose quick-twitch, glucose-burning, Type 2 fibers — the kind a weightlifter uses to do a clean and jerk — and we replace them with slow-twitch, aerobic, Type 1 fibers, the kind that keep a distance runner going for the long haul.
“When we need to make quick adjustments” — shifting our weight when we’re off balance or catching ourselves before we fall — “we just don’t have that same power that we did when we were younger, unless we continually condition our muscles to maintain that [higher Type 2] ratio,” he says.
Nerves change over time, too. “We’re not able to conduct electrical signals quite as fast. And where that becomes important is if your ankle starts to twist or turn, that input isn’t getting to your brain or your spinal cord fast enough to make quick adjustments,” Ripperda explains.
Finally, most of us neglect core conditioning. In day-to-day activities, we aren’t engaging our core muscles, the ones in our lower backs and abdomens that are the basis of good posture and movement, he says.
While an out-of-shape core was offset by lots of Type 2 muscle and quick-firing nerves when we were young, “as we get older, we can’t compensate like that,” Ripperda says, “and that’s where we start running into problems.”
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You can begin addressing these problems, Ripperda says, by “bridging” to strengthen the back. Lay on your back, knees bent and close together and feet close together on the floor. Then lift your butt and hold your thighs and trunk in a straight line for 30 to 60 seconds. “That’s a really easy way to strengthen low back and buttock and hamstring muscles,” he says.
He also suggests a position similar to a pushup for strengthening abdominal muscles. Lay on your stomach on the floor, then hold your trunk up off the floor by balancing on your knees and your forearms, with your elbows lined up under your shoulders. Don’t get up into a crawling position. Keep your legs mostly straight and low to the floor, using your knees (and/or toes) as a point to balance on.
General Strength Training
Weight training or resistance-based workouts will help you keep more Type 2 muscle fiber. Ripperda says they can help in other ways, too.
While you can’t change the speed at which your nerves work, you can “alter the structure of the joint itself, so it actually sends more [nerve] signals,” he says. Strength training “can also help in ‘proprioception,’ a fancy term for being able to determine where our joints are in space.”
Ripperda's advice: Stand near a wall (in case you lose your balance), then raise one knee and balance on the other foot. Make it successively harder for yourself. Put a couch cushion on the floor and first stand on it with both feet, then on one foot, then on both feet with your eyes closed, then on one foot with your eyes closed.
Improving at Any Point
I worry about what being “tippy” could mean in our not-so-distant futures: Moving out to avoid the stairs in a two-story house? Being afraid to travel?
So it’s good to hear Ripperda say, “You can make a substantial improvement in your balance and coordination through strength training and working on position sense.” Balance, he adds, is “something you can improve at pretty much any point in time.”
Denise Logeland is a longtime business writer and editor whose beats have included the health care industry and financing for medical technology start-ups.