How would you teach "old ladies" how to fall?

[Jarlo Ilano]

My friend and I were talking about a patient this morning. She told us how she tripped and fell forward, landing on her knees and hands.

Now, I love the classic forward roll and now the neat forward engagement to neck roll I learned at the seminar... But I'm not sure that's realistic for some of our nice 70+ year old ladies.

I have a couple of ideas, But I would love to hear all/any of yours!

[Chuck Kechter]

Hey Jarlo,

When I teach others to go to the ground, I do it pretty "position" specific. I have found over the years that NO ONE, regardless of age (from 6 to 64) wants to go to the ground ballistically. Fear-reactivity is high in this area of study.

Progressive resistance is key!

For those that are not martially inclined--If you're working on a rear ground engagement, you can remove some of the fear by starting sitting, facing forward with knees up. Play with rolling the spine along the ground to outstretched arm. When compfort is there, move to some variation of the cossack squat, play from there, then ball-of-foot squat (or flat foot squat), repeat, then "powerlifter's squat, repeat, et cetera. . . Control how fast you (and they) hit the ground with core activation and postioning. . .

For side I use the same progression, except in the begining position the knees are down (so they don't "bang" together upon completion of the fall). Then everything progresses the same, except that at the ball-of-foot squat stage I will add a component of sliding the "collapsing" leg in front of the support leg (principles from IOUF here), to keep them from hitting on another and reducing the chance of injury. I use this slide for the rest of the progression.

For front, I actually use three different types of engagements, depending on how the fall develops. For the hands-in-triangle-sprawl type of movement, I break the movment into its components, and start from the knees, and explain how the arms shock absorb, then add the legs kicking back (with spread), and the hip in-back arch to wave force out. From there I go to the ball-of-foot or flat foot squat, powerlifter's squat, and so on.

For the front fall where you arch through it (I can't remember its name :shock:) I start on the knees in a one hand push up position with the other hand behind the back, and play with absorbing the force through the torso. From there to the knees, and up. . .

I also use the forearm stop that I learned from Judo years ago (the only one I perform un-modified by RMAX methodology) as a last-ditch--too-much-momentum-fall-to-do-anything-else. Progression is the same, start on the knees and work up, both in resistance and postition.

At any time these can be modified into rolls.

And for the martially inclined, impellent force can be added by a partner, ala the Softwork seminar. . . And differing types of surfaces can (and should) be practiced on--once the movements have been "mastered." Chances are that no one will be walking across a nice soft mat when falling (except in sport). It will be on grass, hard wood, or concrete, et cetera.

Hopfully this helped.

Talk to you soon my friend!

Chuck

[Connie Brown]

Thinking of the 70+ year olds in my CST Wellness group, I can think of a lot of stages / steps.

On the prevention side: CST for balance, coordination, awareness so you don't trip in the first place. Honest, the people in my group are "getting it" just from WW and light swinging. It is very gratifying to see "eyes light up" with understanding practical solutions to self-defense from falling!

On safely engaging the ground: practice getting to the ground. Just as the rolls in an RMAX seminar come out of practice with FF squats to cossack squaq to long arm roll... Seems as if you could teach LOL (that's little old ladies) how to get down on the ground safely, starting where they are and getting more smooth and graceful. My group members in their 70s just don't do that in life any more and are out of practice.

[Scott Sonnon]

I've been working with elders in Ground Engagement (http://www.rmax.tv/toolbox.html) vs. "falling" for nearly a decade. The key is teaching Incremental Progression in removing tension from the bottom up - collapsing down rather than toppling forward, backward or sideward.

[Jarlo Ilano]

Wonderful! Thank you all for your responses! More please from everyone else out there!

So often, unfortunately, a fall is “the beginning of the end” for many of our elderly friends. I remember this amazing 90 year old woman, sharp as a razor, with a wit to match, who was a patient when I was doing a student internship in a hospital. She remarked that she had a serious injury before, had been living by herself for quite some time, and was in perfect health. However, a fall which resulted in a broken hip, had landed her in our rehab unit. She was not a patient of mine, but my colleagues noted that she was not doing well. Though she looked fine (outwardly) to me, there are certain criteria that need to met before an individual is sent home if they live alone. I’m afraid that this was most likely the beginning of her permanent stay in a nursing facility, instead of living the rest of her time as independent as she was used to.
Any words are an understatement to how sad that is.

