Balance and Falls

As we age, it becomes increasingly important to have good balance to assist in fall prevention. The CDC reports that 1 in every 3 people over the age of 65 years old will fall one time each year. This statistic increases to 1/2 population over the age of 80 years old. Those are some pretty staggering numbers! These falls can result in minor bruises or bumps but also often result in fractures or head injuries. To prevent injury, we suggest assessing yourself to determine if you are likely to be one of those who might be at risk of a fall.

There are several contributing factors to falls and poor balance, some are as follows:

  • Age: Age is a component of many of the following risk factors. You are more likely to have vision issues, underlying medical conditions or medications that may play a part in imbalance.
  • Leg Weakness: the less active you become the more weakness you will notice. This often becomes a downward spiral as you do less you become weaker and more fearful of falls so you do even less.
  • Poor Standing Posture: due to tightness of muscles, changes in bony structures and weakness in certain muscles our posture changes and this effects our balance points.
  • Vision: if we can’t see the fall hazard or where we are putting our feet then we are more likely to trip.
  • Medical Conditions (such as diabetes, peripheral neuropathy, stroke, Parkinson’s disease, vertigo): may also be contributors due to loss of sensation, movement or other issues.
  • Medications
  • Low Blood Pressure
  • Home Hazards

Leg strength and flexibility is important in balance. The muscles in your hips, knees and feet all assist with controlling your body so that it remains balanced. If these muscles are weak then it is more difficult for you to have control over your body as it reacts to position changes and walking. In addition to strength, flexibility is also important in keeping your body moving the way it is supposed to.

Poor balance can be a combination of the above mentioned factors. It is important to determine why you are experiencing poor balance so that you can help yourself prevent future falls. If you are experiencing dizziness, especially when you lay down, or with change positions, or when you sit or stand up too quickly, it can be due to an issue with vertigo or low blood pressure. The tests and exercises below likely will not help in this case. You should always consult your doctor if you experience this type of balance issue to get appropriate treatments, medication adjustments or other assessments as needed.

What you can do to help yourself:
One of the easiest to modify from the list of risk factors is home hazards. This includes throw rugs (kitchen mat, bathroom mat, hallway rug) or power and telephone cords. These obstacles are easy to trip over or to catch on a cane or walker. Removing these and adding night lights to well traveled areas can assist in reducing the risk of falling.

First Test your Balance:
When performing the following exercises/tests it is important that you remain safe and have someone that is aware of what you’re doing and is close by for assistance.

Balance specific:
First, test your abilities. Stand facing the kitchen counter and hold on with both hands. Have a chair behind you as a safety measure! Lift one of your legs up so that you are standing only on one leg. Try to let go slowly and count, in seconds, how long you are able to remain steady without having to touch down. Repeat with this test with the opposite leg. If you are unable remain steady for 15 seconds, you should be working on your balance.

Below are some suggested progressions of balance exercises that you should work on daily to improve and maintain your balance. Remember your safety instructions!

  • Tandem: Exercises performed with one foot in front of the other.
    • Standing: place on foot in front of the other while facing the counter and holding on. Balance like this beginning by using two hands for support. Progress as you improve to using one hand, then fingertips, then no hands at all. If this is too difficult try to just stand with both your feet close together instead of one in front of the other.
    • Walking: using the kitchen counter (or the walls in a hallway) to hold on to at first. Place one foot in front of the other, following the counter then turn and repeat. After you become steady using your hand, try without holding on.
    • Standing on One Leg:
      Like in the test mentioned above, stand at the kitchen counter using both hands and stand on one leg. Remove one hand, use finger tips then no hands. Progress yourself only if you feel steady at each stage. To make this more difficult after you are able to stand on one leg steadily, try performing the same exercise on a pillow or with your eyes closed.
  • Strength:
    Exercises can be done seated or standing at the kitchen counter based on your level of comfort. Some examples of exercises are: marching, kicking to the side with a straight leg, kicking to the back with a straight leg, bending and straightening your knee (while seated). Try for 10-15 repetitions on each leg. As you get stronger you can purchase adjustable weights to challenge yourself further.
  • Stretching:
    Stretch your calf muscles by putting one leg behind you keeping the knee straight and lean toward the wall bending the front knee. Or using a strap while seated pulling your foot up toward your knee keeping the knee straight. Hamstrings can be stretched while laying down using a strap, lifting your straight leg up until you feel a stretch in the back of your thigh.

