3 Tips to Prevent Falls at Home

As the calendar changes from summer to fall, now is the perfect time to make fall prevention a top priority. Since older adults are most likely to fall at home, improving the safety of the home environment is one of the most important steps one can take to reduce risk for falling. In fact, a robust research review of fall prevention research found home safety modification was one of the most well supported interventions available to prevent a fall.

Here are 3 steps that you can take today to improve the safety of your home or the home of a loved one:

  1. Install grab bars. The bathroom is one of the most frequently used rooms of the home, making it a location ripe for a fall. Couple that with the fact that bathrooms are often used at night when the lighting is poor, or after a shower when the floor is wet. Furthermore, stepping in or out of a bathtub can be an extremely challenging task for someone with decreased strength or balance. The best way to maximize safety in the bathroom is to have grab bars safely installed in 3 key areas: 1) Near the toilet, 2) Inside of the tub/shower and 3) Just outside of the tub/shower. Towel bars and other bathroom accessories SHOULD NOT be used as a substitute for a properly installed grab bar.
  2. Remove throw rugs. It should come as a no brainier, but throw rugs can be a huge tripping hazard in the home. It has been mentioned on this blog in a previous post, but I have to say it again: “Just say NO to the throw (rug)!”
  3. Add nightlights to areas commonly used at night. As we get older, our need to use the restroom during the night often increases. That means more trips to and from the bathroom in the dark and more chances to have a fall. Having a nightlight in the bathroom and along the pathway to the bathroom is vital to ensure that you are able to adequately see your environment at night.


“I feel more human now.”

In 2013, the American Physical Therapy Association’s House of Delegates created a new Vision Statement for the physical therapy profession: “Transforming society by optimizing movement to improve the human experience.” Initially,  I was faced with mixed emotions on this bold vision. But, the more I read, talked and thought about this statement, the more I began to appreciate it. The words of California Delegate, Terry Nordstrom, really helped me appreciate the phrase “human experience” and how Physical Therapists play a unique role in improving this experience in every individual we encounter.

While working with a patient recently I was reminded of the impact that physical therapists have on this human experience. “Shirley” had come to me for treatment of her balance. Shirley is 85, had recently fallen a couple of times and had stopped doing many of the things she loved to do, like going out to lunch with her friends or walking by the lake.

Shirley and I worked together for six weeks. First, we started with some relatively simple exercises involving light weight or holding onto things for support. As time went along and Shirley’s confidence improved, her exercises became more difficult to reflect her abilities. By her last session, Shirley was performing high level balance exercise and was able to move over 300 pounds on the leg press.

As we wrapped up her last session, I asked Shirley if she felt she had met her goals for this course of care. Shirley said, “I can’t even begin to tell you how helpful this has been. I’m back to walking around the lake and going to lunch with my friends. I feel more human now.”

“I feel more human now.”

I can assure you, when Shirley and I talked about her goals during her first appointment she made no mention of hoping to feel more human by her last visit. But that is exactly what happened. Shirley showed up regularly, worked hard and followed through on recommendations given for home. As a result, Shirley’s balance and strength improved and she felt more confident to go out and do the things she enjoyed. Physical Therapy improved her human experience.

Prevent Falls with Exercise

“No Falls Friday” is a series of weekly blog posts aimed at reducing your risk for falling.

For older adults, falls are a serious problem. As we have explored in an earlier post, 1 in 3 adults over the age of 65 will fall each year. Falls can lead to serious injury or decline in independence. There are many risk factors as to why a person may fall, but problems with lower body strength and balance are typically contributing factors. Thankfully, these two factors are primarily under our control and can be improved with the right type of exercise.

In a recent Cochrane Review, the authors concluded that group or home based exercise programs are effective to reduce the risk of falling. The best place to start with an exercise program for fall prevention is with a Physical Therapist (PT). PT’s are highly educated, licensed health professionals who will perform a thorough examination to determine the areas that need to be addressed to lower your risk for falling. If an exercise program is indicated, Physical Therapists are experts in exercise prescription. Your PT can design an individualized routine or make a referral to a group exercise program that will match your goals and preferences.