Chuck, what a great progression! I think you’ve just outlined a training session for me and my friends! :lol: In wushu we had that forearm breakfall (part of Ditan work). Looks much more sore than it is (though it is very jarring!). Your thoughts are always helpful!

Connie, thank you for your practical knowledge! Little old ladies :D continue to be a favorite of mine, if not for the actual practice, but mostly for the great conversations that can arise. You are most correct about the awareness issues being primary in preventing a nasty fall. Proprioceptive awareness is key. Those who peg themselves as “clumsy” or “awkward” are often just lacking in the body awareness necessary for smooth movement. They barrel through activities rather than “learning” through it.

Coach, the “collapsing” method is genius. That first night of the Softwork seminar really got me thinking. Falling like a ragdoll instead of a tree… :!:

Some random thoughts:

Often cited in the literature for studying falls, is the noted weakness in the posterior chain of those patients more likely to fall. Hip extensors (glutes, hamstrings) are the “brakes” when upright posture is disturbed.

From my experience, in those most afraid of falling, they tend to reach out for handholds (whether they need to or not). This makes things worse, as reaching out further disrupts their stability. Rather than being reliant on their structure, they reach out for more “solid” objects, this can cascade into a fall very easily. Teaching a person to stay “within their structure” is quite hard.

Walking slowly, is much more difficult than moving at your natural, personal gait speed. Often, when teaching patients to walk again after a surgery/injury, they shorten their stride or walk much more slowly than they would normally, perhaps thinking it is safer. When really, it takes substantially more energy, and takes away from your overall awareness. Sort of like a “target fixation” on your gait, rather than having a good global attentiveness.


This is such an important topic. More from everyone please!!! Personal stories as well as "scientific thought" are very welcome!!

[Connie Brown]

An article I ran across a while ago. Maybe not new to you PT types but, in the spirit of anything goes.


Exercise cuts fall risk for women with thin bones

Last Updated: 2004-06-21 12:06:59 -0400 (Reuters Health)

By Amy Norton

NEW YORK (Reuters Health) - Exercises that boost strength and agility
may help elderly women with brittle bones lessen their odds of
falling, a new study suggests.

Canadian researchers found that both strength training and agility
activities lowered fall risk among women 75 to 85 years old, all of
whom had reduced bone mass or full-blown osteoporosis.

Falls are a major cause of disability among the elderly, and those
with osteoporosis are at particular risk of falling and sustaining a
bone fracture.

The new findings are important, according to study co-author Dr.
Karim M. Khan, because although older adults are generally encouraged
to stay active, people with osteoporosis may be advised to avoid
exercise because of safety concerns.

But this study, Khan told Reuters Health, shows that older adults
with brittle bones should be active, under the proper supervision.

"This study showed very important gains in health, and the safety was
excellent," said Khan, who is from the University of British Columbia
in Vancouver. He and his colleagues report their findings in the
Journal of the American Geriatrics Society.

For the study, 98 women were randomly assigned to perform one of
three types of exercise: resistance training, agility training or
stretching exercises.

Those in the resistance-training group focused on building strength
through lifting light weights and doing exercises such as squats and
lunges. The agility training used games, dance and obstacle courses
to try to improve the women's balance, coordination and reaction
times.

Women in all three groups took 50-minute exercise classes twice a
week at a community center.

After six months, those in the strength-training and agility-training
groups showed a greater drop in fall risk compared with women in the
stretching group. Fall risk, which was estimated with a standard
battery of tests, declined by about 57 percent with strength training
and 47 percent with agility training, the researchers report. That
compares with 20 percent in the stretching group.

According to Khan and his colleagues, much of the benefit from both
types of training had to do with "postural stability." This is gauged
in tests that measure how much the body sways when a person is
standing still. After six months, women in the strength and agility
groups were steadier on their feet than at the study's start.

The findings also suggest that strength training may be a
particularly good way for elderly adults with osteoporosis to
exercise. While participants found the agility program enjoyable, the
researchers note, it carried a higher risk of falls, and it may be a
less feasible type of activity compared with strength training.

The U.S. Centers for Disease Control and Prevention (CDC) has said
more older adults should be doing strength-building exercises to
counter the loss of muscle and bone mass that comes with aging. In a
recent national survey, the CDC found that only about 11 percent of
Americans age 65 and up regularly perform any type of strength
training.

SOURCE: Journal of the American Geriatrics Society, May 2004