Ask a physio: Staying on your feet is a team effort

You reach for the railing on the back steps and realize you actually need it this time.

Nothing happened. Your feet just didn’t feel as sure as they used to, and you catch yourself thinking: maybe my balance is starting to go.

If you have had a moment like that, you are in good company, and you are not wrong to notice. About a third of us over sixty-five have a fall in any given year.

But “my balance is going” is the wrong way to think about it, and the right way is more hopeful. Staying upright isn’t one skill that lives in your legs. It’s a team. When one member has an off day, the others usually cover.

Think about who is on that team. Your muscles, and the sense of where your joints are in space. Your eyes, telling you where the ground is. The balance organ in your inner ear. And, less obviously, your blood pressure, which has to adjust the instant you stand so your head doesn’t go light. Even a few common medications can take the edge off how steady you feel.

Researchers who study falls find they rarely come down to a single cause. They stack up. A little stiffness in the hips, eyesight that isn’t what it was, blood pressure that dips when you rise from a chair, a new pill that leaves you slightly woozy. Any one of those on its own you would manage. Together, on a dark wet step, they find you out.

And here is the good news. The thing on that list that protects you most is also the one most within your control: staying strong and active.

Balance practice helps, and it is worth doing. I wrote a few weeks ago about standing on one leg while you brush your teeth, and I stand by it. But the deeper protection isn’t a trick. It’s the ordinary strength you keep in your legs by using them: the walk, the stairs, the groceries, the garden, the weights if you enjoy them.

When your eyes or your inner ear get caught out, and sometimes they will, it is strong legs that carry out the save. The best fall-prevention programs we have are built on exactly that, keeping your legs strong and giving your balance a little to react to, week in and week out. In studies, that kind of regular exercise cuts falls by roughly a fifth to a quarter. Nothing in a pill box comes close.

So if you have started to feel less steady, by all means practise your balance. But put most of your energy somewhere less glamorous. Get out of a chair without using your hands a few times a day. Take the stairs when you can. Carry your own bags. Keep whatever activity you already enjoy, and nudge it along a little.

Then look after the rest. Get your eyes tested. If you feel light-headed when you stand, rise a bit slower, and mention it to your doctor or pharmacist. Ask whether any of your medications could be adding to the wobble.

Those are small conversations that can take a real risk off the table.

Because the goal was never to feel perfectly steady every moment. You won’t, and neither do I. The goal is to be strong enough, and backed up well enough, that when the ground surprises you, you stay on your feet.

Staying upright is a team effort. Strength is the member you can count on.

Sean Overin is a registered physiotherapist who coordinates the Chronic Pain Program at Tall Tree Health, which has a clinic in Port Coquitlam. This column is general information, not a substitute for individual medical advice.