Falling

It happens all the time

Every 11 seconds an older adult in the US is treated in the emergency room for a fall and every 19 minutes an older adult dies from a fall. These are serious numbers and have far-reaching consequences both economically and emotionally.  It is a scary and painful experience to fall and it frequently results in the fear of falling again.  The latter impacts quality of life as it can restrict a person from activities and social engagements, resulting in further physical decline, loneliness, depression and a sense of disempowerment. It is hard enough to grow older with the general decline in physical strength and resilience, so the added impact of a fall can take a big toll.

Even young people fall

While most of the falls happen among the older population (65+) younger people are not exempt from falling.  I frequently have clients between 30 and 50 years old who come in with injuries incurred from a fall.

We can blame these falls on the obvious; poor balance, cluttered homes, medication, drugs, alcohol and so on. These are all relevant factors and need to be addressed. However, let’s expand our minds a bit and take a slightly different approach to the concept of falling.

A fall is not just a fall

We can fall to gravity and we can fall to pieces, fall into a fortune, fall from grace, fall in love, fall into a depression, fall apart, and fall into the wrong hands. When we fall in love life tends to sparkle and our attitude towards our fellow citizens is kind, forgiving and generous. A fall from grace can be demoralizing and lead to depression, physical decline and fall to gravity.

Both mental and physical falls can be painful and traumatic events, and yet, on the flipside, they can also be a catalyst for change and transformation.  The latter can happen if the circumstances of a crisis force us to change our habits and routines by which we can discover new uncharted territory and opportunities.

There will always be rocks in the road ahead of us. They will be stumbling blocks or stepping stones; it all depends on how you use them.Friedrich Nietzsche

What makes you fall?

When I work with clients who are prone to stumbling, tripping and falling, I look at all aspects of their life and ponder; “What is it that makes this person fall so frequently?” Together, we explore their mode of operation in the world, addressing if they are mentally present or absent, if they are always multitasking, or if they are on their phone most of the time. I also pay attention to how they walk, noticing if they look coordinated or disjointed. Additionally, we explore if their physical falls happen more during times of depression or dark moods.

Treatment to change the brain

My first step is to teach the clients that their mind and body are inseparable. I explain the never-ending exchange of information from the brain to the body and back, just like a highway with an endless line of cars going north and south. If we try to do too many things at the same time this exchange of information gets disturbed, as if the southbound going cars cross over to the northbound going lane, resulting in chaos and disaster. Disruption of the brain/body communication interferes with the neural networks in the brain and can be a leading cause of a fall.

In order to rewire the neuromuscular circuits that are responsible for the lack of stability, the brain needs to get new and different messages from the body. The new input mediates a change in the outgoing neuromuscular messages, and can also modulate the neural networks that regulate emotions. The latter is a good example of the intricate mind/body connection.

I continue the process by helping my clients acquire physical and mental awareness of themselves, parallel to building physical strength and balance via new movement patterns. This combination of events has the potential to initiate changes in the brain that can lead to lasting neuromuscular and emotional changes.

Meet “Lisa”

Let’s look at the example of “Lisa” who seeks my help due to injuries incurred from several recent falls to gravity.  As she hesitantly enters my office, I see a thin young woman with a sunken chest below a heavy head on a flexed neck and a rounded back. Her posture and gait suggest that she is physically weak, but also depressed, which along with the shift in the center of gravity is making her unstable and prone to falling. 

Messages from her muscles and joints inform the brain about the current ailing status of her body. In a perfect world, the brain would respond by telling the body to stand up tall. However, instead, the brain tells the muscles, as well as the emotional brain, to enhance the collapsing posture and dark mood.  This results in a vicious circle that further weakens the inner scaffolding and the client’s ability to catch herself if she trips or stumbles.  How can we interrupt this cycle and help her get physically strong and mentally well again?

Multifaceted treatment

Through the lenses of a Gestalt therapist, I know that psychotherapy can be very fruitful as a means to brake and reverse a mental fall. As a biomechanical expert, I know that gaining strength through full body movements, in all planes of motion, builds stability and prevents falls to gravity.  From the perspective of a neuroscientist, I know that changing the proprioceptive input from the body to the brain will modulate the messages from the motor control center of the brain to the muscles as well as to the emotional brain. And finally, from the eyes of an experienced clinician I know that all of the above works well, if and only if, the client is willing to commit to the process.

Thus, if I assist Lisa in gaining mental and physical awareness, functional strength, and a bit of discipline, her brain circuits will, little by little, start to change. The end result is lasting changes in posture and in physical and emotional strength, manifesting as a reduced propensity to fall. 

In order to achieve the above transformation, it is essential to truly believe that we as human beings can adjust. It is not uncommon to think that we are fixed a certain way and that change is out of reach. My message is that we are not fixed, our brains are changeable (plastic) at any stage of life, and with the right support, guidance and effort we can turn our lives around.