No matter what type of exercise program you perform, a recent systematic review of exercise for fall prevention concluded that the following factors should be present:

  1. The exercise must significantly challenge your balance. Laying on your bed or holding on to the kitchen counter isn’t going to cut it. In order to improve your balance you have to challenge your balance. Placing the feet close together, removing upper body support (ie holding onto to something) and controlling the movement of your body are suggestions offered by the authors. Balance exercise that is effective can be frightening, so getting started with a Physical Therapist will help you to improve your confidence and ensure that you’re exercising correctly.
  2. The “dose” of exercise must be high. A few minutes of exercise per day isn’t enough to be effective. This review found that those who exercised for at least 50 hours, or 2 hours per week for 6 months, had the most profound reduction in fall risk.
  3. Exercise must be ongoing. In other words, to prevent falls, exercise needs to become part of your lifestyle. Exercising for a few weeks or even a few months is great, but if you don’t continue to exercise, the benefits will be lost.

Whether it is for yourself or a loved one, if you’re concerned about falls you should consult a physical therapist. Your PT will listen to your concerns and will work with you to develop a plan to meet your goals. Find your PT here: www.apta.org/apta/findapt/

Discover the “Fountain of Youth” with Aquatic Physical Therapy

The Fountain of Youth, 1546 painting by Lucas Cranach the Elder
The Fountain of Youth, 1546 painting by Lucas Cranach the Elder

For centuries, the fabled “fountain of youth” has lured explorers in search of its powerful waters. As the legend goes, anyone who drinks or bathes from this mythical fountain will have an endless lifetime of youthfulness. While such a place is yet to be discovered, it is likely that there is a “fountain of youth” right in your community. For the person with arthritis or fibromyalgia, your local YMCA, Rec Center or Physical Therapy clinic just may be housing your “fountain of youth” in the shape of a pool.

A few years ago, I had the pleasure of working with a patient named “Sue.” Sue was in her late 60’s and about ten years earlier had been diagnosed with rheumatoid arthritis, an often painful autoimmune disorder leading to inflammation of multiple joints. By the time I met Sue, she had ceased exercising out of fear for making her joint pain and inflammation worse. She had lost a great deal of mobility and was disappointed that she could no longer keep up with her young grand children. Following her physical examination, Sue’s first physical therapy treatment session was held in a 90-degree therapy pool. Within minutes of entering the water, Sue found that she was able to stand, walk and even squat without pain in her often sore knees. “Today is the first time I’ve been able to walk without pain in the past five years,” said Sue, following her first appointment.

Over the following six weeks, Sue made great progress with aquatic physical therapy. She learned to do an independent water exercise routine which she still does religiously two times per week at her community pool. Sue also gained the confidence to begin exercising out of the water and transitioned to a gentle program of strength, flexibility and walking exercise to do at home. While Sue does still have some pain in her joints from time to time, thanks to aquatic physical therapy she can now exercise regularly and play with her grand kids without worry. Simply put, she got her life back.

Aquatic physical therapy is a wonderful, yet often underutilized treatment for conditions like Sue’s. Because of the principles of buoyancy and hydrostatic pressure, entering water will give one the feeling of weightlessness. For people with conditions where weight bearing can increase painful symptoms, aquatic therapy can be an excellent way to begin exercise without the pain that may be experienced out of the water. Aquatic physical therapy can also help to decrease swelling and improve blood flow to muscles and joints1. Exercises can then be done in the water to improve strength, flexibility and endurance to allow the individual to meet their therapy goals.

If you have pain that impacts your lifestyle and prevents you from doing the things you love to do, aquatic physical therapy can help you get your life back. To find a location that offers aquatic physical therapy close by, the Aquatic Section of the American Physical Therapy Association has a helpful directory here. Once you find a location, your Therapist will help you determine if aquatic therapy is right for you. Give it a try, you may just find that “fountain of youth” after all.



