Falls Prevention

Balance seems to deteriorate from the age of forty, some say even earlier. It is a case of “use or lose it”. In elderly people, poor balance more than doubles the risk of being seriously injured in a fall. Research into the falls of elderly people shows that:

· With strength, balance and endurance training, the risk of falling is reduced by 10%.

How does Taiji differ in its approach to falls prevention and rehabilitation?

Generally balance training focuses on walking in straight lines and pays little attention to rotational movements. Unfortunately research has shown that the highest percentage of falls is due to misalignment and strain while turning. Taiji focuses equally on rotational movements and more importantly it focuses on whole body alignment at all stages of movement. By becoming more aware of how we relate to the ground beneath our feet we are naturally able to correct ourselves.

Falls happen when we move outside our balance be it by misalignment during movement or tripping/slipping. Taiji trains you to pay attention to the effects of gravity and how it falls through your body. Waning strength reduced stability and body connection/timing. This reduction in physical stability increases the fear of falling which in turn causes more instability or worst still, makes the suffer so fearful that they no longer move about; literally going off their feet…. Taiji handles these challenged both gently and gracefully.

We have developed two types of falls program (1) training others to teach Taiji principles (2) Taiji in the community.

1) The aim of this program is teach Physiotherapists, OT’s etc to use Taiji principles/methods in their workplace. The structured program teaches balance awareness, simple Chi-Kung sets, Learning to fix yourself before you help others, proper body alignment during rotation, function of the pelvis etc. This program has been successfully delivered to Midlands PCT’s

2) The aim of this program is to run regular classes in the community focussing on strengthening balance and awareness of range of movement.

In a comparative study of Tai Chi and Computerised Balance Training (CBT), The Atlanta FICSIT research team* found that Tai Chi training reduced the risk of falling by 47.5%. The study was conducted with a group of 200 people aged 70+ over a 15-week period with a four months follow-up.

These two approaches were assessed with regard of their influence on biomedical, functional, and psychological indicators of frailty and, secondarily, evaluated their influence on the occurrence of falls. It was noted, “Tai Chi is a low technological, inexpensive group activity, whereas the CBT approach is a comparatively expensive, high technological approach performed individually”. To the surprise of the research team, the CBT approach did not reduce the rate of falls in this study. Tai Chi participants also reported “reduced fear of falling and increased sense of being able to do all that they would like to do”.

Researchers attributed the dramatic improvement in balance to the fact that in the Tai Chi “form” participants continually used body rotational movements on a progressively diminishing base of support. Static balance exercises do not seem to improve balance in later life.

* Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training, Wolf et al., Journal of American Geriatrics Society, May 1996 – Vol 44, No.5.

Some hip fractures occur as a result of a direct injury when the patient hits the ground, but a high proportion occur as a result of stresses and strains set up by a sudden twisting when people are aged and suffer from osteoporosis. One textbook goes as far as to suggest that the majority of fractures of a brittle hip follow rotational forces induced by a stumble or a fall, and not from a direct injury as the patient hits the ground. Dr Thomas Stuttaford in The Times on 29^th January 1998 following Queen Elisabeth the Queen Mother’s fall and hip fracture.

Points to consider in your understanding or Falls prevention

Dying from the feet up

The Chinese believe you die from the feet up and that your legs are your second heart. A physiological explanation for this would be that the constant weight changing during your Taiji practice generates a pumping action that improves circulation, lymph drainage and assists the heart. A psychological example might be that when you become immobile, you lose your zest for life.

Why do children and the elderly over-balance?

Have you ever stopped and watched either? Children have two main reasons, one which applies when very young: When born the head is larger than the body to aid delivery and the body takes a time to catch up therefore making a child initially top heavy which allows them to easily be outside their field of balance. Secondly, and this one applied to the elderly or those recovering from strokes etc. THEY DON’T LOOK OR FEEL WHERE THEY ARE GOING. After watching many pensioners with Zimmer’s, literally bulldozing their way through rooms, tripping over carpets, snagging themselves on chairs, banging into other people, it is easy to see they do not see or maybe consider their surroundings. We see it in young children before they learn care and responsibility and we see it in the elderly who just do not consider. I do not want to offend but am only pointing out facts that can be readily observed. I agree not all people are the same, but this applies as much to children as adults and we are only trying to be aware so we can help.

