Standing Strong

By Marylene Vestergom

“Falls are the leading cause of injury among older Canadians,” says Public Health Agency of Canada. And yes, as we age, the risk increases.

Did you know:

• 20-30 per cent of seniors experience one or more falls each year

• Falls are the cause of 85 per cent of seniors’ injury-related hospitalizations

• Falls are the cause of 95 per cent of all hip fractures

• 50 per cent of all falls resulting in hospitalization happen at home.

Often falls can be attributed to a lack of balance and a weakness in our support system — our ankles and feet. Let’s face it — being sure-footed at any age can be a challenge, but you can take control by incorporating exercises to improve your balance and build strength in the intrinsic foot muscles.

Dr. Benno M. Nigg, professor emeritus of biomechanics at the University of Calgary, is an advocate of the bottom-up approach, which focuses on increasing the strength of the small muscles crossing the ankle joint.

“Everything starts with the base,” says Nigg. “If you have weak ankle joints, you’re unstable at the base. If you’re unstable at the base, that has an effect up the body, and we have some evidence that this contributes to injuries.”

Nigg thinks we should start thinking laterally. “Train the foot and ankle joints in all directions. Consider if you were building a skyscraper and you need to reinforce its stability. Where do you start? The bottom. 

So whether you’re young or old, if you want to be stable in your movement, strengthen the ankle joints, and by doing that, a lot of things fall into place.”

Toronto’s Norm Spence, a personal trainer and a STOTT Pilates certified instructor, agrees with Niggs’ bottom-up approach. Stability and balance is something Spence focusses on quite frequently in his practice. “Our feet respond to sensations, keeping us aware of our surroundings and footing. That mind-body connection signals if we are walking on a flat or uneven surface, etc. This awareness helps in our stability and balance. Unfortunately, sometimes we don’t notice as our ability to respond to these sensations diminishes; it’s a subtle decline. The good news is it can be restored.”

So where do you start?

First, balance is not just a senior moment. In fact, a recent study published in the “Journal of Gerontology: Medical Sciences” found that balance starts to decline midlife. But Dr. Clarfield at Toronto’s Cleveland Clinic says it’s never too late to improve your balance. “Start focusing on those tiny muscles in your foot and ankle as these are the muscles that allow us to react quickly and provide the stability in our day-to-day activity. Work up to balance exercises to improve stability and balance. If the mechanics are not finely tuned, including flexibility and strength, it can lead to stress and issues with your knees, hips and lower back.”

And since you don’t need any fancy equipment, Spence says many of these exercises can be done in the comfort of your own home, even before you get out of bed. “You just want to make sure you’re working all directions and you include both dynamic and isometric exercises. The key is to focus on building flexibility and strength and make sure the movements are slow and controlled.”

Make these simple exercises a daily habit. Here are a few suggestions.

Lying in bed

1. Straighten your legs and gently point your toes and hold; then pull your toes toward your shin and hold. The movement should gently rotate your ankle and provide a slight tug on your calf muscles. 

2. In the same position perform ankle circles in both directions; imagine your big toe is a crayon and you’re drawing circles. An added benefit to these movements is maintaining good circulation in the lower legs. Repeat 3 sets of 10 of each movement. 

Standing at a counter or while brushing your teeth

1. Barefoot, stand with your fingers on a counter or window sill, and slowly raise your heels off the floor to stand on your toes. Hold for 4 seconds, then slowly lower your heels to the ground and rest. Repeat 3 sets of 10.  As your strength and balance improve, take your fingers off the counter or progress to one foot only.

2. Every morning and evening, while brushing your teeth, stand on one leg, barefoot, and move up and down about 5-8 cm by bending the knee. When you’re stronger add a cushion so your stance is a bit unstable. Complete 50 repetitions on each side.

During screen time

1. While sitting in a chair with your feet not touching the ground, try to write each letter of the alphabet, in the air, with your foot. Lead with your big toe and keep the movements small, using only your ankle and foot. Repeat with your toe on the ground, to work your foot muscles.

2. Press your foot towards a resistance (wall, table, chair, your own foot or a resistance band). The presses should occur in all directions.

3. Stretch a hand towel in front of you and place your bare foot on the end of the towel nearest you.

Keeping your heel on the floor, curl your toes to bunch up the towel and drag it towards you. Continue until you’ve bunched up the entire towel.

Do this a few times and repeat with the other foot.

Before starting any exercise program, it’s always best to seek the advice of your medical professional.