Why do I fall so often?
December 27, 2016 9:35 AM   Subscribe

Or, perhaps more precisely, what is it that people do who do not fall frequently?

This question has bothered me for some time, but Friday was the straw that broke the camel's back. I was STANDING STILL, putting my umbrella away, preparing to get into a cab, and I fell on my ass. The sidewalk area was slippery -- it's a stupid design flaw that runs throughout an approximate 3 block area (if you know San Francisco, it's the Embarcadero Center) -- but no one else was falling, whether they were standing or walking.

I knew it was slippery and I was taking care as I walked. I was walking more slowly than other people, and I still was losing my footing.

Was it my shoes? I was wearing Merrell booties, which I bought precisely because I've been wearing a similar pair for a few weeks and hadn't fallen in them.

My history is so full of falls that I've actually had a brain MRI to rule out MS. I've sprained ankles, and skinned knees and hands, but mostly I just get bruises to my body and ego. Can you imagine having a little elderly gentleman try to pick your ass up off the ground? I was sure he was going to fall over onto me.

20 years ago, I attributed this to not paying attention, walking too quickly, not picking my feet up properly. I no longer walk too quickly, and several falls in the last couple of years have been when I was on alert that I was walking on a potentially slippery area, but dammit, OTHER PEOPLE walk way more quickly than I do on these slippery areas and do not fall.

Sometimes I can blame it on the fact that I'm walking downhill. Once or twice, I've decided that it was because I had put my weight on a slick spot on the sole of my shoe (and then thrown out the shoes).

My balance is fine -- not impeccable, but I can stand on one foot with my eyes closed no problem, my sense of direction is fine, my ears are fine, my posture is good. My vision is corrected with eyeglasses. I had frequent vertigo 30 years ago, and it passed after a couple of years (I think it was probably due to dehydration).

I'm so concerned about this because it's not getting better and I'm not getting younger. I went for one six-month period without a fall and I celebrated. No one else I know thinks of that as any kind of achievement. What is it going to be like in 10 years?

These falls always take place outside, while I am walking. The first bad fall I remember was when I was 14, and I was walking down a set of concrete stairs. Since then, I have never walked down stairs without holding onto the rail.

What am I doing wrong? Obviously, you all can't diagnose my problem without seeing me walk and fall, but what are potential reasons that I'm overlooking?
posted by janey47 to Health & Fitness (33 answers total) 9 users marked this as a favorite
If you are falling while standing still, I would look towards inner ear problems. That is where your balance comes from.
posted by DarlingBri at 9:39 AM on December 27, 2016 [6 favorites]

I had a friend who had balance problems. He doctor told her to stop shoving q-tips so far into her ears; she stopped and her balance improved. For real.
posted by rada at 9:42 AM on December 27, 2016 [6 favorites]

Do you by any chance happen to walk pigeon-toed, with one or both toes pointing inward? I used to trip much more because I was always tripping over my toes. I started being more conscious about purposely turning my toes outward as I walked. It's definitely helped.
posted by potrzebie at 9:46 AM on December 27, 2016 [2 favorites]

Since you've said your balance is fine, I'm going to focus on how you put your feet on the ground. When you walk (or run - are you a runner?), do you toe/midfoot/heel strike? Where is your center of gravity when you're standing and walking (forward, backward)? Do you pronate when you walk? There is lots and lots of research out there on the ways in which bipedal walking is a nontrivial undertaking, biomechanically speaking, and plenty out there on building gait and standing stability. I think it would be really interesting to go to a running store and get a gait analysis (even perhaps when walking) to see what that might tell you.
posted by Emperor SnooKloze at 9:49 AM on December 27, 2016 [3 favorites]

Sometimes a person can have a very mild version of a neuromuscular disease, like Charcot-Marie-Tooth, and just think they're particularly clumsy or prone to falls.
posted by Soliloquy at 9:49 AM on December 27, 2016 [6 favorites]

The sidewalk area was slippery

I am not a big faller, but I have a horror of slick ground (especially painted crosswalk lines, my nemesis) because I slip. Other people don't seem to be slipping, but even without falling I always feel myself lose traction in any kind of hard-soled shoe and occasionally even in grippy shoes. I think it is a lot to do with where I put/how I shift my weight when I step (I definitely have a pretty awful gait when trying to walk/run for exercise, and I have high arches and prone to plantar fasciitis). On slippery surfaces, I have to make sure my knees stay bent so my center of gravity stays centered.

