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Seniors worry a lot about falling. If they’ve never fallen, they worry that they will. If they have fallen, they are worried about falling again. The truth is, falling can create incredible problems for anyone at any age, but the older we get, the more serious it can be. Recovery from injuries can be slow; other problems may develop as time goes by. My own experience bears that out.
In September 2011, I was 66 years old, a fitness instructor for older adults, a retired schoolteacher, and in generally good health. I was walking to visit a friend who had just come home from hospital. I was carrying three books in a bag in my left hand and, as I approached a little store that sold flowers, I decided I’d buy a small bouquet for my friend. I chose a bouquet and walked around the corner, heading to the front of the store with the books in one hand and the bouquet in the other. The sidewalk was not particularly wide: a flower stand on one side, a tree on the other.
I had to go around a woman who was looking at the flowers, and my right foot stepped on the edge of the sidewalk. I was in the exact same position as the person wearing the shorts in the photograph below, except I was closer to the edge of the sidewalk when my foot came down (photograph by Bob Ingraham):
As my right foot landed on the edge of the sidewalk, I lost balance and the ankle twisted. To compensate, I attempted to use my left foot for support, but the heavy books in one hand and the flowers in the other contributed to my inability to maintain balance. I twisted my left foot (while trying to shift weight) and went down hard on my left knee which hit the pavement head-on.
Two lovely ladies — sisters who live in Vancouver — stayed with me. My backpack had come off, and I had dropped both items in my hands. I knew that I had hurt my knee and both ankles — they were all aching. But, my instinct was to get up as fast as I could because one always feels a little silly sprawled out on a public sidewalk. I got up, with the help of the two sisters, and they led me to a chair which was just outside a cafe nearby (you can see chairs and tables in the distance in the photograph).
As soon as I got to the chair and sat, I became very, very dizzy. I knew I would faint if I didn’t get my head down, and soon. Just getting it below my knees didn’t seem like enough and I told the sisters I had to get to the pavement, but they were worried about my lying on the “dirty” pavement. Instead, I just kept my head down. This intense dizziness lasted longer than anything I had ever experienced before — perhaps six minutes. Thankfully, it finally went away. The strangers wouldn’t leave me until I had called my husband and he came to get me.
When I got home, I could examine my knee which had several abrasions and cuts, including a large one at the top which would take months to heal, and where a scar remains. I had torn a hole in my jeans.
The photograph on the right shows how my knee looked that day. (I took this picture!)
The Doctor’s Visit
A few days later I went to see the doctor and he confirmed that both ankles were sprained, the knee would take time to heal, and — to my surprise — he was sure I had suffered a mild concussion from the very strong movement of my head. We both concluded that my severe dizziness was caused by the concussion. We didn’t know then that we were probably only partially right.
One might think that that would be the end of it, so to speak. I faced many weeks of rehabilitation on my ankles and my knee, but things got better.
Two Months Later
Then, something else happened: In November, two months later, I awoke one morning with a spin inside my head. This lasted only 5 seconds. During the day, I felt some lightheadedness and dizziness. The night-time “spins” continued, sometimes one or two a night. They were always brief, 3-5 seconds, always when I was lying down. What I didn’t connect at this time was that it usually happened when I turned my head. At about the time that I decided I should see the doctor, these short episodes of vertigo went away as mysteriously as they had come.
Five Months Later
In February, the night-time spins returned, but much more severe. There were sometimes two or three a night, and always when I turned over on to my left shoulder. I also had some dizziness during the daytime. There was occasional discomfort in my right ear: a blocked, “full” feeling. For a while, I stopped getting down on the mat during my fitness classes.
At this time, I did some self-diagnosis, using the internet. I tried to find out the causes of vertigo, and I learned that it was possible that the vertigo was due to to loose crystals — sometimes referred to as ear rocks — in the inner ear. This is a benign condition known as paroxysmal positional vertigo (or BBPV) and can be triggered by a head injury or a virus; the condition is more common in older adults.
Made of calcium carbonate, there are about a thousand of these crystals in the inner ear. When we move our head — the crystals stimulate nerve cells that, in turn, send signals to our brain which helps to give us our balance. Sometimes these crystals fall into one of the inner ear canals, confusing the brain. BBPV is usually treated with a series of simple head movements which will help to put the crystals back in their place.
My first step, after learning all of this, was to do the Dix-Hallpike Test with my husband’s assistance. I simply had to make the vertigo happen by lying down and rolling over to my left. As I did so, my husband saw my eyes moving to the right ear and back to the middle when I was “spinning”. This is an indication of an inner ear problem.
I then learned about the Epley Manoeuvre: I won’t describe it here, but it is intended to move the crystals around and get them back in the right place. There are many good examples of this procedure on the internet. I did this once, with my husband’s assistance, and again about two days later. My symptoms began to abate and soon went away.
Six Months Later
In the meantime, my G.P. had suggested I see an ear/nose/throat specialist — who was not able to confirm much for me. The ENT physician did, however, suggest that I see an allergist because I was very congested and he thought the severe congestion might be causing the dizziness. He also recommended that I go to the ENT Clinic for some inner ear tests.
