Fall prevention for runners and hikers returning from injury

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's Sebastian, your co-host for the Restoring Human Movement podcast. Thanks for joining the Movement Movement. Again, if this is your first time to the show, we have two different formats. We have long format and short format. This is a short format, one that I'm doing for my car. And so the audio is a little bit different, but we're going to cover some nice topics today, such as fall prevention. This is mainly for, this can work for a lot of people, but I'm going to reference it in regards to, it was a runner and hiker who asked me this recently, and I think it was a really good question.

And I think there's some misleading information on the internet about what attributes are needed to prevent things like a fall, especially when you're getting back into your activity after having an injury. So as the situation goes, there's a lot of things on the internet which are incorrect. I would say that even some of our things over the years maybe have been taken out of context, but we try to provide context. And so the context here is going to be if you want to get back into running or hiking, but you're worried that, especially if you're a little bit older in age, like 50 or 60, not old, old, but you know, get to that age and usually someone's parents fall and then they start thinking about fall prevention.

Now, the things, especially after an injury that need to be considered is there's a lot of things that can be deconditioned and a whole limb can be deconditioned, an ankle, a foot, a hip. And I will cover some tips and suggestions today that I give people. But I think the first thing we need to be aware of is that if you have an injury and you're avoiding all activity, you may be making a big mistake, mainly because as you're letting that one tissue heal, let's say you have your knee that's healing, then you're letting your hip become weaker as well. So there's many ways to get around this instead of doing squats or things that bother the knee or even running, you could do things like max contraction, voluntary contraction.

So it can't be on a tennis machine of something like a glute max muscle, which may be something like a GHD machine. You can also do max voluntary contraction of the hamstring and quad in a range of motion that doesn't provoke the knee. And these will keep strength around, especially if you do it even as low as once a week. There was a podcast that I covered another, some meta-analysis and systematic review associated to minimal effective muscle training. And so this would be the easiest thing that you need to do is keep your body online while your injury is healing. And it'll make it so you don't have potential of things like falls in your future.

So we all know the risk of falling is that you break your hip and then you become inactive and lifestyle is much different and you may be bedridden and you're older age and so on. Like there's huge problems with falls. But personally, I think that a lot of times when people do fall, there are some preventable things that can be done in the earlier stages of their life to make it so they can prevent but also recover from a fall. And I'll explain what I mean by that as we go here. So the question that I was asked about fall prevention was, do I need to do something like like a single leg squat to be able to be strong enough to prevent a fall?

I said, no, it's not really related at all. There are the things that we can look at though, like forward fold test to see if there's adequate wink sign in the toes. And there's also the ability to do like something like a single leg hinge. I think a single leg, single leg test, like you're just lifting a leg standing is a good starting point. It's, I don't think it's the best because all the joints are locked out and we're depending upon our passive tissues versus some of the active ones. But I think generally everybody should be able to stand on one leg for bare minimum 10 seconds. Like they say, if you can't do 10 seconds, then there, there may be some other reasons for that.

Some vestibular inner ear things. There could be cerebellar issues. There could be other, there's so many other issues that can create that, but usually people should be able to do 10 seconds. No problem. Now let's talk about the things that could be done to prevent the injuries. Being able, being aware is number one. Uh, I remember I was, took my dog to dog beach and my dog was younger at the time and she didn't listen completely. We're still training. And so she ran up to somebody who was walking on the beach alone on a dog beach, looking down at his cell phone. And then, so my dog ran by him very close as dogs do and didn't hit him, but he became really startled and kind of buckled himself.

And he started, you know, being very upset at me and the dog and, you know, I, spatial awareness, you need to be looking around, know what's around you. Now I'm not saying my dog is in the right to charge, charge him and run fast past him, but you need to be aware of where you're going. You can be watching where you're walking. There's nothing we can really do to a hundred percent to prevent traumatic falls. Like someone knocks you over or someone pushes you over that can't be, that can't really be mitigated, but if you're walking and you're at a dog beach and you know that golden retrievers like to play around people's legs when they're playing with each other a lot, maybe you bend your knees and watch them.

They don't just look out at the ocean. So prevention is number one. Number two is recovering from a fall to make sure you don't fall. And so that's going to be like, almost like a fall could be, could be eminent, making sure that your body has the ability to recover from it. Dan John did a great, he was doing a workshop on this at a perform better summit in long beats years ago, where he did a whole hour on basically fall prevention. And he had another guy up there who specialized in fall prevention. And so he reframed it as a recovering from a fall. And so he said, if you're going to fall, most people fall when they're initiating a step, not letting them, they're already walking.

And so you, when you see them start to go down, you can see them kind of like get onto one leg. They don't usually fall backwards or, or, or to the side necessarily. They kind of fall forward and towards the side, almost as if they're tripping forward because their momentum is kind of taking them forward. But they're also going off to the side because they're on one leg. And because the other one got tripped up. Right. And so he basically took that position and he froze everybody, act like you're going to fall and basically freeze. And so basically what they turned into was an isometric single leg hinge exercise.

