Falls prevention and promotion of balance, with Chiropractor Peter Thompson
A talk given by Peter Thompson to the Walkie Talkie Walking Group during Senior’s Week.
Thanks to the Walkie Talkie Walking Group for inviting me to address you.
By way of background, I have been a Chiropractor and Osteopath for over 30 years.
I have lectured at University training Chiropractors and at TAFE training Massage Therapists for many years.
I have recently begun practice across the road at the Woonona Medical Practice, (the old Illawarra Retirement Trust Building).
Reading through you history I note that the Walkie/Talkie Walking Group was begun in 1994 as a Falls Prevention Project. The aims were to encourage gentle exercise, to improve balance and gait and to widen the social network for elderly, isolated people.
Another important function of your group is the promotion of community awareness through participation in Seniors Week, Heart Week, Arthritis Week and World NO tobacco Week. Each of these areas is of interest to me for various reasons.
Today I would like to make comment on several points taken from the group’s aims.
Falls prevention, promotion of balance and gait.
Falls account for a large number of preventable injuries to seniors and are the leading cause of injury deaths. Interestingly, the rate of fall deaths is increasing. Women are twice as likely to fall compared to men. We all know how much longer it takes to heal from injury as we get older. Many people never fully recovery from falls. Their reduced mobility results in less exercise, causing deteriorating fitness which leads to poorer health. Having worked in hospitals, I have seen this first hand. Another consequence of injury may be the release of a clot (known as an embolus). This can cause stroke or heart attack .
Falls and mishap tend to occur much more frequently when we are tired from overexertion. In preventing falls it is very important to be honest to yourselves about your endurance levels and your physical capacity to perform your planned walk or activity. In this regard, being ‘egged on’ by your fellow walkers or (perhaps more commonly) by your own self talk can be disastrous!
Balance: The act of walking is a truly amazing feat (excuse pun). It relies on balance, co-ordination and integration of many different systems of the body. Balancing the body requires constant feedback of information into the central nervous system coming from all the parts of the body.
The nervous system maintains balance via a three systems: 1 Vestibular system of the inner ear, 2 Vision, the eyes are orientated to the horizontal line of the horizon, 3 Those nerve endings found throughout the body (50% in the neck) that react to gravity, stretch, pressure, length, tension of the tissue in which they are found. Each of these systems must be provide the brain with accurate, reliable information that is consistent with the other two systems in
order to maintain a feeling of equilibrium. Little wonder that many people suffer from travel sickness.
So, when you have a middle ear infection and/or neck pain, be extra careful when you walk, particularly over uneven or irregular surfaces such as in the bush.
The brain must interpret this information in order to know where each part of the body is, both in relation to other body parts and also in relation to gravity. Specific and very accurate information must be constantly supplied, otherwise how would we know whether the foot was turned too far in or out too far when a step is taken? An incorrect assessment of the position of our foot might result in us planting it incorrectly on the ground, resulting in us rolling our ankle and spraining the ligaments. Interestingly, when the ankle ligaments have sustained repeated injury, they become unreliable in the information that they send to the brain. Subsequent tripping, stumbling and re-spraining of the ankle thereafter become much more common.
Walking is a mechanical event. It imposes quite large mechanical forces upon our bodies. Each step jars the body. Our musculoskeletal system, co-ordinated by our nervous system, have evolved a variety of adaptations in order to minimize the impact of these powerful forces on our delicate frames. For example, the weight bearing structures of our body are larger and stronger than the non-weight bearing regions, eg. Knees hips and pelvis compared with our elbows and hands.
Another adaptation is found in the way our body parts are connected. The way we are put together creates a series of inbuilt ‘spring’ mechanisms that deflect force. Many of the tissues that connect our parts and holds them together are like either elastic bands or like compressible rubber. Walking and exercise help to maintain flexibility and resilience in this connective tissue. (We stay rubbery).
When these structures are working the way they were intended we can tolerate large mechanical forces with relative ease. However, the progressive inflexibility that accompanies aging results in greater impact strain to our bodies.
Any factor that reduces the efficiency of this ‘machinery’ leaves us open to the full impact of these forces. Injury, overuse strain or degenerative joint diseases such as Osteoarthritis may result. I will discuss Osteoarthritis in a moment.
On the positive side, activity will strengthen bone and soft tissue. A process called hypertrophy occurs. The bones are strengthened with additional mineral salts, the connective tissue becomes larger and better able to handle the added mechanical force. Muscle development resulting from training is the most obvious example, however, all the ‘connective tissue’ of the body (ligament, tendon, fascia, etc.) becomes stronger and larger as well.
This ‘hypertrophy’ or ‘overgrowth’ I just mentioned may have detrimental effects on the body as well as strengthening effects. When tissues are placed under overwhelming and inappropriate mechanical forces, the body responds by building up the wrong tissues. This resulting in the Osteoarthritic changes seen on Xray with accompanying stiffness, immobility and pain.
Ways of reducing likelihood of fall injuries.
Increase leg and lower body strength by walking regularly.
Using weight bearing exercises is recommended: light weight with appropriately high repetition is advised for healthy joints, contracting the muscle while not moving the joint is advised for faulty (diseased or traumatised) joints.
Review you medications under the guidance of your GP. Drug actions or interaction between your different medications may cause light headedness or dizziness.
Eye checks should be performed regular. Use distance lenses while walking where required.
Maintain blood levels of Vitamin D.
Be screened and be treated for Osteoporosis.
Make the home safer using grab rails, ramps, reducing trip hazards, providing good light in the house, etc.
Walking enhances the capacity and efficiency of our lungs. They work bigger and better! This takes pressure off the heart while at the same time the heart muscle strengthens in the same way all the other muscles are strengthened with exercise. The ‘stroke volume’ of the heart (volume of blood pumped per beat) improves, thereby allowing the heart to beat in a more relaxed way, a ‘working holiday’ so to speak.
The bodies plumbing system improves with walking. Blood and lymph fluid relies on pumping and pushing of fluid throughout the body. These powerful pump mechanisms eases the workload of the heart.
So, the message is to make sure your walking is done with forethought and consideration of your body so that your walking will always be a gentle, health promoting event.