I did see an allergist and it was confirmed that I did have a lot of allergies, though there were not many suggestions for help in that direction. A sinus rinse he prescribed did help with the severe congestion during the day, and the daytime dizziness seemed to improve.
Ten Months Later
So, six months after my fall, I am still unsure what caused the vertigo. But I finally get some answers after a three-hour appointment at the ENT Clinic, five months after I was recommended for an appointment.
I was impressed with both audiologists. They tested my hearing and they did many tests on my vestibular (inner ear) system.
I won’t discuss the hearing tests, as they had nothing to do with my balance or the fall, but here are the balance tests they gave me, all of which I passed with flying colours (those of you who attend my fitness classes will recognize some of these):
- Balance Test #1: Stand with feet hip width apart on a small towel. Close eyes. Maintain balance.
- Balance Test #2: March briskly in place with eyes closed for 50 counts. Most people will move slightly. I moved forward about 6” and turned to the left about 30-degrees — these are both within a “normal” range.
- Balance Test #3: Stand with feet hip width apart on a piece of fairly hard foam. Close eyes. Maintain balance.
- Balance Test #4: Wearing a special pair of goggles which is connected to computer software, I stare at a spot on a wall while the tester unexpectedly moves my head to right or left. She checks the eye movement on the computer software.
- Balance Test #5: With a different pair of goggles, I stare at moving red lights, either going horizontally or vertically. The audiologist monitors the eye movements on the computer software.
- Balance Test #6: This was basically, the Epley Manuever, as mentioned above. Lie back on a firm surface with head over edge. Tester holds head. Turn head to right, then to left. (I continue to wear the goggles, now with a cover over it, so I could see very little. No frame of reference possible.)
- Balance Test #7: Lying on table, turn to right side. Then to left side. (Still wearing the goggles with a cover.)
- Balance Test #8: Warm water is put into the ear for about 30 seconds. Then wait to see what symptoms occur. Then other ear is done. (The goggles are also worn for this, pretty much making things dark.) How fast one recovers from this disruption to the inner ear is the test portion of this exercise.
- Balance Test #9: Cold water is put into the ear for about 30 seconds. Then wait to see what symptoms occur. This test was done because she was not entirely happy with the results of the warm water in the ear. (Goggles still worn here.)
Symptoms vary for people who have the water put in their ears. Mine were apparently mild; however, doing four in a row made the symptoms get worse as we went along. I had some dizziness, nausea, hot flashes, a flu-like feeling. With each test, the symptoms would go away quickly, then return with the other ear. Fatigue set in about half way through. I was told that these symptoms were the result of the vestibular system being interrupted. (This is basically a test to see if the system responds to outside forces.) Afterwards, I had to remain lying down. The symptoms dissipated. Then I sat for a while. Then I got up and walked out. I felt rubbery-legged for about half the walk home, but fine after that.
So, ten months after the fall, when I am now almost completely healed and have no more vertigo, I finally have, from the audiologist, a complete and thorough description of what happened, beginning with the fall.
This is it:
Immediately after that fall in September 2011, I had severe dizziness and almost fainted. This was most likely caused by an inherited condition I have called Postural Hypotension (the tendency to faint within 5-10 minutes after rising if one gets up too quickly, particularly first thing in the morning). When I fell, I went down fast and got up too fast. The remnants of that severe “attack” of postural hypotension lasted for several days, causing some of the dizziness. The concussion — diagnosed by the doctor about a week later — also contributed to the dizziness. (Remember, I don’t have vertigo yet.)
The first vertigo occurred in November, only at night, very small and minor. That was the beginning of the inner ear issue. Crystals had been shaken loose in the fall and they were starting to move around. The vertigo stopped because the crystals stopped moving.
Then the vertigo occurred in February, much worse, only at night when I turned to my left. Now, the crystals were really moving around. Doing the Eply Manuever was the best thing I could have done. The vertigo went away.
I’m not sure I will ever achieve full range of motion in my ankles, particularly my left ankle which had been injured severely several years before.
So, fall prevention is a very good idea, although it is not easy to do.
I would recommend: * Avoid carrying bags — use a cart or a backpack. It’s really important to have those hands free. * Watch your step. Uneven sidewalks are a real hazard. (I did call the city about this and they came and filled it in with asphalt within 24 hours.)
I find myself thinking that I could actually teach a course in fall prevention and balance training. Hmmm....new project?
- Can regular exercise prevent falls?
- More minutes of Physical Activity may lead to Better Balance
- Seniors like to Walk
- Falling: Is there a way to fall to minimize injury?
I am a BCRPA-certified fitness instructor in Vancouver, BC. I teach four classes at the West End Community Centre in Vancouver, BC, mostly designed for the older adult. The Inevitable Disclaimer: Everything published here expresses only my opinion, based on my training and research. What you do with the information is entirely your own responsibility. I am not liable for any injury you suffer that seems to be related to anything you read here. Always consult your doctor before beginning an exercise program. For other articles, return to the table of contents.
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