While there are many reasons why people are at an increased risk of falling as they age, today’s post is going to focus on the role of flexibility in preventing falls.
I have briefly touched on some of the reasons why we are at an increased risk of falling in other posts and will provide more detail in future posts, but for now, let’s just group them together in a few categories:
- Nutritional imbalances
- Nutritional deficiencies
- Lack of physical activity
- Lack of strength and power
- Osteoarthritis
- Poor flexibility
- Postural problems
- Neural feedback issues
- Vision impairments
- Medication side-effects and interactions
As you can see, there are quite a few factors that can result in the loss of balance and increased likelihood of falls. More often than not, in fact, there are probably multiple contributing factors rather than a single cause, which can make the solution increasingly difficult to narrow down.
So what can we do?
There are a number of options that we can take to address the aforementioned reasons for falls. We can modify our diet to address the nutritional imbalances and deficiencies and, while I am not a nutritionist, I will certainly provide some information regarding this in future posts. Likewise, as I am not an optometrist or a physician, I cannot speak to the impairments in vision that you may be experiencing or the side-effects and interactions associated with the medications that you may be taking. I highly recommend that you speak with the proper medical provider to address the concerns that you may have in these areas.
What I can offer you, however, is a proven way to increase your physical activity, increase your strength, power, balance, and flexibility, and maybe even, along the way, help with your osteoarthritis and postural problems.
How do I start improving my flexibity and preventing falls?
First, you want to start an exercise regimen that will increase your flexibility while also improving your strength, power, and balance. This includes proper, focused, stretching and targeted exercises on the specific muscles and systems that are vital to preventing falls.
Poor Flexibility, Posture, and the Preventing Falls
Remember the song lyrics that teach the concept that all body parts are connected? “The toe bone is connected to the foot bone; the foot bone is connected to the heel bone….” Because tight muscles in the neck, trunk, hips, and lower extremities are all connected in some way, tightness can lead to postural changes that can change a person’s center of mass, usually moving it behind them.
When the center of mass is behind a person, it makes it easier to fall backward.
Falling backward in mature adults can lead to compression fractures of the wrist, spine, pelvis, and hips.
A lack of flexibility of the connective tissues tends to limit motion in the joints of the ankles, knees, hips, and trunk which affects a person’s posture, walking patterns, bending, getting up and down from a chair, getting into and out of bed, and other functional activities.
Poor posture can contribute to falls because the center of mass moves away from neutral and puts a person more at risk because the muscles are not operating at their optimum length and strength. One of the unseen side effects of prolonged weakness, stiffness, and postural deformities includes wedging of the vertebrae of the spine known as Kyphosis. When the bones become wedge shaped, they are more at risk to fracture, particularly if someone falls. Osteoporosis is a common term used to describe a weakening of the bones making them more vulnerable to fracture. Wedging is often associated with osteoporosis and poor posture.
Stretching exercises are important as they can lengthen and strengthen the muscles involved and restore their center of mass closer to neutral or central, which is important for preventing falls.
How Did I Get to This Point?
For those 60 years and over, a lack of flexibility may have occurred from your occupation. For example, if you performed your job duties while sitting for most of the day, it is natural that certain muscle groups would become shortened and tight. Commonly, the hip flexors (Iliopsoas), knee flexors (Hamstrings), and ankle flexors (Gastrocsoleus) all become shortened after years of sitting for hours in a chair.
If you then go home and sit in front of the TV to relax from work, you are assuming the same posture you just maintained for 6-10 hours, which compounds the shortening problem. For others, it may be their shoulders and neck become stiff from not reaching overhead enough during the day or not turning the head due to staring at a computer screen in front of them year after year. Joints and muscles stiffen up if we do not use their full range of motion on a regular basis.
Another contributing factor to excessive tightness of the shoulders and neck is poor sitting posture. Muscles attach to all sides of the bones in the head, spine, pelvis, and extremities to provide stability, counterbalance, movement, as well as keep the body upright. Sitting in a rounded posture thrusts the head forward affecting the cervical, thoracic, and lumbar spine over time, causing the cervical spine (neck) to extend reflexively, allowing our eyes to look forward instead of at the floor.
