When 44-year-old Pam Toto found herself sprawled on the concrete one summer evening last year with a shattered left wrist, she was, to say the least, surprised. Toto, an occupational therapist at the University of Pittsburgh, has been helping patients improve their balance for 20 years.
"I was wearing high heels and the back of my shoe caught in a stair," Toto says. It was dark, she did not see that the steps had a lip that could catch her heel, and there was no railing on the stairway. Toto tripped down four or five steps, then careened another 20 feet before falling to the pavement, shattering her wrist. "I have spoken on falls nationally," she says, "and after that I was afraid to go down steps."
It's possible that in the same situation, almost anyone could have tumbled and ended up with a similar injury, but Toto doesn't think so: "If I were 15 years younger, I wouldn't have fallen."
A Risk for the Middle Aged, Not Just the Elderly
Most of us see dangerous falls as a risk primarily for people over 65, but health professionals like Toto know better. According to the federal Centers for Disease Control and Prevention, about 5 percent of people age 45-64 needed to see a physician after a fall in 2010. The roots of disequilibrium often start long before age 65, and failing to realize that your footing is not what it once was can have dangerous consequences. "You’re on the ground already and that's when you realize you've lost your balance," says Dan Rootenberg, president of SPEAR Physical Therapy in New York City, who specializes in vestibular rehabilitation (helping people who suffer from dizziness or vertigo).
If you want to avoid finding yourself face to face with the sidewalk one day, the time to take action is now. "Consider balance, like strength and endurance training, as one of the pillars of your fitness program," says Mike Ross, exercise physiologist at Loyola University Health System’s Gottlieb Center for Fitness near Chicago.
How Stable Are You?
The experts suggest you ask yourself these questions to gauge your balance and begin to assess your falling risk:
- Have you changed your approach to any of your normal daily activities, such as getting dressed? Maybe you sit down to put your pants on now, or you lose your footing a little when you pull a shirt over your heard with your eyes closed. Have you come to prefer baths to showers? Are there any pastimes you've given up or engage in differently? Any of these may be a clue that you need to address balance issues. "One of my clients in his 50s stopped playing golf because of an embarrassing slice," says physical therapist Ryan Cummings of Fox Rehab in Cherry Hill, N.J. "He just couldn't shift his weight."
- Has your walking changed, even subtly, compared to a year or five years ago? For example, are you starting to list in one direction as you stride? Similarly, do you have to give more thought to stepping onto a bus, or onto escalators, than you once did? If your gait has changed, says Dr. Joe Verghese, a neurologist at Albert Einstein College of Medicine in New York City, that indicates important changes in your stability that might not emerge in a clinical test.
- Have you had falls, or near falls, in the past year? "When people catch themselves from falling, they don't call it a fall," Toto says. "They say, 'I got down safely.' They're not aware their balance has declined."
- Be honest: Are you afraid of falling? If the answer is yes, it probably means you are at greater risk of falling because you're aware that your balance has declined. "Most people who admit to a fear of falling haven’t actually fallen," Toto says.
- Think about other factors that might be affecting your footing, like an ankle sprain that has not properly healed and may need more attention, or a decline in vision. "It's not necessarily a balance problem," Verghese says, "but you should get checked out. Maybe you just need a new prescription for your glasses.”
How to Test Your Balance
You can use these two tests to gauge the state of your balance. If you fail either of them, ask your doctor for a referral to a physical therapist who can give you a professional assessment.
- Stand on one foot. Using a timer, or asking a friend to time you, see if you can hold the position for 30 seconds. Then try it with the other foot.
- Stand with your feet together for 30 seconds. If you can remain statue-still, you're doing well. If you sway forward and back, or side to side, you may have a problem.
At an assessment, a physical therapist will work to pinpoint the cause of disequilibrium, which could be the vestibular system (the inner ear); proprioception (your ability to sense where you are in space through feedback from sensors in your joints); or muscle imbalances. A therapist will also ask about your drug and medicine history. Generally, if you are taking more than five medications, you may be at greater risk of falling.
(MORE: How to Avoid Falls)
A Checklist for Improving Your Balance
- To improve your balance, you need to challenge it in a safe, controlled manner. Stand on one foot by the kitchen counter. (If you feel wobbly, hold on.) See how long you can hold the position without support. As you get stronger, you should be able to hold it for a few seconds, or longer. You should improve with practice. When you can easily stand on one leg for 30 seconds, try it with your eyes closed. When that becomes easy, try it while standing on a soft mat.
- Keep your legs strong. A good exercise is to get up and down from a seated position in a chair 10 or 15 times, Ross says.
- Dance! A recent study conducted by Verghese suggested that long-term social dancers have better balance and gait than other adults.
- Try tai chi or Feldenkrais lessons. The Feldenkrais method employs simple, easy movements that can help you re-organize your body motion habits so they are easier and more efficient. You can learn more from the Change Your Age program by Frank Wildman.
As for Dr. Toto, she has thrown away the shoes she was wearing when she fell, and she now takes off her heels whenever she descends a staircase in the dark.