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This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2023. For the original video go to https://www.youtube.com/watch?v=ULqk9PpG4qk&t=235s
Brad: Greetings, greetings. Today, we have a very interesting episode. We're going to talk about the hundreds of people that we have worked with with broken hips. Now, I've narrowed it down to the two biggest reasons for falls causing these hip fractures, and we will get into those in just a minute.
Mike: So in this video, we're going to show you two different balance exercise routines that you can do at home to help prevent these falls from happening, and it should only take a few minutes.
Brad: All right, now over the decades, Bob, Mike, and I have all worked with these people with broken hips, and we always talk to them and they're more than happy to share their story of how their hip was fractured. It's so repetitive where what happens is someone is getting out of a chair, they stumble, or they're getting up, there's activity in the room, and they're not paying attention to where their feet are, or they're walking, and a rug is caught, a throw rug or their pet is on the floor, and they're shuffling their feet, and down they go as a result of that shuffle. These are all things that are so common, and we hear them time and time again, and I think we can get onto the next segue, Mike.
Mike: Having poor balance is not a good thing, obviously, but the real problem is when you fall and then you fracture something because then you're going to be weaker, and your balance has become even worse for a period of time. So in this video, we're going to show you some balance activities that you can do to help prevent these falls from happening in the first place.
Brad: Right, and it's going to happen to all of us. Our walking, which we call gait,
and our balance get worse with age, just like vision or getting gray hair. However, the good news is we can show you some things to correct it and really minimize the risk of falls. All right, we're going to break down the three most common causes of these falls in a little more detail as a therapist looks at it.
Mike: Number one is tight ankles. Oftentimes, if you can't lift your foot up and you have a tight ankle, it's harder to walk, and you probably aren't walking in a nice, correct pattern, increasing your risk of falling.
Brad: Right, that's where even just a crack or a lifted sidewalk, a 1/2-inch little lift can catch that on your toe because you're shuffling, not dorsiflexing enough, tight ankles, down you go. The next thing is poor gait habits. It segues right into that. That's the shuffling. When you get old, you ever find yourself shuffling along, and you think, "What's goin' on?" You have to pay attention to what's going on down there. Get those feet moving, and lifting, and things will go much better.
Mike: And the third common cause is poor balance or proprioception deficits. So that means maybe you have peripheral neuropathy, or you don't have good sensation in your feet, and you can't feel the ground, as well. That's a common cause of falling.
Brad: And that's where a lot of people that are diabetic, which is more and more common all the time as we age, that's where that proprioception and that neuropathy is a big deal. We want to address that. All right, one of the big solutions that can really eliminate falls is simply using an assisted device, in other words, a cane or a walker or some kind of walking stick. That's really helpful and eliminates a lot of the exercises necessary. However, there are people in that gray area, where they don't really want to use an assisted device, and maybe they don't need it, but they're in that area. So Mike, do you have anything to say about these devices?
Mike: These devices often will allow you to not shuffle, as we talked about earlier, and correct your walking pattern. So just using one, even though you may not feel like you need it, it's better to have one and not fall than to not have one and take a tumble.
Brad: Right. Again, a cane is one thing. A walker is a very big difference because they are more cumbersome to take around throughout the community. So that's where these exercises really are advantageous when you do not want to negotiate a walker. All right, the first exercise, the routine, what we're going to do is address the ankles, those tight ankles we've already talked about. Simply, you start out in a seated position, lift your feet up off the floor so they’re in the air, and you pull up, dorsiflex, and push down. Really focus on pulling the toes up. That's the most important part because that's where those falls happen when you cannot pull the toes up. You'll feel a stretch. Do 10 of these.
Brad: You can do these throughout the day, every now and then. Just do 10 of them at least five times a day. It's very quick. Now, the next thing you're going to do to strengthen the ankles once you stretch them is done in standing. Have something to hold onto to balance, a chair, a cupboard, something of that nature.
Mike: Then you're going to do some ankle exercises. So you're going to go up on your toes, and then you're going to rock back on your heels, and you're going to do 10 to 20 repetitions each way. This is going to work on your balance a little bit. It's going to work on your strengthening, and it's going to work on your range of motion within your ankles. So you're getting three positives out of one exercise.
Brad: One word of caution with this is when you are rocking back on your heels it's really critical that you have something solid to hold onto because you may want to fall backward, particularly if you already have a balance problem, and that could result in a broken hip or something of that nature. So really make sure there is something solid to hold onto. Stay safe. All right, the second routine, this is really critical. This is to stop that shuffling that you may not even be aware of until that trip comes along, and the first thing we're going to do is you need some sort of support for balance and safety. You may just use a cane or a stick. I have the Booyah Stik, or just a chair but, again, a solid chair, a cupboard, a solid counter base or a sink where you can put your hands around the sink is really ideal because it really gives you support in directions, especially backward. So the first thing is simply marching.
Mike: So this is going to work on your balance a little bit. This is going to help with the shuffling because, if you pick your feet up more, you're less likely to trip.
Brad: Right, and really get those knees up as high as you feel comfortable because, again, we're going to do this 10 to 20 repetitions. The whole idea is to get your mind aware of what your legs are doing. If you want to work your balance, simply hold it up and go slower so you're balancing on one leg a little bit. Again, if you feel like you're really wobbly, that's too much. You need to have more support. It should just feel like your ankles are working a little more, and you feel a little wobbly, but you feel safe. We want to stay safe with all of these. Now, we're going to go on to the next start by stepping sideways, which is a really big thing that makes falls. Okay, now we're going to go on to sidestepping because this is a very high or frequent cause of falls. We're stepping sideways. We don't pick up the foot, and down you go right on the hip, and there you got a fracture. So if you have something to hold onto, like a handrail, do that, or a countertop that you can hold onto, that works fine. If your balance is fairly good and you feel comfortable using a stick or cane, that's fine, too. Now, we're going to work sidestepping, and actually look down and see what your feet are doing. Some people are not aware of what's going on down there, and they're not aware that their feet are only 1/8 inch off the floor or maybe even dragging because you can't feel it if you have diabetic neuropathy. So I want you to really make note of picking those feet up. Go about four or five steps to the right, four or five steps to the left, and repeat that a number of times, and it's one of those things that, after you do this a number of days in a row, that muscle memory is going to kick in, and you'll start doing that without thinking about it, minimizing your risk for falls. A very important part of this.
Mike: And the last option is a little more advanced. It's going to help with stairs and especially lifting those feet up and prevent the shuffling. So you're going to need some type of step as Brad has here or a staircase. Make sure you're using rails or some type of support like Brad is, and you're going to simply bring one foot up, tap the step and then bring it down. Now, you can just work one leg at a time. Try to do 10 repetitions and then switch. If this seems easy, you can try alternating. So you're going to go right and then left. This is a little more challenging because each time you have to shift your weight to the other side, working on your balance. What do you have to say, Brad?
Brad: Well, if you feel more advanced and you want to get a little more exercise, as well as a balance challenge, go up to the next step and do that. Again, you need to feel stable and not unsteady when doing those. So don't overdo it. Good judgment is absolutely crucial, so whichever step you want. Yeah, this one I really like because, again, it doubles it. There are a lot of people that do, when you go up a stairway, you catch your toe because you didn't lift high enough, and then you stumble forward. So very good, work that one, if it's available. Take care and enjoy.
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