Reducing Falls

Reducing Falls is a Joint Effort

We have all experienced a stumble, slip and trip, usually without any long-term repercussions, but for an elder the stakes can be devastating. According to the Centers for Disease Control and Prevention (CDC), each year more than one of four adults aged 65 and older falls. Falling is the number one cause of fatal and nonfatal injuries from head to toe. Every year this means 29 million elders fall, 3 million emergency department visits, 800,000 hospitalizations with 300,000 for hip fractures, and 28,000 deaths.

In 2015 the CDC reported that just medical costs related to falls were more than $50 billion dollars (1). This cost doesn’t take into account the toll a fall takes on the loss of independence and quality of life for the individual and family. This is growing problem with 10,000 American baby boomers turning 65 each day. (2)

The Anatomy of a Fall

Reducing falls begins with understanding why they happen. According to the National Academy of Sciences, a fall is an unintentional event resulting in the person coming to rest on the ground and occurs in three phases.

Phase one is the event that initiates the loss of balance (3). This is when the body’s center of mass (inches below the belly button) is displaced beyond its base of support (usually the feet, unless performing a head or hand stand!). Environmental hazards like a lose rug, an uneven or slippery surface can initiate the event. Intrinsic factors that most commonly initiate the loss of balance include weak legs, stiff joints and poor postural reflexes.

Phase two of a fall involves the failure of systems that maintain balance and posture (3). This includes the inability of the joints and muscles to detect and correct the perturbation in time to avoid a fall. Balance is maintained by sensory inputs from visual (eyes), vestibular (inner ear) and proprioceptive (joints and muscles) systems. Ankle proprioception is critical for balance and postural control. This failure is largely due to stiff joints, weak legs and poor neural systems.

The good news is that increasing joint strength and flexibility, especially at the ankles, can improve sensory and motor systems to sense and respond to the loss of balance to help reduce the chance of falling.

Phase three of a fall occurs when the person’s body hits the ground (3). The potential for injury depends on the force and direction of the fall and the strength of bones and soft tissues. Strengthening joints and muscles through a full range of motion can develop stronger muscles, ligaments and bones that are more resilient to withstand an impact. This helps reduce the chance of a broken bone, fracture or sprain. If an injury does result, it will be less severe.

One out of five falls results in a serious injury like broken bones or head injury (1). Even when there isn’t a physical injury, the fear of falling grows which also increases fall risk. Typically after a fall, elders become less active and the downward spiral of decline grabs hold and festers. Seated strengthening exercises remove the fear of falling and can build confidence in abilities to promote greater activity and social engagement.

Targeting the Root Causes of a Fall

The root causes of falls are weak legs, poor balance and reduced joint flexibility (4). Why does this happen as the years pass? The main culprits are sarcopenia and inactivity. Sarcopenia is the age-related loss of muscle and strength that begins in the third or fourth decade of life (5). Limited mobility doesn’t happen overnight but consists of several decades of a slow, insidious decline.

Research demonstrates that regardless of age, the loss of strength, balance and joint flexibility can be reversed (4, 13, 14), indicating that mobility disability and a higher risk of falling is caused more by inactivity than aging.

As elders move less, joints become stiff, rigid and painful. Muscles shrink, strength is lost as the nerves that activate them wither away along with the sensory nerves that are needed to detect and correct the loss of balance. The principle of “move it or lose it” definitely applies!

Strengthening joints through a full range of motion can improve joint flexibility, strength and balance, boosting independence and quality of life. Here’s the science to shed light on why it works.

Better Mobility Begins at the Joints

The function of a joint is to allow movement. Joints connect rigid bones and allow them to flex. Muscles surround joints and contract to do the moving. Joints and muscles create movement and maintain balance. They work together to restore balance with sensory nerves located in joints and muscles that detect a perturbation, and correct it with a muscular response to stay upright and balanced. Rigid joints lead to weak muscles and the increased risk of falling.

Strength

For a joint to function properly it needs to move freely through its full range of motion. When joints are stiff, range of motion is restricted. This reduces the amount of force that can be generated because a smaller range of muscles are engaged. Joints that can’t move well are more prone to injury and pain. People move less leading to more muscle atrophy further compounding the loss of strength.