And we just froze there. And so he, we kind of took this and play with it a little bit. We changed with the foot position one, had it cross the body a little bit. We let, had the arm lead a little bit more as if you're falling further. And basically the cue was don't fall. And then you would find that position over and over again after you've done it isometrically a few times and you try to expose yourself to the position. So your body's been there before it and it can recover. So recovery from a possible fall is step two. And I think step three is going to make sure that you are training your limbs to have the strength to also post up from a fall that is going to happen.

Now, I think the biggest concern for everybody with falls is breaking their hip and rightfully so. There are complications that can come from breaking your hip, such as pulmonary embolism, inactivity. They say people's quality of life after a hip fracture of about one year is it can be very low. And so we want to prevent that as much as possible. Now, things like breaking your wrist and stuff like that, we don't want that either. But those limbs can save the hip, the brunt force that could possibly create a fracture. Now, I'll tell you a story that I actually, over the last six months, I've slipped and recovered twice.

Actually, one of them I did, I did actually fall. But I would say I spared myself the grief of actually fracturing myself. So one of them was just recently, it was last week, we were, we were at a dinner. And so we were in an area where there was tile on the floor. And so it was raining outside. And so there was an outside restroom, we walked through the water to get to the tiled restroom. And of course, they have that little yellow cone that says slippery, but you know, who pay attention to that? And so as I started to step in there, I, my foot actually slid. And so the other, the other foot came in really quickly, just to get me right.

I was in the middle of the room, I couldn't, I couldn't grab on to anything, I just slipped. And the other one came underneath me real quick, almost like I tensed up my whole body to find another support. And so the body's normal reaction is to find another support limb, not to find your head, but it's to find a hand, a hand or another foot. Worst case scenario, it'll like, you'll use yourselves to, you'll use like a knee or a thigh if you actually start to go down to, to decrease the amount of load on the body. Now I was fortunate to get a foot underneath me, but if I wasn't so fortunate, I did have to get an arm or a, or a, or a forearm or something like that.

And this is when I went up into Utah, I was not quite so fortunate. And so in the morning I walked down the stairs and as people in Utah probably already know, it doesn't have to necessarily snow to have ice. And so in the morning it was dewy, I guess, and it was, it had rained a little bit the prior day, but not really a lot. But in the morning it's the temperature so low sometimes that it freezes and you look down, there's no snow on the steps and it looks perfectly fine because ice is clear and I slipped. So I thought the steps were fine. I slipped, I had nice shoes on. I said, like I had hiking boots on, I had all the stuff, right?

And so it didn't really matter. I slipped in on both sides of me was railing. This was a wood staircase. It was about 15 steps down. I slipped on probably the second or third step and I went, started to go, my legs slipped down about two, three steps. My arms went out to the side, like a starfish to grab my, grab the railing. And then I did impact the side of my butt onto the staircase. And so I've met a lot of people who actually have spinal injuries associated to vertical compression like this. I was fortunate enough to land on my tailbone or my, or my sacrum and I recovered perfectly fine. Now my arms saved me because my arms were quick enough to get out and brace against something.

But if your arms are deconditioned or you don't do anything physically active with your arms because you don't think they're important at all because you're a runner, I would disagree. So things like planks and pull-ups and things like that can be helpful to build some strength because basically as my arms go out and they contact the railing, they're taking the full weight of my body the best they can to stop the fall from happening. And so the things that saved me were basically my lats and my pecs in that scenario. So I still hit the area I didn't want to hit, but it, where the force wasn't so strong that it actually created any damage or any fractures.

Okay. So those are basic things that you guys can do. And the last thing that you can test yourself on is, is something called the forward fold test. The forward fold test is basically testing something called, something called the forward fold envelope, which is imagine if you're leaning forward to look over a railing, but you're leaning from your ankles, it's kind of like there's a breaking point where some people can barely lean before they start to kind of lean forward and fall over. And there's other people can lean forward, kind of like a smooth criminal. And the forward lean is the forward fold envelope.

And so what stops you from going, what stops you, what makes the ability that where you can go further and recover more from change of center of gravity is your feet, your calves, and basically your core. And so this test is a good test to narrow down how the foot functions by looking down at your feet to see if your toes are hammering, if they're winking at you or they are the last one. The last one is the third one, but let's not cover that right now. Probably the easiest thing to see is hammering. So if you look down at your feet and you see that they're both, one side looks dramatically different than the other.

Usually it's because it looks like your toes are playing the piano. And so hammering of the toes is a clear sign of muscular imbalance of overactivity of the calf. They go to the toes and with some muscles and then under or under activity of the foot muscles, which also go to the toes together when they work well, they create something called wink sign, which you can Google wink sign of the foot. So this is something that you can look at. And if you find that there's a deficiency there, there's an entry point and easy thing you can do and you can start to rehab and throw a prehab the foot because usually people don't have pain with it.

So I guess what we consider rehab, it'd be prehab, just good old standard preventative maintenance. So I hope this was a helpful podcast to you guys and you get a better idea of easy ways to get control over possible fall risk that you may be having. I don't wish a fall upon anybody, you know, but if you do fall, there are ways to rehab from that rehab around that as well. But if you guys have questions or you want to be assessed by us at performance place, just reach out or our phone number 714-502-4243 or email is info at p2sportscare.com. We have virtual consultations, which are very affordable and we can see if we can help you out in that way.

Talk to you guys later.