I have no idea who you'd see about that. Maybe a podiatrist? First rule out any structural issues that might need orthopedic assistance and go from there?
posted by Lyn Never at 9:52 AM on December 27, 2016 [2 favorites]

You say you had an MRI to rule out MS, but have you had a full neurological exam? If not, it might be a good idea.
posted by brianogilvie at 9:53 AM on December 27, 2016 [10 favorites]

Neurologist time. This isn't normal and should be checked out.
posted by fshgrl at 10:10 AM on December 27, 2016 [3 favorites]

Agree with the neurological workup - and I would also schedule an appointment with a physical therapist. Even if the neuro exam comes up clean, it's possible that with aging, and maybe putting on some weight since your 20's, and your joints getting a little stiffer, some sub-optimal balancing, gait, and ways of moving are now catching up with you. A PT could assess your gait and balance, and help you learn ways of walking/balancing that are less likely to result in falls.
posted by Rosie M. Banks at 10:13 AM on December 27, 2016 [8 favorites]

I'd definitely recommend talking to your regular doctor about it -- describe your history and your concerns, and ask specifically about any of the possibilities in this thread that seem plausible to you. They can help point you towards additional resources or give you a referral to a specialist (like a neurologist or a physical therapist or an orthopedic surgeon or whatever it is that you need).

One other possibility to ask about: might your ankle(s) be unstable? If you've had repeated sprains or rolls, you may have stretched or torn the ligaments that keep your foot stable, which would make you prone to more falls and sprains over time. Ask to your regular doctor about it. If they agree this is a possible issue, then they can help point you to the right next step. That might be ...
- Using a brace to provide additional stability
- Referral to a physical therapist, who can teach you simple exercises to improve strength, coordination, and balance
- Referral to an orthopedic surgeon, who can consult with you about surgery to repair the ligaments if they are seriously injured

Anyway -- that may not be your particular issue (or it may not be your only issue), but I'd definitely suggest exploring it with your doctor.
posted by ourobouros at 10:15 AM on December 27, 2016 [5 favorites]

One of my friends who falls a lot was told to work on her core strength and balance by a physical therapist (she generally is good on both, but I guess you can always improve).

An outside of the box idea is also to take aikido classes, which teach you to fall with precision.
posted by aaanastasia at 10:39 AM on December 27, 2016 [3 favorites]

This is kind of a random question, but can you ice skate? I grew up playing hockey, and maybe this isn't related, but I rarely slip or fall. I attribute it to learning how movement affects balance on skates. Obviously, you should see a doctor to make sure it's not a physical issue, but if you get a chance, maybe spend some time on skates and see if that helps.
posted by kevinbelt at 10:47 AM on December 27, 2016 [1 favorite]

I have a friend who always had bad walking form, then fell and sprained her ankle, then proceeded to fall many times after this. Working with a personal trainer has helped. She has not stopped falling entirely, but she falls less and recovers more quickly.

I agree that it could be neuro, but I would also work with a physical therapist and see if that can help. You do want to do what is possible to improve this before you're a senior citizen. I'd also be really vigilant about your calcium levels because falling + osteoporosis is a big lifestyle issue.
posted by vunder at 10:51 AM on December 27, 2016

Are you hypermobile, by any chance? I fall more than most people I know and it's a combo of not-great natural balance and very loose joints, especially in my ankles/lower body.
posted by terretu at 10:52 AM on December 27, 2016 [8 favorites]

My balance is fine -- not impeccable, but I can stand on one foot with my eyes closed no problem, my sense of direction is fine, my ears are fine, my posture is good. My vision is corrected with eyeglasses.

This doesn't exhaust the varieties and functions of spatial sense. Balancing while in a static position is completely different from balancing yourself during forward propulsive movement in territory less familiar than your home. (You're only falling outside, right, not at home?)

