Physical Therapy Guide to Falls
Falls and a fear of falling can diminish your ability to lead a full life. A fall can result in injury, loss of independence, and decreased ability to do the things that are important to you. Physical therapy to improve your balance, muscle strength, and endurance can help to lower your fall risk. And, according to a new study, choosing physical therapy to help prevent falls is superior to doing nothing and is cost-effective.
Although 25% of older adults fall each year, falling is not a normal part of aging. A physical therapist can assess your risk factors. They can help you address risk and remain independent. Your physical therapist can:
- Design a personalized plan for your specific fall-prevention needs.
- Help you make your home as safe as possible.
- Educate you about the medical risk factors related to falls.
- Teach you appropriate strength and balance-training exercises.
- Work with your other health care providers to address any underlying medical conditions that could increase your falls risk.
- Recommend appropriate community programs to help you maintain your strength and balance.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and exercise. You can contact a physical therapist directly for a falls risk screening. To find a physical therapist in your area, visit Find a PT.
What Are Falls?
A fall is defined as any event that leads to an unplanned, unexpected contact with a supporting surface, like the floor or a piece of furniture, which is not the result of an injury, shove, or medical event such as a heart attack or fainting spell.
A near-fall is a stumble or loss of balance that would result in a fall if you were unable to catch yourself.
There are lots of factors that can increase your risk of falls, including:
- History of a previous fall.
- Advanced age.
- Difficulty with walking or keeping your balance.
- Leg weakness.
- Medical conditions such as heart disease, diabetes, stroke, Parkinson disease, or Alzheimer's disease.
- Taking too many, or certain types of, medications.
- Getting dizzy when you stand up from sitting or lying down (orthostatic hypotension).
- Home hazards such as throw rugs, poor lighting, or a lack of handrails on stairs.
- A recent hospital stay.
- Trouble with your memory and thinking.
- Depression or anxiety.
- Being in overall poor health.
- Being female.
- A lifestyle that involves too much sitting.
- Becoming fatigued easily.
- Problems with your vision or skin (touch) sensation.
- Limited flexibility.
- Unsuitable footwear.
- Joint pain or arthritis.
- Improper use of a walker or a cane.
The more risk factors you have, the greater your risk of falling.
How Is It Diagnosed?
Adults aged 65 years and older should be screened by their primary care provider on a yearly basis to help determine their risk for falling. Also, you should see a physical therapist if you:
- Worry about or fear falling.
- Have had a loss of balance.
- Have had a fall.
A physical therapist can conduct a brief check (screening) of your falls risk by asking you a few simple questions. They also will conduct tests to assess your:
- Ability to get around.
- Leg strength.
How Can a Physical Therapist Help?
Many studies have shown that physical therapy can help to reduce the risk of falling in adults ages 65 and older. In a new study (that looked at falls risk in women ages 80 and older), researchers calculated the economic impact of choosing physical therapy to prevent falls, and they found that doing so saves $2,144, including all the hidden costs of your time, pain, missed life events, and the dollars paid for services.
If the screening shows that you are at risk for falling, your physical therapist will perform a thorough evaluation, including:
- Review of your medical history and any medications.
- Checking your heart rate and blood pressure measurements at rest and while you change positions (from sitting or lying to standing).
- A simple test of your thinking (cognitive) abilities.
- Assessing your balance, strength, and walking ability.
- A simple vision test.
- Assessing your feet and footwear.
- A home safety assessment.
Based on the evaluation results, your physical therapist will design a plan that is tailored to your specific needs. Your treatment plan may include:
Balance training. Balance training is the most important and effective part of falls prevention. Your physical therapist will safely guide you through exercises that challenge your ability to keep your balance. These exercises also are designed to help you recover from a loss of balance.
Walking and moving. Walking is a popular physical activity. However, if you have poor balance, starting a walking program can increase your risk for falling. Talk to your doctor or a physical therapist before you begin a walking program to make sure that it is right for you.
Doing more than one thing at the same time — safely. Older adults who have difficulty walking and talking at the same time are at a higher risk of falling. To help increase your safety during daily activities, your physical therapist may design a training program that will challenge you to maintain standing and walking while you do another task. Examples include walking or standing while counting backward, having a conversation, or carrying a bag of groceries.
