The relationship between fall prevention and mobility maintenance

Fall prevention and mobility maintenance are never two independent things, but a two-way binding symbiotic relationship - mobility degradation is the primary high-risk factor for falls, and the trauma and fear caused by falls will directly penetrate the foundation of mobility maintenance. WHO clinical statistics show that more than 90% of elderly hip fractures are caused by falls, and more than 30% of patients will experience irreversible mobility decline within 1 year after surgery.

I have been in a community rehabilitation center for almost 5 years. The most embarrassing case I have ever encountered is 68-year-old Aunt Zhang. She used to walk 3 kilometers around the park every day and danced an hour of fan dance with the square dance team. Last winter, when she went downstairs to throw garbage, she stepped on an icy floor tile, and she fell down and fractured her hip. The operation was successful, but she became frightened after being discharged from the hospital. She always felt that if she fell again, she would collapse on the bed. She had to be supported by her family members even when she was walking. Half a year later, the muscle strength of her lower limbs was measured again, and she found that she had lost 42% compared to before the operation. She now has to use a walker when going out, and rarely even goes out of the community door. In fact, her physiological recovery conditions can completely return to the previous state. It was just the shadow of a fall that completely depleted all the mobility she had accumulated over the past ten years.

When I first entered the industry, I thought that preventing falls was just as simple as installing handrails, changing to non-slip shoes, and clearing roadblocks. After I came into contact with more cases, I discovered that there have always been two different intervention ideas in the academic community and the practical circle. There is no absolute right or wrong, but they are just suitable for different groups of people.

One is the "risk-pre-emptive" approach commonly used in rehabilitation departments, which prioritizes minimizing the external risk of falling, and then slowly improves mobility after the condition is stable. This is especially suitable for people who have had a history of falls, have gait disorders, or have just undergone lower limb surgery - you can't let an old man who has just had a hip replacement practice standing on one leg. If he fails to stand firmly and falls, the benefits will be much greater than the training. The other is the "capacity-building" approach in the field of sports medicine. It is believed that as long as the strength of the lower limbs, core stability, and balance ability are up to standard, even if you occasionally encounter slippery or tripping situations, the body can quickly mobilize muscles to adjust the posture, and you will not fall at all. Fall prevention is only a natural result of adequate maintenance of mobility. This idea is more suitable for young people and young and middle-aged people with good physical foundation and no history of falls.

When I do intervention, I never stick to a certain method. For example, Uncle Li, who was 72 years old, was an outdoor enthusiast before retiring. He had degenerative knee disease and his Berg balance test score was only 60% of normal people. At first, his children were afraid that he would fall, so they bought wheelchairs. I first went to his home and made small improvements: I removed the threshold of the entrance hall, installed L-shaped handrails in the bathroom, removed all exposed wires and rolled-edge carpets on the floor, and chose a pair of walking shoes for him with loose toes and deep tread soles. I also arranged for him to come to the rehabilitation center three times a week, and practice for 20 minutes each time: squat against the wall, stand on one leg with eyes open, and walk in a straight line, all easy movements. Don't tell me, his balance score has risen to 85% in just 3 months. Now he can still go to the park for a three- to four-kilometer walk every day with his old friend, and he has not fallen once in more than half a year.

Don’t think this is something only the elderly need to worry about. A while ago, a 28-year-old girl came to me and said that she fell three times in the past six months. The last time she fell, she tore her knee ligaments. She asked me if I should put anti-slip mats all over the house. When I asked, I found out that after she sprained her foot while wearing high heels before, she never dared to use her injured foot to exert force. She kept leaning on her center of gravity when walking. Over time, the muscle strength of her lower limbs on both sides decreased by 30%, and her sense of balance was completely poor. I didn't ask her to do any complicated modifications. I just asked her to stand with one foot raised while brushing her teeth at home, and practice squatting with a pillow under her hands while watching TV. First, she would level the muscle strength on both sides and change her walking posture, so that she would naturally not fall. You see, even young people cannot escape this cycle: if you don’t pay attention to maintaining your mobility, the risk of falling will naturally come to your doorstep. If you dare not move after a fall, your mobility will only get worse and worse.

In fact, mobility is like the battery of the electric car you ride every day. If you charge it on time and don't use it violently, the battery life will always be good. Fall prevention is like the anti-fall bars and anti-skid tires you install on your car - you can't rely on the anti-fall bars to keep you safe when the battery of the car is running out of power and it can't be driven anymore, right? On the other hand, if you crash your car every day, no matter how good the battery is, it will cause poor contact.

After doing rehabilitation for so many years, my biggest feeling is that fall prevention should not be regarded as some "special work for the elderly" that requires serious preparation, and mobility maintenance should not be regarded as a professional thing that can only be done by going to the gym. Don't stare at your phone all the time when walking, wear shoes that fit your feet, don't pile up a pile of unopened express boxes on the floor at home, and stand on one leg for 10 seconds when waiting for the elevator. These seemingly inconspicuous little things actually give you the freedom to "go wherever you want."