I'd bet it's likely to be down to some form of ankle instability, as ourobouros says, plus your own assessment 20 years ago that you're less attentive to your environment than the average bear (or, maybe, just have less well developed feedback mechanisms wrt proprioception, maybe require lots of practice in given environments), combined with the fact that you tend to rush. Some of each of those can go along with hypermobility, are you especially bendy? (missed terretu's answer, agree to look into it!)
posted by cotton dress sock at 11:02 AM on December 27, 2016 [3 favorites]

I think I'm revising my earlier answer from podiatrist to physical therapist as well - they should be able to do a series of assessments and measurements (like what if one of your legs is a teensy bit shorter than the other, or you have mild previously-undetected scoliosis or the onset of osteoporosis making your hips uneven), check for leg and ankle strength, test your visual/spatial functioning, test for hypermobility, etc. They may then refer you on to someone else, but for the overall look-see it might be a good first step.
posted by Lyn Never at 11:21 AM on December 27, 2016

I'll be watching with interest as I nearly posted a similar question - I fall all the time and finally managed a horrible Colles fracture to my wrist while running which needed surgery this autumn. (Have I fallen since? Yes, and fucking ouch!)

I hope you will see your doctor and ask for any referrals or follow up needed. In my case, my doctor concluded it was dyspraxia I just never outgrew, and recommended physical therapy to work on balance and proprioception. I've literally been counting steps in sets of 20 to make myself aware of my feet, especially when hiking or somewhere slippery, and I feel like that's been helping with being mindful.

Good luck, break no legs!
posted by carbide at 11:55 AM on December 27, 2016 [6 favorites]

If physical therapy ends up being a treatment option, I have recs for good ones in SF (there are a lot of bad PTs out there). MeMail me.
posted by radioamy at 11:59 AM on December 27, 2016 [1 favorite]

I have that problem. Mine is caused by a stroke in the cerebellum. I just use as much caution as possible. Rarely fall but it takes concentration.
posted by JayRwv at 12:07 PM on December 27, 2016 [1 favorite]

We've got about 13,000 employees, most in an industrial-type area. We were chronically getting a lot of slip/trip/fall-type minor injuries. They changed the morning optional "stretch and flex" routine (about 10 minutes or so first thing in the morning when the crews are getting their morning briefings on) to more of a stretching and balance-drill routine. There are some drills in this video series.

You say your balance is fine, and that's what most people say. There are still falls. There are still people who fall more than others. BUT, it's undeniable that the volume of reportable falls drastically declined over time after introducing the drills. So maybe that could help if there's not a neurological cause going on.
posted by ctmf at 12:11 PM on December 27, 2016 [6 favorites]

How much trail hiking do you do? The more you do the better your perception, balance and confidence will be on flat pavement. A walking stick or two may help inspire confidence on slopes as well.
(This is ruling out neurological probs).
posted by artdrectr at 12:21 PM on December 27, 2016 [1 favorite]

So, to address some questions:

I see a podiatrist and recently received orthotics, which quite frankly don't seem to make much difference but I wear them.

I can ice skate, though I haven't in years. I took ballet during my formative years, from about 5 to about 16.

I recently had a spinal xray, which showed modest levoscoliosis at L2.

I don't appear to have much hypermobility. I would say it's more likely the opposite is true.

Thanks for all your great suggestions -- I'm going to try balance drills and other exercises mentioned in here, and I'm making an appointment with my dr to discuss neurology and/or PT.
posted by janey47 at 12:22 PM on December 27, 2016

If it's not neurological (good idea to look into that), I too came in here to suggest working on your core strength. It doesn't sound like you're doing much physical activity apart from walking? You'd be surprised how fast your core can go downhill if that's all you're doing.

I had the most sprained ankles and falls in my life when I couldn't afford a bike (my favorite thing to do) and thought I couldn't run because of an unlucky combination of things in childhood that led to running coaches telling me that.

Tai Chi gave me a new respect for balance in movement several years ago. Made a huge difference. I'm not able to afford classes where I live now, but the basics stayed with me and I practice always feeling rooted in my body while moving.