Stability

Ligaments connect bones to bones and surround joints to provide stability. With restricted movement, ligaments become weak, compromising joint control, power production and increase the risk of injury.

Proprioception & Balance

Proprioceptors are sensory nerves that live in joints, connective tissue and muscles whose function is critical for balance. These sensory nerves create a sense of body awareness so you can know where your body parts are without looking. This is how you can walk without looking at your feet.

Proprioceptors are constantly sending signals to the brain about joint position and movement. Over time, as movement is practiced, neural activation of muscles becomes stronger and the brain makes body maps. This is how we can move throughout our day without thinking about it, practice and get better at playing golf or dancing. Toddlers fall a lot until their proprioceptive system is strengthened and refined by moving constantly. Before you know it, they are running, jumping and hard to keep up with!

Proprioceptors are responsible for detecting and correcting the loss of balance. Joints and muscles, especially at the ankles, send signals to the brain, along with input from the visual and vestibular (inner ears) systems, for lightning fast processing. Joints that move freely send complete information so muscles can respond by contracting at the right time with the right amount of strength. Stiff joints compromise balance since they can’t sense the full range of information. Without good information, muscles have a difficult time responding correctly to avoid a fall.

Training Proprioceptive Power

Just like a toddler, being active in a variety of activities strengthens proprioceptors. They are located in joints, connective tissue and muscles and are sensitive to changes in length, muscle contraction and speed (19). By strengthening joints through a full range of motion, the full range of proprioceptors can be activated to effectively improve balance control.

Mobility Starts from the Ground Up

Mobility and balance begin the moment feet touch the ground. Ankle strength and flexibility play a critical role in balance control (7, 8, 9, 11). Feet and ankles are lush with proprioceptors and are busy sensing and sending frontline information to the brain. Strong ankles that move freely can best sense and respond to the ever-changing environment with feet and leg muscles contracting at the right time to stay upright and balanced.

Biomechanics and the Joint Connection

All joints are connected and work together for movement. Ankles are the base of the entire kinetic chain, influencing the function of all the joints stacked above. Stiff and weak ankle joints negatively impacts the function and movement of all the joints above (11).

Ankle dysfunction impairs knee and hip function and can cause pain which spells disaster for good mobility (12). Pain at one joint is usually due to a problem at the joint above or below (11). To improve the function of the entire body, start from the ground up. When building a house, a strong foundation is needed or the walls can crack and eventually fall. The same principle applies with locomotion.
Range of motion training can improve the way joints move and reduce pain by releasing synovial fluid that lubricates the joint. Synovial fluid also nourishes cartilage that cushions the ends of bones for shock absorption and smooth, frictionless movement. Overall function can improve as metabolism and energy production is boosted with more nutrients and oxygen being delivered. The body’s innate healing capacity can be activated and inflammation can be reduced for greater pain relief.

That’s the science why improving joint flexibility from the ground up can increase strength and balance to effectively reduce fall risk.

A comprehensive program to reduce falls should also address the components of mobility and deficits in key motion and muscles seen with elderly fallers.

Mobility Components

Moving throughout the activities of daily living and engaging in a variety of recreational and social activities requires strength, power, endurance, flexibility and stability.

Strength is the ability to exert force and is the foundation of all function. Without adequate strength, even the most basic tasks can become difficult, if not impossible without assistance.
Power is the ability to use strength quickly. We use power to get up from a chair or climb stairs in a short period of time. Power is most closely associated with the successful performance of daily activities. With ½ second to respond to a perturbation, power is needed to avoid a fall.

Endurance is the ability to use a low level of strength over prolonged periods of time. Housework, gardening, cooking and shopping are some activities that demand stamina. When muscles become fatigued it becomes more likely to experience a trip or stumble while out running errands. When dorsi-flexors become fatigued (the muscles that raise toes while walking), seniors commonly “catch a toe” that can lead to a fall.

Flexibility is the ability to move joints through a full range of motion to move well.

Stability is the strength needed to control joint position and produce power. Joint stability comes from strong ligaments and muscles that surround joints.

