To better understand the need for a good balance assessment, it only makes sense to address the reasons in which people have a tendency to fall. Risk factors involved in falling include, but are not limited to: general weakness/deconditioning, mobility limitations, neuropathy, as well as different pain factors including back, leg and foot pain. Each decade that passes after the age of 55, incidence of falls rise by 4-7% with the impact of falls becoming more significant as time passes.
It has been shown that if you have fallen once, you have a 67% chance of falling again within a year. When someone falls, they begin to have decreased confidence in their ability to stand, walk and navigate the challenges of daily living. The reduced confidence leads to decreased activity levels, increased weakness, and therefore an increased likelihood of subsequent falls.
The Good News
The good news is that many of the risk factors mentioned above can be addressed with skilled physical therapy treatment. With a thorough musculoskeletal assessment that can identify strength and mobility impairments, we can identify potential limitations in someone’s ability to correct a loss of balance. Often times an assessment of single leg balance, Berg Balance testing, or Timed Up and Go (TUG) can establish a baseline for improvement and establish an initial risk of falling. Once this baseline is established, physical therapy can address many of the risk factors for falling that have previously been mentioned.
Strength/Mobility limitations: People are likely familiar with physical therapy treatment to address strength deficits with the often mentioned “no pain, no gain” reputation that many people in this profession have adopted. What is not mentioned, is that research strongly suggests that muscles don’t function properly when the joints or the soft tissue itself is painful. These limitations must be addressed prior to the initiation of a balance/gait training program. If they are not, then the program is destined for failure from the beginning. Once these mobility and pain factors have been addressed, therapy can proceed with the introduction of an appropriate strengthening program. Many strength programs that are meant to improve balance remain short of truly addressing function. We will often tell patients that “they’re not likely to fall while lying down, so let’s not exercise lying down.”
Neuropathy/Spinal stenosis: These limitations are included in the same category, not because they are the same, but because the treatment approach would likely be similar. If there are pain symptoms in the legs and feet with standing and walking, or “I can’t feel my feet” then you likely are going to change the way that you move. Often times, we will see a much smaller stride and a wider stance with an attempt to limit the amount of time that you have to balance on one leg versus the other. Single leg balance exercises on a firm surface or foam surface are typically a good starting point, followed by single leg balance exercises with changes to our center of mass that can include single leg cone taps. There are many different ways to challenge and improve someone’s balance, however it is important to start with the basics and build your exercise program to promote safety and confidence.