Life is all about balance. Good and evil, chaos and order, sweet and sour, whiskey and water. Put simply, balance is the ability to cope with the force of gravity and not fall over. As with many skills that we develop in childhood, there is a tendency for balance to deteriorate as we age, and whilst nobody likes to see children fall, they are more likely to bounce, whereas adults hurt themselves. In cold financial terms, falls by the elderly result in significant costs and burdens to the health services. Just what is it that makes older people more susceptible to falls, and what can we do to mitigate against that?
Balance and ageing It’s estimated that the pressure receptors and proprioceptors in the joints, muscles and tendons of the lower leg are responsible for about 70 percent of balance in healthy individuals. While there have been other, more ethical, studies since, legend has it that in the days of the Soviet Union, an experiment was done to work out how vision, the vestibular system and the legs themselves contributed to balance. The story goes that when a group of people were asked to walk down a hallway blindfolded, the risk of falling went up by less than 20 percent. When the vestibular system of the inner ear was somehow disabled, the risks increased by a similar amount. Our Soviet comrades, wanting definite answers quickly, then injected an anaesthetic into the subjects’ feet and legs. Perhaps unsurprisingly, the risk of falling increased enormously, and the conclusion was reached that the legs were pretty important. Not the kind of research you’d get funding for these days, but fascinating nonetheless! As we age, the muscles of the leg tend to shorten and weaken, reducing range of movement at the ankle, thus removing the ankle-sway segment of balance and the ability to react quickly. Other co-existing illnesses may have an effect on balance: diabetes can damage the peripheral nerves, low blood pressure and vertigo cause dizziness, and breathing difficulties increase muscular tension. A history of injury in the foot and ankle can impair balance, either by stiffness or reduced proprioception (awareness of the position and movement of the body). Similarly, impaired foot mechanics (read bunions or very stiff feet) such as those more common in older populations, will impair balance.
Improve your balance What can be done to improve and maintain balance? Research has shown that strength training in older populations reduces the risk of falls, while also having the added benefit of maintaining bone density, which may reduce the risk of fracture if you do fall. Additionally, remember balance is a skill, and practice makes perfect. If you consider the skills of walking and running as being the most physically difficult thing that most of us do day-to-day, and break those movements down further, the dangerous part of walking and running is the part where you are standing on one foot. So, practice standing on one foot! To make it harder, remove the visual input from the system: close your eyes. A healthy adult should be able to balance for 30 seconds with their eyes open, and 15 seconds with them closed. If it’s difficult, hold on to a chair to begin with and gradually reduce the amount of pressure you put through them. Maintaining ankle range of movement is crucial, remember: if you don’t use it, you’ll lose it. Exercise classes such as yoga and tai chi help to improve balance and movement, while also being a great social gathering. Which fits that most important of life’s balancing acts, work and play.
Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.
This post first appeared in The Mayo News