Key Motions and Muscles Affecting Balance

Research shows the elderly fallers have impaired ankle and hip ranges of motion (12) and weak muscles needed for balance. Those muscle groups include:

  • ankle dorsi- and plantar flexors (flex & extend)
  • ankle invertors and evertors (15, 16) (inward & outward)
  • knee extensors and flexors (straighten & bend)
  • hip abductor and adductors (14) (leg out to side & together)

Summary

It can be overwhelming trying to address the root causes of falls including joint strength and flexibility, lower body strength and balance plus all of the components of mobility to reduce fall risk. The MoveMor™ Mobility Trainer makes it all simple.

MoveMor™

The patented MoveMor™ Mobility Trainer is the first-ever multi-directional resistance system that is designed to gently strengthen ankles, knees and hips through a full range of motion to restore functional mobility, quality of life and reduce fall risk.

Evidence-Based

More than ten clinical studies continue to prove these benefits in as little as 10 minutes, 1X/week:

  • Better Balance
  • Increased Strength
  • Greater Ankle Flexibility
  • Increased Independence
  • Improved Continence
  • Reduced Fall Risk

Safe

Strengthening from one safely seated position removes the risk and fear of falling.

Easy

Just sit, strap feet in and move through a comfortable, pain-free range of motion.

Effective

Seniors feel their legs getting stronger, enjoy using MoveMor™ and studies prove it works.

Little Effort, Big Benefits

Unlike any other product, greater mobility, quality of life and independence in 10-20 minutes, 1-3X/week.

Saves Time

  • One simple system helps older adults fall less and live more
  • Without any reconfiguration, move seamlessly between ankle, knee & hip exercises
  • Turn-key progressive programming provided including videos

Full Range of Motion can Improve Joint Function & Mobility

  • Helps relieve pain by lubricating joints and nourishing cartilage; restore function by lengthening and strengthening ligaments, tendons and muscles; improve balance by fully engaging sensory nerves within and around joints for better body-brain communication
  • Joints work together and to improve function of the entire body, start from the ground up
  • Quickly and easily improves ankle strength and flexibility, vital for balance and fall risk reduction

Versatile

  • Lightweight and compact for small treatment areas, portable for patient visits and home use
  • Strengthens key muscles affecting balance
  • Seven color-coded resistance levels meet the needs of a wide range of ability levels
  • Group sessions promote physical, mental and social wellness

Progressive Programming

  • Exercise programs & videos at https://resistancedynamics.com/exercise-programs/
  • Five progressive programs address the components of mobility including:

 

Phase Program Purpose
1.      Strength

Take 10 to MoveMor™

(10 exercises, 10 reps, 10 minutes)

Joint mobility and gentle strengthening

2.      Mobility Better Mobility with MoveMor™ Fuller range of motion to move better, enhance gait, balance
3.      Stability Strong & Stable Joint strength, control and balance
4.      Power Power Moves Quicker reflexes, dynamic balance, enhance ADLs, reduce falls
5.      Endurance Dancing with the Stars Walk, move and stand longer, fall less

The Bottom Line
The MoveMor™ Mobility Trainer and progressive programming makes it a highly effective, safe and simple solution to reducing falls by addressing the root causes of weak legs, poor balance and reduced ranges of motion. Research suggest that greater ankle strength and flexibility may result in more consistent balance improvements and falls reduction (15, 17, 18). Our studies show that is true!
Clinical studies continue to show better balance, increased strength, greater ankle flexibility, increased independence, improved continence and fall risk reduction. We are not aware of any other product and/or program that can birth these benefits in such a brief time with minimal effort.

Enhance mobility, quality of life and prevent a fall today!

Purchase MoveMor™
MoveMor™ Mobility Trainer includes:

  • Frictionless board
  • Foot Beds
  • Straps & Strap Extenders
  • Exercise Guide
  • 5 Progressive Programming Videos
  • Four Sets of Color-coded Tubing
Purchase MoveMor™
MoveMor™ Mobility Trainer includes:• Frictionless board
• Foot Beds
• Straps & Strap Extenders
• Exercise Guide
• 5 Progressive Programming Videos
• Four Sets of Color-coded Tubing
Level Light Heavy
Beginner Yellow Orange
Intermediate Green Blue


Retail: $339.99
Call for Discount Pricing

  • Resistance Dynamics: 303.515.7070
  • Fabrication Enterprises: 800.431.2830
  • Direct Supply: 800.475.5441
Seated Exercise for Standing Mobility | Surprisingly Simple, Amazingly Effective

