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• What Are Falls?
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• What Kind of Physical Therapist Do I Need?

What Are Falls?

A fall is defined as any event that leads to an unplanned, unexpected contact with a supporting surface, like the floor or a piece of furniture, which is not the result of an injury, shove, or medical event such as a heart attack or fainting spell.

A near-fall is a stumble or loss of balance that would result in a fall if you were unable to catch yourself.

There are lots of factors that can increase your risk of falls, including:

• History of a previous fall.
• Advanced age.
• Difficulty with walking or keeping your balance.
• Leg weakness.
• Medical conditions such as heart disease, diabetes, stroke, Parkinson disease, or Alzheimer's disease.
• Taking too many, or certain types of, medications.
• Getting dizzy when you stand up from sitting or lying down (orthostatic hypotension).
• Home hazards such as throw rugs, poor lighting, or a lack of handrails on stairs.
• A recent hospital stay.
• Trouble with your memory and thinking.
• Depression or anxiety.
• Being in overall poor health.
• Being female.
• A lifestyle that involves too much sitting.
• Becoming fatigued easily.
• Problems with your vision or skin (touch) sensation.
• Limited flexibility.
• Unsuitable footwear.
• Joint pain or arthritis.
• Improper use of a walker or a cane.

The more risk factors you have, the greater your risk of falling.

How Is It Diagnosed?

How Can a Physical Therapist Help?

Many studies have shown that physical therapy can help to reduce the risk of falling in adults ages 65 and older. In a new study (that looked at falls risk in women ages 80 and older), researchers calculated the economic impact of choosing physical therapy to prevent falls, and they found that doing so saves $2,144, including all the hidden costs of your time, pain, missed life events, and the dollars paid for services. 

If the screening shows that you are at risk for falling, your physical therapist will perform a thorough evaluation, including:

• Review of your medical history and any medications.
• Checking your heart rate and blood pressure measurements at rest and while you change positions (from sitting or lying to standing).
• A simple test of your thinking (cognitive) abilities.
• Assessing your balance, strength, and walking ability.
• A simple vision test.
• Assessing your feet and footwear.
• A home safety assessment.

Based on the evaluation results, your physical therapist will design a plan that is tailored to your specific needs. Your treatment plan may include:

Balance training. Balance training is the most important and effective part of falls prevention. Your physical therapist will safely guide you through exercises that challenge your ability to keep your balance. These exercises also are designed to help you recover from a loss of balance.

Walking and moving. Walking is a popular physical activity. However, if you have poor balance, starting a walking program can increase your risk for falling. Talk to your doctor or a physical therapist before you begin a walking program to make sure that it is right for you.

Doing more than one thing at the same time — safely. Older adults who have difficulty walking and talking at the same time are at a higher risk of falling. To help increase your safety during daily activities, your physical therapist may design a training program that will challenge you to maintain standing and walking while you do another task. Examples include walking or standing while counting backward, having a conversation, or carrying a bag of groceries.

Strength training. Strengthening is a key element of fall prevention when combined with balance exercises. Your physical therapist will design a personalized strengthening program that focuses on specific muscle groups. This program will help improve your standing balance, your balance while walking, and your ability to recover from a loss of balance.

Pain management. Certain exercises, such as strengthening and aerobic exercises, can help to relieve pain in addition to decreasing your falls risk. Research shows that physical therapy can help people reduce or eliminate their need for pain medication, including opioids.

Education. Your physical therapist will take the time to explain how you can best manage your own risks for falling. They also may talk to you about the best activities to help maintain your quality of life, and offer educational resources, such as:

• National Council on Aging. Falls Prevention for Older Adults.
• Centers for Disease Control and Prevention. STEADI – Older Adult Fall Prevention.
• Homemods.org. Fall Prevention Center of Excellence.

Fear management. It is important that you talk with your physical therapist about any fear you have of falling. They will work with you to build your confidence and help you get back to the activities you may be avoiding because you are afraid of falling. Your physical therapist also can identify which activities you should avoid to stay safe.

Community programs. Community-based falls prevention programs help people to:

• Reduce their fear of falling.
• Set goals for increasing their physical activity.
• Make their homes safer.
• Exercise more to increase their strength and balance.

These programs often are led by volunteer coaches. A popular community-based falls prevention program that has been shown to reduce falls is the ancient exercise system known as tai chi. Your physical therapist may be involved in setting up one of these programs or can help you find programs in your area that are best for you.

Personal recommendations. Your physical therapist can provide personal recommendations based on your condition and goals to help you:

• Increase the safety of your home environment by making changes, such as removing throw rugs or clutter.
• Adjust how you complete your daily tasks to reduce your falls risk.
• Choose appropriate footwear.
• Learn about proper nutrition and how to improve your sleep schedule. They also can provide other general information that can help reduce your falls risk.
• Meet with other health care providers when appropriate.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to identify falls risk and treat people who have a fear of falling, and balance problems. You may want to consider:

• A physical therapist who is experienced in working with older adults or people with neurological problems. Some physical therapists have a practice with a focus on balance rehabilitation or falls prevention.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic or geriatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can search for physical therapists in your area who have these and other credentials by using Find a PT, provided by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• Ask about the physical therapists' experience in helping people who have experienced a fall, have a fear of falling, or have balance problems.
• Be prepared to describe your symptoms in as much detail as possible.