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Ask a physio: Staying on your feet is a team effort
Feeling less steady can reflect several factors working together, from vision and blood pressure to medication. Registered physiotherapist Sean Overin says regular activity that keeps the legs strong is central to fall prevention, alongside balance practice and attention to other health factors.
You reach for the railing on the back steps and realize you actually need it this time. Nothing happened; your feet just did not feel as sure as they used to, and you wonder whether your balance is starting to go. If you have had that moment, you are in good company, and it is worth paying attention: about one-third of people over 65 fall in any given year.
But “my balance is going” is the wrong way to think about it. Staying upright depends on a team of systems, which offers a more hopeful way to look at the problem. Your muscles and your sense of where your joints are in space work alongside your eyes, which tell you where the ground is, and the balance organ in your inner ear. Blood pressure matters too: it has to adjust as soon as you stand so your head does not go light. Some common medications can also make you feel less steady.
Researchers who study falls find they rarely have a single cause. Factors can stack up: some stiffness in the hips, eyesight that is not what it was, blood pressure that dips when you rise from a chair, or a new pill that leaves you slightly woozy. You might manage any one of these on its own. Together, on a dark, wet step, they can catch you out.
The good news is that the factor that protects you most is also the one most within your control: staying strong and active. Balance practice helps and is worth doing. A few weeks ago, I wrote about standing on one leg while brushing your teeth, and I still stand by it. But the deeper protection is not a trick. It is the ordinary strength you maintain in your legs by using them: walking, taking the stairs, carrying groceries, gardening or lifting weights if you enjoy it.
When your eyes or inner ear get caught out — and sometimes they will — strong legs can help you recover. The best fall-prevention programs are built on that principle: keeping your legs strong and giving your balance something to react to, week in and week out. Studies show that this kind of regular exercise cuts falls by roughly one-fifth to one-quarter. Nothing in a pillbox comes close.
If you have started to feel less steady, practise your balance, but put most of your energy into less glamorous activities. Get out of a chair without using your hands a few times a day. Take the stairs when you can. Carry your own bags. Keep doing activities you already enjoy and gradually do a little more.
Look after the other factors too. Get your eyes tested. If you feel light-headed when you stand, rise a little more slowly and mention it to your doctor or pharmacist. Ask whether any of your medications could be adding to the wobble. These small conversations can take a real risk off the table.
The goal was never to feel perfectly steady every moment. You will not, and neither will I. The goal is to be strong enough and well supported enough that when the ground surprises you, you stay on your feet.
Staying upright is a team effort. Strength is the member you can count on.
Sean Overin is a registered physiotherapist who coordinates the Chronic Pain Program at Tall Tree Health, which has a clinic in Port Coquitlam. This column provides general information and is not a substitute for individual medical advice.