 

References

  1. https://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
  2. https://www.cdc.gov/features/older-adult-falls/index.htmlgg
  3. National Academy of Sciences 1992. Falls in Older Persons: Risk Factors and Prevention https://www.ncbi.nlm.nih.gov/books/NBK235613/
  4. Adams, K et al 1999. Aging: Its Effects on Strength, Power, Flexibility, and Bone Density https://pdfs.semanticscholar.org/93a1/cca5c206e8a7af51875bd6e402bdb9a1dc9a.pdf
  5. Mobasheri, A & Mendes, AF. Physiology and pathophysiology of musculoskeletal aging: current research trends and future priorities. Frontiers in Physiology 2013; 4:73.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3620548/
  6. Lee, A et al 2013. Preventing Falls in the Geriatric Population. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3854807/
  7. Menz, HB, Morris, ME, Lord, SR (2005). Foot and Ankle Characteristics Associated With Impaired Balance and Functional Ability in Older People, The Journals of Gerontology Series A, volume 60, 1546–1552. https://academic.oup.com/biomedgerontology/article/60/12/1546/558012
  8. Bok, S., Lee, T.H., Lee, S.S. (2013). The Effect of Changes of Ankle Strength and Range of Motion According to Aging on Balance, Annals of Rehabilitation Medicine, volume 37(1), 10-16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604218/
  9. Spink MJ, Fotoohabadi MR, Wee E, Hill KD, Lord SR, Menz HB (2011). Foot and Ankle Strength, Range of Motion, Posture, and Deformity are Associated with Balance and Functional Ability in Older Adults, Archives of Physical Medicine and Rehabilitation, volume 92, 68-75. https://www.ncbi.nlm.nih.gov/pubmed/21187207
  10. Han J, Anson J, Waddington G, Adams R, Liu Y : The Role of Ankle Proprioception for Balance Control in relation to Sports Performance and Injury. BioMed Research International 2015, Volume 2015, Article ID 842804, 8 pages https://www.hindawi.com/journals/bmri/2015/842804/
  11. Cook, Gray 2010. Movement: Functional Movement Systems: Screening, Assessments and Corrective Strategies. Aptos, CA: On Target Publications
  12. Friel, K. et al, 2006. Ipsilateral Hip Abductor Weakness After Inversion Ankle Sprain. Journal of Athletic Training 2006, 41(1): 74-78.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421486/
  13. Chiacchiero M, PT, DPT; Dresely B, DPT; Silva U, DPT; DeLosReyes R, DPT; Vorik B, DPT : The Relationship Between Range of Movement, Flexibility, and Balance in the Elderly. Topics in Geriatric Rehabilitation 2010 Vol. 26, No. 2, pp. 147–154 http://downloads.lww.com/wolterskluwer_vitalstream_com/journal_library/tgr_08827524_2010_26_2_148.pdf
  14. Orr R, Raymond J, Fiatarone Singh M : Efficacy of progressive resistance training on balance performance in older adults : a systematic review of randomized controlled trials. Sports Med. 2008;38(4):317-43.
  15. Spink MJ, Fotoohabadi MR, Wee E, Hill KD, Lord SR, Menz HB : Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Arch Phys Med Rehabil. 2011 Jan;92(1):68-75.
  16. Bok SK, Lee TH, Lee SS : The effects of changes of ankle strength and range of motion according to aging on balance. Ann Rehabil Med. 2013 Feb;37(1):10-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604218/
  17. Menz HB, Morris ME, Lord SR : Foot and ankle risk factors for falls in older people: a prospective study. J Gerontol A Biol Sci Med Sci. 2006 Aug; 61(8):866-70.
  18. Shumway-Cook, A. and Woollacott, M.H.: Motor Control: Translating Research into Clinical Practice, Wolters Kluwer, Philadelphia, PA, USA, 5th edition, 2017.
  19. Ribeiro, F & Oliveira, J. Aging effects on joint proprioception: the role of physical activity in proprioception preservation. European Review of Aging and Physical Activity, October 2007, Volume 4, Issue 2, pp 71–76. https://link.springer.com/article/10.1007/s11556-007-0026-x