Improving your flexibility and strength will make great strides in helping your balance.

Again, it is important that you feel safe walking and moving. Be sure you are safe while performing these exercises and do not perform them without someone else close by if assistance is needed. If you do not feel safe, consult your physical therapist or your physician. Balance issues are treatable and can improve your safety and confidence in a short period of time! Visit RI Limb Prosthetics, Orthotics And Physical Therapy for more information.

Post Contributed by Mellissa Walters, DPT.

Yoga For Back Pain — Part 2

Improving mobility of the lower body is also important in controlling back pain.

Tightness in large muscles in the lower body are also very frequent causes of in low back pain. The most common culprits are the hamstrings (back of your thigh) and the hip flexor, a deep muscle in the front of your hip that attaches to the low back. The hip flexor can causes increased curve in the low back  and pulls your pelvis forward if it is tight. The hamstrings often cause a flattening of the curve in the low back and tilt the pelvis backwards when it is tight. This creates abnormal stresses upon the spine.

Again review detailed instruction on each pose at

  1. Hip Flexor Stretching: Stretch should be felt in front of hip and thigh of the back leg.

  2. Hamstring stretching: There are many forms of hamstring stretching. Performing stretching on one’s back is the safest place to begin because the back is supported, minimizing stress on the spine.

Lastly, yoga is beneficial in stabilizing the core by increasing abdominal awareness with the use of breath work. Breath assists the expansion and contraction of the abdominal cavity which houses the abdominal and lumbar musculature. So, as we deepen our breath in and use our breath to propel our motion it stimulates the activation of these muscles. Yoga teaches us to draw our attention to our core and move mindfully from our center to build strength and stability in the spine.

Standing and balance poses also encourage simultaneous contraction of muscles in the front and back of the body. This teaches the core to work in the ways that we move on a daily basis. Therefore, the combination of awareness, breath, and balance poses make yoga endurance work out for our core.

This article highlights only some of the ways yoga can assist in treating low back pain. However, it is important to note that not all back pain is the same. Different diagnoses have different causes and aggravating factors. It is important understand your limitations before initiating a yoga program. Yoga is not appropriate for treating severe back pain or acute aggravation of back pain. Yoga is a great way to manage low back pain that has been diagnosed and controlled. Please consult your physical therapist or primary care physician before you begin. Namaste.

If you have any questions or are interested in more information on this topic check out or contact Ericka at (401) 884-9541

Post contributed by: Ericka Fryburg MPT

Yoga for Back Pain — Part 1

Low back pain is one of the most common reasons people seek out physical therapy care, and clients often ask if yoga can improve their low back symptoms. Therefore, as part of National Yoga Month this September, Tru-Care Physical Therapy would like to share some insight why yoga is often considered effective in the treatment of back pain.

Yoga has many benefits that assist in the management of low back pain that include improving posture, increasing flexibility, and stabilizing the spine by increasing core strength.

Part I

First, and most importantly, yoga can help improve postural imbalances that lead to low back pain. You can increase body awareness with basic poses. The most basic of all standing yoga poses or “asanas” is Tadasana or Mountain pose. At first glance it may seem like you are simply standing. However, it is the attention to “how” you are standing that makes it so important. For guided instruction on how to do mindful Tadasana pose see the previous post on standing posture from May 2013.

The next benefit of yoga is increasing flexibility of the spine and extremities. The main components of spinal motion are flexion (forward bending), extension (backwards bending), rotation (twisting), and lateral flexion (side bending). Yoga asanas address all of the motions of the spine through poses of various intensity and difficulty. Below are some gentle yoga poses that address each of these motions.

When performing these poses listen to your body so you do not cause pain. Take slow, deep breaths and try to increase your motions. The pictures below are taken from which is a great reference for all things yoga. The Yoga Journal site also provides step by step instructions to safely perform each of these poses. 