Strength training. Strengthening is a key element of fall prevention when combined with balance exercises. Your physical therapist will design a personalized strengthening program that focuses on specific muscle groups. This program will help improve your standing balance, your balance while walking, and your ability to recover from a loss of balance.
Pain management. Certain exercises, such as strengthening and aerobic exercises, can help to relieve pain in addition to decreasing your falls risk. Research shows that physical therapy can help people reduce or eliminate their need for pain medication, including opioids.
Education. Your physical therapist will take the time to explain how you can best manage your own risks for falling. They also may talk to you about the best activities to help maintain your quality of life, and offer educational resources, such as:
- National Council on Aging. Falls Prevention for Older Adults.
- Centers for Disease Control and Prevention. STEADI – Older Adult Fall Prevention.
- Homemods.org. Fall Prevention Center of Excellence.
Fear management. It is important that you talk with your physical therapist about any fear you have of falling. They will work with you to build your confidence and help you get back to the activities you may be avoiding because you are afraid of falling. Your physical therapist also can identify which activities you should avoid to stay safe.
Community programs. Community-based falls prevention programs help people to:
- Reduce their fear of falling.
- Set goals for increasing their physical activity.
- Make their homes safer.
- Exercise more to increase their strength and balance.
These programs often are led by volunteer coaches. A popular community-based falls prevention program that has been shown to reduce falls is the ancient exercise system known as tai chi. Your physical therapist may be involved in setting up one of these programs or can help you find programs in your area that are best for you.
Personal recommendations. Your physical therapist can provide personal recommendations based on your condition and goals to help you:
- Increase the safety of your home environment by making changes, such as removing throw rugs or clutter.
- Adjust how you complete your daily tasks to reduce your falls risk.
- Choose appropriate footwear.
- Learn about proper nutrition and how to improve your sleep schedule. They also can provide other general information that can help reduce your falls risk.
- Meet with other health care providers when appropriate.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to identify falls risk and treat people who have a fear of falling, and balance problems. You may want to consider:
- A physical therapist who is experienced in working with older adults or people with neurological problems. Some physical therapists have a practice with a focus on balance rehabilitation or falls prevention.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic or geriatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can search for physical therapists in your area who have these and other credentials by using Find a PT, provided by the American Physical Therapy Association.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- Ask about the physical therapists' experience in helping people who have experienced a fall, have a fear of falling, or have balance problems.
- Be prepared to describe your symptoms in as much detail as possible.
The American Physical Therapy Association provides this information to help consumers:
- Make informed health care decisions.
- Prepare for a visit with your health care provider.
The following articles provide some evidence and resources related to physical therapy treatment for balance problems and falls prevention. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. They link to either a PubMed* abstract of the article or to free full text. You can read them or print out a copy to bring with you to your health care provider.
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148-157. Article Summary in PubMed.
Montero-Odasso MM, Kamkar N, Pieruccini-Faira F, et al. Evaluation of clinical practice guidelines on fall prevention and management of older adults: a systematic review. JAMA Network Open 2021;4(12):e2138911. Article Summary in PubMed.
Sherrington C, Fairhall N, Kwok W, et al. Evidence on physical activity and falls prevention for people aged 65+ years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act. 2020;17(1):144. Article Summary in PubMed.
Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;1(1):CD012424. Article Summary in PubMed.
Guirguis-Blake JM, Michael YL, Perdue LA, et al. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;319(16):1705–1716. Article Summary in PubMed.
Centers for Disease Control and Prevention. Facts about falls. Updated August 6, 2021.
Lusardi MM, Fritz S, Middleton A, et al. Determining risk of falls in community dwelling older adults: a systematic review and meta-analysis using posttest probability. J Geriatr Phys Ther. 2017;40 (1):1–36. Article Summary in PubMed.
Avin KG, Hanke TA, Kirk-Sanchez N, et al. Management of falls in community-dwelling older adults: clinical guidance statement from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Phys Ther. 2015;95(6):815–834. Article Summary in PubMed.
Abdulla A, Adams N, Bone M, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42 Suppl 1:i1–i57. Article Summary in PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
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