Becker, Bruce MD. “Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications.” PM&R. Vol. 1, 859-872, September 2009.





3 tips to keep you injury free this spring


Here in Michigan, Spring has sprung! The ice has left the lakes, the snow banks have melted and the first flowers of spring have started to bloom. For many, Spring also marks the beginning of yard work season. As a Physical Therapist, Spring is the time of year when the clinic starts to get busy with those aches and pains that creep up when we start working in the yard again. But that doesn’t have to be the case for you. Follow these three simple tips to make your Spring injury free:

1) Prioritize

A long winter can leave your outdoor spaces looking pretty shabby. In order to successfully accomplish all of the things you need to do in the Spring, it is very helpful to make a simple checklist. Grab a sheet of paper and just start to write down all of the jobs, large and small, that you would like to finish this Spring. You may think about splitting bigger jobs up into smaller ones. For example, instead of just writing “Rake the yard” it would be more manageable to break this down into “Rake front yard”, “Rake back yard”, etc. Once you have all of your jobs on paper, re-write them into checklist form on a separate sheet of paper. Prioritize your projects from most important to least important. Then, be sure to use this checklist to guide you through your work. You will get a real sense of accomplishment as you start to see the boxes checked on your list.

2) Pace Yourself

It is important to remember is that Spring is an entire season, not a single day or a single weekend. The majority of the aches and pains that I see in my office this time of year are from folks who try to accomplish all of their spring cleaning in 1 or 2 days. After a winter of hibernation, our bodies are not conditioned to be raking, digging and working for an entire day. Instead, we should be pacing ourselves by doing small amounts of work at a time. Aim for doing 20-30 minutes of one activity at a time. Then, after a rest break, move on to a different activity so that you are varying the strains on your body. For example, instead of doing all of your raking in one day, rake part of the yard followed by some trimming.

3) Know your limits

Lastly, for the best chance that your Spring stays injury-free, make sure you don’t do jobs that are unsuitable for you. If you feel that your balance is “a little off,” then don’t get on a ladder to clean the gutters. Do you have trouble lifting a bag of cat litter? Then you probably shouldn’t be trying to lift a hundred pound tree limb. Hopefully you get my point. We all have areas of strength and weakness. If you feel you are weak in a particular area, ask for help or hire it done.

I hope you all have a very enjoyable Spring, and hopefully with these 3 tips, it will be injury free as well!

When a Picture Is Not Worth 1,000 Words


Pictures have the ability to capture the beauty, emotion or awe of a moment that sometimes just can’t be put into words. Take, for instance, the photographs of a child’s first birthday party or the colorful dance of the northern lights. In cases like these, a picture really is worth every one of those 1,000 words.

But there are some pictures that just can’t tell the whole story. Radiographs, commonly known as x-rays, are typically the first type of medical imaging ordered when someone has knee pain. While x-rays are very helpful in identifying fractures or more serious problems, they often fall short when attempting to correctly predict the symptoms of knee arthritis. For example, in this 2012 study 114 subjects with knee pain and arthritis were asked about the amount of pain and disability they experienced. The results of the study showed that there was no correlation between the degree of arthritis on x-ray (graded I-IV) with the amount of pain or disability the subjects experienced. In other words, subjects with the most severe amount of arthritis on x-ray (grade IV) had virtually the same symptoms as those with minimal arthritis (grade I).


Well, what if we look at the results of a fancier picture? After all, this is 2015 right? X-rays are so 1980…this is the age of the MRI. Well, when it comes to predicting who will and who won’t have pain in their knees, the MRI doesn’t fare much better than the old-fashioned x-ray. Take, for instance, this 2012 study published in the British Medical Journal. 710 subjects who had normal x-rays of their knees then had an MRI. 89% of these subjects with normal x-rays were found to have at least one abnormality in their knee. These “abnormal” findings included bone spurs and cartilage damage, two signs that are commonly associated with arthritis of the knee. What’s interesting is that only 30% of those with an “abnormal” MRI reported knee pain. That means that 70% of people with an “abnormal” MRI did NOT have knee pain. So “abnormal” findings on MRI are actually quite normal and do not always correlate with pain.