Abdominal Breathing

Children breathe with the abdomen before they are taught to ‘hold in their stomach and stand tall’. We later learn that breathing with our chest alone reduces the depth of the breath thereby increasing the need for more breaths. Consider how you feel when anxious or tight chested if you have asthma and you will easily see the detrimental effect chest breathing has. By breathing with your abdomen your will draw down your diaphragm and learn to use more of your lung capacity. This improves oxygenisation to the blood, calms the mind/body and lowers the centre of gravity.

Function of Dorsiflexors and heal strike

The dorsiflexors are what allow you to work your car pedals or tap your foot to music. When they weaken it becomes hard to lift your foot without the toes dropping. This causes the foot to drag when walking and increases the risk of falls. Taiji teaches you to place your heal down first and to clearly define your steps. Poor definition is classified as poor heal strike and gives the impression the person is attempting to climb stairs as they lift their leg higher than would normally be necessary. The heal/toe exercise is designed to help but eventually the use of high ankle supportive footwear or ankle bracing may be needed. A bi-product of this is that the calf muscles shorten due to imbalance of use, which leads to the person leaning forwards and thereby increasing the risk of imbalance due to over-toppling.

Space awareness

One of the clear benefits of Taiji is improved space awareness. The steady, clearly defined movements, the walking exercises and concept of ‘aligning with gravity’, all add to an improved awareness of being. Exercises are designed to increase awareness of your range of balance and the need to move within that range. You learn to listen to your body and appreciate/understand what affects your balance. You learn to be aware of the ground beneath your feet…..

Learn to do less and understand body connection

A key phrase I use in my own classes is ‘learn to do less’. We think we need to do much more than we actually do to achieve the result we want. Consider your car: when driven hard it burns more fuel wares out sooner and doesn’t necessarily get you there any sooner; your body is no different. Through correct body connection your will move more efficiently, generate a greater result from less effort and have more energy to spare for when it is really needed. When you get up in the morning, your start with a certain amount of energy and as you go trough the day this is used up. Would it not be wonderful if by the end of the working day you had some energy left for yourself? Segmenting the body as we move causes a great deal of wastage and strain, so look how the body is constructed and feel the connections: hips to shoulders, knees to elbows, hands to feet. When you are weighted in your front leg is you ankle, knee and hip aligned? Is your shoulder aligned with your hip? Can you feel your weight falling through your body easily and uninterrupted? Does your whole foot feel connected to and pressing the ground?

Fallen arches, diminishing nerve response, stroke numbness etc all affect your feeling of connection, but slow steady practice will improve your awareness and understanding of your body connection.

Why stand when we can sit and rest…?

Sitting allows muscles to rest but can, in time also weaken them. Sitting exercises are OK for those who cannot stand, but are not meant to replace standing practice. Sitting does not work the specific muscles and ligaments that control your balance. Sitting can diminish your feeling of connection to the ground. These types of exercises can be taken as part of a whole program but must lead to standing and moving practice. In turn static standing exercises do not work your range of balance. Taiji’s rotational movements working on single weighted stances increase your range of balance.

The importance of correctly sitting and standing

Have you ever stood up quickly and gone light headed? A sudden drop in your blood pressure, which affects your balance centres, causes this. Now if you were already weakened from old age, poor blood pressure, stroke, illness etc, can you see how easy it would be to fall and possibly injure yourself? It is essential that correct methods of standing and sitting be taught. These should be steady and use each joint in a scissor action to ensure correct body movement is considered. By leaning too far forwards when standing or sitting, it is easy to topple forwards and over balance; by leaning too far back it is easy to fall into or over the chair and land with a thud which can jar and cause quite serious damage.

The key to everything in Tai Chi can be summed up in the Zen concept of living in the here and now, of being aware and paying attention to the moment. It is in the attention to detail, of listening to our bodies. This helps us to help others and keep us all on the road to recovery.

For more details of our Tai Chi for Falls program and how to book us for workshops etc.