  1. Cow: improves back bending (extension) of the spine.

    As you inhale, lift your sitting bones and chest toward the ceiling, allowing your belly to sink toward the floor. Lift your head to look straight forward.

    Exhale, coming back to neutral “tabletop” position on your hands
     and knees. Repeat 10 to 20 times.

  2. Cat: Improves forward bending (flexion) of the spine.

    As you exhale, round your spine toward the ceiling, making sure to
    keep your shoulders and knees in position. Release your head
     toward the floor, but don’t force your chin to your chest.

    * Cat and cow can be held as isolated stretches for 30 secs each (2-3 reps)or you can move between the two poses with each breath doing 10-15 reps of each.

  3. Child’s Pose Stretch: improves lumbar flexion. It is also a great place to begin side bending by walking both hands to one side creating length in the side of the body.

    Begin kneeling and sit onto your heels.

    Reach arms forward in front of you and lower your head toward the floor.

    Sustain the position 30-90 secs relaxing into the pose with each breath.

  4. Supine Spinal Twist: improves rotation of the spine. Performing twists lying on your back is the safest place to begin twisting because the back is supported, minimizing stress on the spine.          

    Begin on your back with arms to the sides.

    Turn your head to the right.

    Bring your right knee up and across your left leg<.

    Let your right leg rest across the left stretching towards the floor.

    Child’s pose and spinal twist can be performed for 30-60 secs. Attend to your breath as you slowly let your low back stretch.

For more detailed instruction in performing these yoga poses you can again refer to

Next post will instruct in 2 hip stretches that will effect the low back, as well as more information on breath and balance. If you have any questions or are interested in more information on this topic check out or contact Ericka at (401) 884-9541

Post contributed by: Ericka Fryburg MPT

Weight Lifter’s Elbow??

Weight lifter’s elbow? Never heard of it! How about Mommy’s elbow? Carpenter’s elbow? Typer’s elbow? Salesman elbow? ….. No?

Perhaps Tennis or Golfer’s elbow? Yes I am sure that most of you have heard of these 2 issues. But all the others are the same problem. Any of the options above create similar stress on the elbow as does tennis or golf. Mom tries to do all her tasks one handed while keeping hold of a crying child; Joe swings a hammer or holds a drill overhead for hours at a time; Jean decides that doing 3 sets of lateral raises with increased weight should be OK; and Fred sits at his computer programming all day long with fingers flying across the keys.

All of these tasks stress the forearm muscles. These muscles actually are responsible for motions and movements at the wrist. The common extensors are the muscles that pull your wrist up and they attach to the outside condyle (bony area) of your elbow and the common flexors attach to the inside condyle and they pull our wrist down. They also control the movements of the fingers for opening and closing the hand.

So how does the elbow get injured in these activities? As the muscles contract and hold that drill steady the muscle puts strain on the tendon where it inserts into the elbow. This force on the bony anchor can lead to microscopic trauma over time. Little tears that our body heals without difficulty. But the healing can lead to decreased flexibility and strength. As time goes by the injury progresses and the tendon begins to be painful. This is now a tendonitis — inflammation of the tendon. This is the best time to treat this condition. The longer a tendon remains inflamed and irritated the more change takes place at the tendon making it more difficult to resolve.

What are the signs of elbow tendonitis?

  • Stiff, achy elbow joint
  • Sharp elbow pain with lifting and gripping
  • Difficulty picking up your coffee cup
  • Difficulty with lifting especially with the arm out in front

How can you treat tendonitis at home?

  • Rrest the elbow.
  • Stretch the muscles of the forearm.
  • Massage the tendon where it inserts into the bone.
  • Perform eccentric or lengthening type exercises for the involved muscle group (1-2#).
  • Ice

Arm out in front. Bend hand toward ceiling.

Arm out in front. Bend hand toward floor

Arm out in front thumb to floor. Push hand away from body.

Massage tendon across side to side at elbow.

Start position. Slowly lower hand.

End position.

If you are unable to resolve the symptoms see your physical therapist for more detailed and focal treatment. Visit RI Limb Prosthetics, Orthotics And Physical Therapy