In the case of complicated issues like knee pain, pictures (x-rays and MRI) really are not worth 1,000 words. After all, even a very expensive picture is still just a picture. No picture can take the place of a detailed and through interview from your healthcare provider. How long has your knee hurt? When and how did it start? How does it feel to you? How has it impacted your lifestyle? What would you like to do about this? What are your goals for the future? These are just a few of the questions that should be answered before proceeding with any treatment for knee pain.

If you have had one of these images taken of your knee before, remember it is just a picture and no picture can begin to tell your story.

Footwear and Falls

“No Falls Friday” is a series of weekly blog posts aimed at reducing your risk for falling.

There are two rules when it comes to socks: 1) Thou shall not wear socks with sandals and 2) Thou shall not go with stocking feet in the home, for it shall increase your fall risk.

Photo by OddMan47
By Oddman47 via Wikimedia Commons

Wearing stocking feet in the home, while cozy and comfortable, does increase one’s risk for falls. In one study, the risk for falling was found to be 11 times greater when barefoot or with stocking feet in the home versus wearing shoes. 11 times greater! Those stocking feet don’t sound so comfortable now, do they?

In another study that compared footwear and falls, over half of all the falls reported occurred when subjects were not wearing shoes (barefoot, socks or slippers). Interestingly, only 10% of these subjects reported that not wearing shoes was their typical footwear preference in the home. Maybe these folks were used to wearing shoes around the house, so when they were barefoot or in stocking feet they were caught off guard and were more likely to fall. Whatever the reasons, there is plenty of evidence that when we don’t wear shoes indoors, we are more likely to fall.

So the next question is, “What is the best kind of shoe to prevent a fall?” Well, there is no one correct answer to this question. In all of the studies that compare different types of shoes, there does not seem to be one distinct shoe type that outshines all of the others. There are, however, a set of features that are commonly accepted as being very important to maximize safety. Those are:



  • A “well-fitting” pair of shoes should be worn both indoors and outdoors
  • The heel height should be low and slightly beveled
  • The sole should be firm and thin and may contain tread to help on slippery surfaces

So there you have it. Remember to cover up those socks with a sturdy pair of shoes to decrease your risk for falls. And equally important, remember to never, ever wear socks with sandals. 🙂

Just Say NO to the Throw (Rug)!

“No Falls Friday” is a series of weekly blog posts aimed at reducing your risk for falls.

Throw rugs: beloved by older adults and abhorred by health professionals. These rugs tend to be everywhere in our homes and it seems that the older we get, the more we accumulate. It is easy to see why throw rugs are so popular. They can add color, texture and warmth to otherwise cold tile or wood floors. But hiding behind their decorative threads, throw rugs can pose a serious fall hazard to older adults. As we see in the above video, Mr. Beneke finds out the hard way how dangerous a throw rug can be.

Last week we talked about some of the things that can be done to help reduce one’s risk for falling. Home safety modifications were found to decrease risk for falls by 12%. Now 12% may not seem like a monumental change, but it just might be the difference in you or your loved one having a fall. The Centers for Disease Control (CDC) has published a detailed home safety checklist that can be used to make your home as safe as possible. I strongly recommend you use this tool to go through each room of your house and correct any hazards that you identify. But the first and most effective change that you can make is to remove all the throw rugs around your home.


“No Falls Friday”: How Can We Keep Bernie From Falling?

“No Falls Friday” is a series of weekly blog posts to help you decrease your risk for falling.