If Tai Chi isn't available to you, try running. It's cheap and easy BUT you need the right shoes – you're ahead of the curve with a podiatrist on your side! I took up running again this last February, and worked on my core. Not that much, just your usual active stretching pre-run, balance work and static stretching afterwards, and planks and other easy core work outside running workouts. It is amazing how much more stable I am on my feet. I can catch myself while slipping on one foot. I've landed wonkily on branches/odd spots I hadn't noticed that would have given me a sprained ankle not so long ago – now I just keep going, no issues. All has to do with core strength and your body getting used to movement.
posted by fraula at 1:21 PM on December 27, 2016 [2 favorites]

Do you have low blood pressure?
posted by ellieBOA at 2:20 PM on December 27, 2016

If the sidewalk was slippery, and you fell on your butt, think about whether you put a lot of weight on your heels. Keep your weight more on the balls of your feet when walking on slippery surfaces. It's one balance trick I learned from skiing that transfers nicely to hiking downhill and walking on ice.
posted by Opposite George at 3:21 PM on December 27, 2016

Definitely doctor to be sure. I have inner ear issues from time to time (it's freaking true about the qtips). I get random vertigo from time to time. I also drag my feet sometimes when I walk, no bueno. Sometimes I feel like my ankles just buckle trying to dump me to the ground maliciously. So, I fall down a lot, as well, but significantly less since I started working out with a focus on my core. My posture is better and my balance significantly better.
posted by pazazygeek at 3:23 PM on December 27, 2016

I'm fairly clumsy and I have felt yoga has been really helpful to improve my balance (and I love it for a lot of other reasons too).

Those Merrell booties don't look like they have a very stable base. I think you should consider different footwear, and specifically flat soles. If the sidewalk is uneven that sole would probably become an issue.

You mentioned you used to get a lot of vertigo. Meniere's disease is a cause of vertigo that can be severe in some parts of your life and then not bother you for years. It's diagnosed clinically. My husband has Meniere's and anecdotally, his balance is terrible sometimes (randomly, the balance problems seem to flare up the same way the vertigo did although now he is treated with meds and hasn't gotten a flare in a long time). He doesn't fall to the ground, but he does suddenly fall into walls or have to grab onto doorways at times.
posted by treehorn+bunny at 5:13 PM on December 27, 2016 [3 favorites]

I also fall a lot. In my case; it's weak ankles (probably stretched ligaments and hypermobility). I do a lot better when I build up the tiny stabilizer muscles around my joints, particularly ankles and knees. Yoga is good for this, and for balance and proprioception in general. I absolutely fall less when I am stronger-- I can feel my ankles start to roll, but strong core muscles, quads, ankles can catch me before I hit the ground.
posted by instamatic at 8:14 PM on December 27, 2016 [1 favorite]

hi! i trip over my own feet on a regular basis & i've diagnosed myself with dyspraxia. I mean just reading abt the symptoms was a life changer. obv ymmv.
posted by superior julie at 9:08 PM on December 27, 2016 [1 favorite]

This was me before I started personal training about a year and a half ago. One of my goals was to stop falling, and I've only fallen twice in the last 6 months and caught myself before falling to the ground both times. The biggest difference for me was doing a lot of core work, and I could tell when I caught myself that what I was doing was stabilizing my core.
posted by fairlynearlyready at 10:36 PM on December 27, 2016 [2 favorites]

Came here also to suggest getting checked for Meniere's disease.
posted by leslies at 6:15 AM on December 28, 2016

Years ago when I taught gymnastics I went to a conference in which a speaker mentioned a study that showed balance, specifically on the balance beam, got better with improvements in overall fitness.
posted by oneirodynia at 6:11 PM on December 28, 2016

Is it possible you have some degree of something like dyspraxia or poor proprioception? I fall, like, *all the time*, and it's partly down to hypermobility issues and low muscle tone but mostly down to the fact that I basically have no inbuilt sense of where my body is in space. No depth perception, spatial awareness etc. I fall downstairs so often that it's basically just another method of getting downstairs for me.
It is something you can learn to do to some extent. It might be worth your while seeing a specialised physio or occuptional therapist to get evaluated, if that's something you can do.
posted by BlueNorther at 8:02 AM on December 31, 2016

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