Balance and gait; recognizing these warning signs can prevent your next fall.

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Poor balance abilities, being clumsy, falling, and tripping over things is a common experience for many people.  If you are younger, a fall may hurt but it is not likely to cause a major injury. On the other hand, older folks can break a wrist, arm, shoulder, or hip.  These types of injuries can result in a permanent loss of function. A need for a surgical repair requiring risky anesthesia in the elderly can be devastating. If you have poor balance when you are young, it is likely to worsen as you age unless you do something about it.

Common warning signs of a balance and gait problem.

Why do some people have a better sense of balance, while others tend frequently fall or trip over things easily?

Most balance problems begin when we are infants.  Walking, developing physical strength, neurological programming, and then proper gait and postural habits develop with toddlers and continue going through our growth cycles into adulthood.  Girls have an adaptation that is more complex because their hips also get wider, which requires even further adaptations to walk properly and develop coordination and balance as they grow. Our brains adapt learning patterns of movements known as neuroplasticity. This begins early on in infants and is part of language development and movement development. Neuroplasticity happens very fast in infants and takes longer in adults and is a large part of the mechanism behind re-teaching and readapting movement, habits, and rehabilitation of many types of injuries. When we are babies, we learn to lift our heads as we develop muscular strength and coordination.  We then begin the lay on our stomachs and roll, which begins strength and neurological training of the core muscles.  The next stage is crawling which leads to walking when we see other children doing it.    Not all children progress as quickly through these stages and some may skip a stage, which may be part of why we develop balance issues later in life. There is a way to test the theory of missing a step.  Simply try the skills that you should have learned as an infant by laying on your stomach, rolling, lifting your head up, crawling, and then getting up.  If some of these are difficult, practice them and see if your balance and strength improve.   Many of our patients who have tried this said it helped their balance and in some cases, their vertigo as well. As we go through the toddler stages, we are clumsy and all of us have flat feet.  As we grow, we begin to walk and run and our gait patterns adapt to our body style and our growth.  By the age of 6, we walk more like our parents and continue to grow.  Males get taller, females get taller and their hips widen further challenging balance.   If there are imbalances at the feet, they will affect the knees, shins, and lower as well as the upper back. Our body style also causes adaptation problems as well. When we reach adulthood, mobility is a combination of adaptation from body mechanics, growth spurts, injuries, the neurological system, muscles, and the fascia which surrounds all organs and musculature that controls the firing patterns of muscles.

What is a normal gait?

There is actually a range of normals and many styles of gait, some more and others less efficient. How we feel is our subjective sense of normal as discussed in my book Cheating Mother Nature, what you need to know to beat chronic pain. If we feel good this is what we think is normal.  If we hurt, that is of course abnormal. If you visit the park and watch people walk, you will see a range of normals including some people who lean forward, others lean to the side, others limp and unaware they are doing so and some rock from side to side. Some of them will have a good sense of balance while others don't.   Some have modified their walking style because they have knee, hip, or foot pain. Others have body asymmetries they do not understand or know about. How is their sense of balance?    We would have to ask them. We may find that certain types of gait adaptations that lead to a shorter gait are likely to cause balance problems that if not properly addressed, can lead to a damaged knee, ankle, and hip joints, and cause problems such as plantar fasciitis.  As they age, seniors whose balance has worsened and whose walking stride has shortened can require a walker to prevent falls.

A longer more confident stride often is more balanced has more flexibility. 

The more efficiently we walk, the less tight we will become with regular exercise which is important for us both physically and cardiovascularly.  Poor walking habits result in higher ground impact, more pain, more joint problems over time, and less flexibility, especially with exercise. Seniors often use walkers to prevent themselves from falling.  This causes them to adapt further toward walker dependence resulting in poorer balance increasing the likelihood of falling without the walker as their gait worsens over time. If we recognize many of these bad gait adaptations when we are younger, it is likely that we may never need a walker.   My dad was the perfect example of this as he could mount stairs and rarely fell until he was 89 years old when he fell and broke his hip. Early intervention can not only help you avoid pain earlier in your life but may also help you avoid injuries due to poor movement patterns.

Can you retrain gait, improve flexibility and reduce ground impact: absolutely!

The current model of a specialist for everything is why our system has failed seniors most spectacularly. The symptoms of a poor gait can include hip pain, knee pain, back pain, sciatica, vertigo, neck and shoulder problems.  Visiting a doctor who looks at your parts instead of the person has resulted in chronic pain, surgical procedures that did not work or made things worse over time, and chronic pain that could have been avoidable. Pain management clinics are part of the problem as they treat pain rather than trying to understand the mechanism behind it and treating the symptom with medication and procedures that are invasive. I visited a friend in Florida a couple of days ago and while we were talking, I noticed he was wearing a wrist splint.  He explained that his doctor diagnosed carpal tunnel syndrome and he was told to wear it all the time and he thought it was from typing. He then told me about his back being stiff all the time which his wife noticed, His toe and foot pain was evaluated by his podiatrist resulting in his wearing ill-fitting shoes that did not hurt his feet like his old ones did as they were wider.  The shoes were a half size small but were wider than his previous sneakers.   His left side where he was wearing the wrist splint was tight from the feet up. The two doctors looked at the parts of him that were hurting rather than the mechanism behind why he hurt.  This is why we need a primary care approach to the musculoskeletal system with a holistic point of view. You cannot treat the parts before you understand the person. I did a brief evaluation and his grip was very weak on both sides with the left side being worse and he had restrictions in both his shoulders and in his left forearm. His lower back was very stiff and his left side was much tighter than his right.   He also mentioned his balance was getting worse. I worked on his foot, shoulder, and arm and his feet instantly felt better, he felt looser, his lower back felt improved, and his grip strength improved markedly. He also felt like his balance had improved and his stiff toe was now much more flexible. I told him to avoid wearing the splint as it was not solving his problem but making it more chronic. I educated him on how to properly size a shoe.  It took me 10 minutes to work on all of these problems improving how he felt immediately. Walking and moving better improves body function and also reduces joint pain.

Here's why you should visit a chiropractor first for balance and gait problems.

Walking is holistic and so is the way we move. Why would you use our current model of a specialist for everything when you need a primary care approach to the musculoskeletal system?  The only providers who are trained to evaluate and treat the musculoskeletal system holistically are your local chiropractor. What should you expect during your first visit to our office?
  • A thorough holistic history.  I will ask you about your current and also past conditions, falls, injuries, and what type of care you may have had for these conditions.
  • A holistic exam that starts with taking your blood pressure and evaluates how you walk, move and I perform orthopedic tests to improve awareness of any other problems you may have.
  • A chiropractic treatment will consist of manipulation to improve movement and flexibility.  Myofascial release treatment to improve the way you move as well.
  • Foot orthotics may be recommended if you have a mechanical imbalance from the ground up that is essential to improving how you move.
  • If needed, you may be referred to another healthcare practitioner.
It takes a few visits to improve your flexibility and to retrain poor gait habits.   Sometimes we perform a treadmill evaluation if necessary to further understand and treat poor gait habits. Retraining gait will require you to do some homework including recommended exercises as your brain begins to be retrained and older bad habits are replaced with better gait habits. Who should you see first for gait or balance problems?  All roads lead to the chiropractor.  Schedule an appointment using this link.