Falling while running, haven’t we all?
As we start the New Year and with winter gritting services underway across SW London, the thought of slipping while running is a consideration and something to avoid, unless for me, it involves all sorts of glorious mud. Then it’s a necessity.
Over the year’s, I’ve lost count of the number of times I’ve fallen or almost fallen while running. Oftentimes, it happens when I’m either switched-off, half asleep, distracted or ignoring an injury. Sometimes it’s at that moment when I think, “I feel good.” Then BAM! I lose my footing, almost roll an ankle or catch a foot on a root, rock or paving slab.
Most recently, albeit seldom, near falls are just what I’ve needed to jolt my conscious and improve focus and form.
Structured coaching has taught me a lot about falls and how to avoid falling. More correctly, I’ve been coached to ‘see’ and ‘feel’ how I move, improve durability, recover stability and land in good positions. I’ve also had clarity of thinking at times when I should have fallen head over heels, but instead experienced perfect coordination.
Essentially, running is a series of steps and ‘mini-squats,’ one foot at a time. Single leg stability and control are essential for all track (and off-track) and field events.
Running relies on stable foot contact as well as a stable trunk and pelvis allowing the hip to flex and extend powerfully. Achieving this level of stability can be found in jumping, including counter movement jumps (CMJ), depth jumps and box jumps, among others. Examples follow:
Jumping is a reliable measure of lower-body power – jumping is critical for runners as it is the only opportunity to produce force in the quickest amount of time, as well as program the body to properly absorb force and land in good positions.
Understanding the kinetic chain or how we move ourselves – mobility, stability, force production and direction, and how coordinated links in a chain move the body – underpin health, sporting movements and performance. Synchronization of the whole kinetic chain is key to efficient and effective movement; and effective force production should be efficient without leakage. Leakage being things like too much bouncing up and down; swinging the body from side to side; hip dropping; dragging the feet; or landing on heels or toes.
Maintaining strength and balance goes beyond running. In the wider population, according to the WHO, falls are the second leading cause of accidental or unintentional injury and deaths worldwide.
In the United Kingdom, a third of adults over 65 and half of adults over 80 will have a fall; and adults who fall once are more likely to have another fall. Falls in later life can be devastating, leading to significant injury, loss of independence and confidence and they might even be fatal.
Falls are costly to treat
UK government data shows that the NHS spends £2.3 billion per year treating the consequences of falls. Data shows that in England alone over 200,000 people aged 65+ are admitted into hospital each year because of a fall and nearly 60,000 people are admitted because of a hip fracture.
Falls are preventable
The most common and modifiable risk factor for falls is the age-related deterioration of strength and balance. Small improvements in an individual’s strength and balance as well as posture can make significant improvements.
However, evidence shows that while balance can be learned quickly, it can be lost quickly; and while general exercise is a good base for balance, postural control is the foundation of our ability to stand and walk independently, and there are wide-ranging factors at play in postural control.
Six pillars of balance
- Sleep – lack of sleep or poor sleep worsens postural control. Over-the-counter sleep aids such as diphenhydramine (Benadryl) cause drowsiness and combined with other pain medications will affect balance.
- Medications – many prescribed drugs can increase the risk of falls, and the more drugs you take, the greater the chance that one or a combination of them will make a fall likely, due to reduced alertness, slower reactions and dizziness. Atrophy and surgery can also have noxious effects on balance.
- Quality of life / mental health / stress – a decrease in activities of daily living (ADL) and cognitive decline can affect blood pressure, body mass and balance, among other things. A diet poor in calcium, vitamin D, protein, water intake along with unstable blood sugar levels can damage physical abilities – affecting bone density, muscle, strength, hydration and insulin resistance. Further, fall risk is increased with anti-anxiety drugs, antidepressants, narcotics and alcohol.
- Heart – heart problems that affect blood vessels and brain function can cause dizziness, loss of balance and coordination. Drugs that are prescribed to keep blood pressure under control and decrease the risk of stroke and heart failure, can cause blood pressure to get too low so that when you stand up from a lying or sitting position (orthostatic hypotension), you might feel lightheaded or faint.
- Exercise – general exercise is not enough; postural control – enhancing the vestibular system and spatial orientation are key to balance training.
- Functional fitness – exercise should focus on improving strength, flexibility and motor control.
Structured exercise programmes
For adults in later life, structured exercise programmes, such as FaME, are proven to be effective at reducing falls. For a minimum of 24 weeks, comprising two hours per week – one hour led by a qualified instructor and an hour of prescribed exercises to carry out at home – using minimal equipment, resistance bands and a mat. Clinical trials show that FaME has efficacy in adults who live independently; prevents and reduces falls; reduces the fear of falling; and increases habitual physical activity and fitness.
Evidenced based elements of the FaME programme include:
- Functional leg muscle strengthening and balance retraining that progress in difficulty
- Functional progressive trunk and arm muscle strengthening
- Bone loading targeted at prime fracture sites
- Endurance/cardiovascular training (including walking) and flexibility training
- Functional floor skills and skills to rise from the floor
- Adapted Tai Chi
There’s also a social element to the programme, with post exercise tea and coffee, that has numerous positive benefits including helping participants adhere to the programme.
For runners who are prone to falling, or who have a fear of falling, the curative properties of jumping are legion. For those who already incorporate strength sessions into training, other health and lifestyle factors such as sleep, diet, hydration and medications may play a part in fall prevention and reduction, so it is important to look beyond running in order to improve stability and control.