In my last post, I discussed about the power of the kettlebell for older adults. The tool that builds elite athletes is the same tool that can improve strength, balance, and posture for someone in their 80’s+.
Now, I want to take the time to discuss something that can be even more powerful for older adults than the kettlebell...getting on the ground. I ask most of my 80+ year old patients, “When was the last time you were on the ground?” I typically get two responses…“I have no idea.” or “When I last fell.” These responses may seem innocent, but they can indicate two things: a lack of familiarity with the ground and fear.
Lack of Familiarity
If a person hasn’t lowered themselves to the ground in a controlled manner, doubt can easily creep in as to their ability to get to the ground. Along with doubt, comes fear…fear of the unknown.
Falling is the leading cause of injury death in the elderly. For many older adults, a simple fall is the difference between living independently at home and living in an assisted-care facility. This brings fear for many. As this study demonstrates, as fear goes up, performance goes down.
Most of us have experienced this. I often experience it when I go hiking in the woods. For example, if a fallen tree is flat on the ground, I can walk on it with no problem. Yet, if that fallen tree is three feet over a stream, I feel like I’m walking across the Grand Canyon on a tightwire. The only thing that’s different between the two scenarios is perception, and perception drives behavior. For someone that’s fearful of falling and being on the ground, walking can feel like a tightwire act.
To improve the situation, embracing the very thing that causes the fear may be necessary.
Getting on the ground
Why would older adults even want to get on the ground?
To begin, for those of you looking to help someone improve their ground mobility, it is imperative:
Getting to the ground may be second nature for one person and a kamikaze nose dive for another. Empathy must be present to understand the person’s perception of the activity. If the main objective is to remove fear, the process of getting to the ground needs to be conducted in a manner that makes the person perceive a non threatening, non fearful activity. To do this, Graded Exposure and Activity can be good to use. You can think of graded exposure and activity as a progressive, step-by-step method to reintroduce activities into someone’s life that is perceived as painful, threatening, or fearful. I like to think of it as breaking down a movement or task and setting up the person for early and frequent victories.
All MSK members have experienced this when working with Lori Crock. When Lori takes members through her On Ramp Classes, she doesn't throw people to the wolves and have them do kettlebell snatches on their first day. This could be very defeating and flat out dangerous. She’s constantly assessing and providing the appropriate intervention at the appropriate time. For some, day one may be performing a simple hip hinge with a dowel rod along their spine. For others, day one may be performing single arm swings. Every person is being progressed to the same end point (kettlebell snatch), but each person may take a different path. Same principle goes for helping someone get to the ground.
From here, I want to share a series of pictures demonstrating some techniques that have been successful with my older patients. This is not meant to be an exhaustive list on ground mobility but a small sample of very practical movements that can be beneficial for older adults (or any human!).
Getting to Quadruped (Hands & Knees)
Options once in Quadruped
Quadruped to Standing
With consistent practice of these transitions, functional performance can improve as the fear of falling is reduced.
Feel free to practice these transitions yourself or with any loved one’s you may have. Also, please share any other ideas you may have in improving the fear of falling or mobility in our beloved elderly population.
*The model gave consent to be photographed “as long as the photos are used to help someone else”. This gentleman is a 91 year old WWII veteran that was a paratrooper in the 517th Parachute Regimental Combat Team. He still lives with his wife of 54 years in their first home together! Amazing couple!