When you sit like this, the shoulder blades naturally move forward on the ribs creating a rounded shoulder posture. If you maintain this posture for long periods of time, certain muscles will lengthen too much, others will shorten too much, and eventually your center of mass will be affected in a negative way. The negative impact of this is that imbalance results as the muscles that lengthen too much become weak, the short ones become too strong and imbalance results.
Improving Flexibility
While there are different theories from the researchers as to how exactly it is beneficial, the research unquestionably points to the fact that static stretching of at least the lower leg muscles prevents muscle injury and improves muscle condition. The benefit of a consistent stretching program over the course of many weeks, and continued throughout one’s lifetime, is in an increased range of motion. This increased range of motion is vital to maintaining one’s balance.
Types of Stretching
Stretching can really be grouped into four different categories or types:
- Static – placing a muscle and connective tissue in a lengthened position for a prolonged period of time, usually 30-60 seconds.
- Ballistic or bouncing – placing a muscle and connective tissue in a lengthened position and then adding a gentle rhythmic bounce while holding for 30-60 seconds.
- Dynamic or functional – actively moving the antagonist or opposing muscle group, therefore, this type of stretching is not held for a prolonged period of time. Example: Marching with knees straight and touching toes with fingertips requires the quadriceps to contract and the hamstrings to lengthen. Often performed prior to an exercise or sporting event.
- Proprioceptive Neuromuscular Facilitation (PNF) – placing the muscle in a mildly lengthened position then adding muscle contraction of the opposing muscle group for 3-20 seconds followed by relaxation into a new lengthened position and held for 30 seconds. This has been shown to inhibit the target muscle group which will allow it to then lengthen farther. Another type of PNF is known as contract-relax-agonist-contract. In this type of PNF the person places the target muscle group in a mildly lengthened position, then contracts the target muscle group for 3-20 seconds followed by relaxation and then contracting the opposing muscles for 3-20 seconds, then stretching into a new lengthened position and holding for at least 30 seconds.
Which Type of Stretching Program Should I Use?
Static and PNF stretching have been shown to be superior in improving joint range of motion but may not be as effective prior to resistance training or endurance performance. Dynamic stretching is used frequently as part of a warm-up routine prior to participating in a sporting event. Ballistic or bouncing is not recommended by any of the research groups because bouncing excites the neural response instead of relaxing it and therefore the muscle does not elongate and lengthen. I discourage our patients from using ballistic stretching in the office or at home.
The conclusion of many researchers is that the benefits of the stretching program, irrespective of which method one uses, only last from a few minutes to a few days; that is why a person needs to continue to stretch 5-6 times per week for 12 weeks, then once the desired range of motion exists, the frequency can be reduced to 2-3 times per week.
What Muscles Should I Stretch?
A stretching program should address the following:
- Calves
- Hamstrings
- Hip Flexors
- Low back and buttocks
- Knees
- Quadriceps
- Tensor Fascia Latae (TFL) – Side of trunk and hip
- Hip abductors
- Stomach muscles
- Shoulder muscles
Other Frequently Asked Questions About Stretching
Below are several of the frequently asked questions and responses that I receive when initiating a stretching program with a patient:
- How many times should I repeat a stretch in order to get positive results? – Answer: A minimum of 3 repetitions.
- How long should I hold a static stretch? – Answer: 30-60 seconds per stretch with a 10 second rest period in between. Better results occur when held for more than 60 seconds in those over 50 years old.
- How many times during the waking hours should I stretch? – Answer: A minimum of 1-2 times per day.
- How many days per week should I stretch? – Answer: 5-6 times per week for 12 weeks, then 2-3 times per week for life.
- How intense should I stretch? – Answer: Moderate discomfort should be felt in the target muscle during the 30-60 second stretch.
Call to Action
The call to action for today’s post is to get up off the couch and start moving. and stretching. This is the first step to improving your balance, so don’t wait!