Photo credit: Adam Jones via flickr


Pictured in the photo above is a woman we’ll call “Bernie.” Bernie is in her mid-eighties, lives by herself and is fiercely independent. She handles her own cooking, cleaning and financial affairs. She takes a walk every day, either to the store or the bank or sometimes just for exercise. Over the past 6 months, Bernie has fallen a few times. Nothing major, just a few bumps and bruises and a bit of shaken confidence. Bernie has a lot of friends who have fallen, too. Many of those folks weren’t so lucky. Some have ended up with broken bones and one friend even landed in a nursing home. Bernie is worried that if she falls again, the results could be much more dire.

How can we keep Bernie from falling again?

As we have discussed in a previous post, falls are a complex issue with multiple factors that contribute to one’s risk of falling. Just as there are a variety of factors that contribute to falls, there are also numerous treatments available to help lower one’s risk for falling. As you would expect, some of these treatments will be more effective than others. One of the best methods for evaluating the effectiveness of a particular treatment or treatments on a disease or condition is via a Cochrane Review. Let’s take a look at this 2013 Review titled “Interventions for preventing falls in older people living in the community” to see if we can glean any ideas that would keep Bernie from having another fall.

  • Exercise:

    • Group exercise that combined 2 or more modes of exercise (ie strength + balance exercise) decreased risk of falling by 15%
    • Home based exercise that combined 2 or more types of exercise reduced risk for falls by 22%
    • Tai Chi decreased risk of falling by almost 30%
    • Single modes of exercise in isolation (ie only strength training or only balance exercise) did not significantly reduce risk for falls
  • Home Safety Modifications

    • Home safety assessment and modification helped decrease risk of falls by 12%

So back to our original question: How can we keep Bernie from falling again? Based on the results from this Cochrane Review, referral to a Physical Therapist (PT) is a no-brainier. PTs are experts in exercise prescription. A Physical Therapist could help tailor an appropriate home exercise program for Bernie or could refer her to an appropriate group exercise or Tai Chi class. PTs can also perform a detailed home assessment and make recommendations for safety improvements to the home.

We must remember that Bernie is a unique individual with her own unique set of factors that will determine her risk for falling. This Cochrane Review pooled data from nearly 80,000 subjects, so we can’t reasonably make decisions on what she needs based upon this review alone. This is exactly why a referral to a Physical Therapist is so vital. PTs are educated to perform a detailed fall assessment and to deliver  treatments based on this assessment to clients at risk for falls. For needs that are outside of the scope of a Physical Therapist, PTs will refer to an appropriate provider that can address those concerns.

Bottom line, how can we help lower Bernie’s risk for having another fall? See a Physical Therapist.

Three Low Cost Options for Medical Equipment

Whether it is for themselves or a loved one, chances are most older adults will need at least one piece of medical equipment in their lifetime. Just like anything with the word “medical” attached to it, the prices of medical equipment can often cause a great deal of sticker shock. Take for example, a standard front wheeled walker. A quick Google search of online retailers reveals prices from $40-60 for a new walker like the one pictured below. A brand new standard cane will fetch at least $20. More expensive pieces like a shower bench can run well over $100.



While some insurance providers will cover part of the cost of medical equipment, the hassle of obtaining a prescription and ordering from a vendor sometimes outweighs the ease of purchasing the item directly. If you are looking for a piece of medical equipment, here are three places you should check before paying full price:

  1. Community Loan Closets: nearly every town, large or small, will have a loan closet for medical equipment. Check here for a listing a loan closets in the Traverse City area and throughout Michigan. Loan closets collect used and donated equipment that is loaned to residents for a small fee (or sometimes FREE!).
  2. Second hand stores and garage sales are a great resources for gently used medical equipment. Be sure to inspect the equipment for excessive wear and that all necessary parts are present. If the equipment appears to be at all damaged, don’t risk buying it.
  3. Ask around: If you happen to need a piece of medical equipment, trying asking your friends, family and neighbors. You might be shocked to learn how many of your friends have a small loan closet right in their basement! You won’t know until you ask.

Once you have the equipment you need, be sure that a trained professional inspects the piece before you use it. Walkers and canes are often adjustable and should be fit by a professional to match your height. You should also be educated in how to use the equipment to ensure that you are safe while doing so.