Frequent Falls Are Not Just a Matter of the Legs

You tell me you turned off the light at night and stumbled once on your way out of the room. During the day you were fine.

Your legs are the same legs, day and night.

Three Things Hold Up a Standing Body

Even while standing still, the body sways slightly without stopping. A separate process is continually at work catching and correcting that sway.

The material used to hold the body steady comes from several different sources.

What comes up from the feet and legs. The sole of the foot reports which side is bearing weight through the intensity of pressure, and the ankle and knee report how much they are currently bent. This sense — the body measuring its own posture and sending that information up — is called proprioception.

What comes from the inner ear. Inside the ear is the vestibular system, which measures which way the head is tilting and how fast it is moving.

What comes from the eyes. Where the wall, the floor, and the doorframe are comes from here.

As long as these three do not conflict with one another, you are not even aware that you are standing.

When One Grows Unclear, the Others Take Up the Slack

When one of the three grows unclear, the body does not simply stop there. It reduces the share given to the less reliable source and adds more weight to the more reliable one. It reassembles the work of standing on the fly.

For some, as they age, what comes up from the feet and legs is no longer as clear as it was. When that happens, the body shifts the load toward the eyes. In bright places, on even floors, where something to hold on to is in view, this passes without incident. It was invisible only because something was compensating for it.

Then you turn off the light. The source carrying the largest share drops out in an instant.

Compensating Also Costs Something

Compensating is not free.

Ask someone to talk while walking, and their gait changes. This means walking is not accomplished by the legs alone. Some people find their stride shortens or their pace slows. The shorter someone's stride while talking and walking, the more often they tend to fall later on. This means attention was going into walking as well.

So when you retrace the moment of a fall, it is usually while doing one more thing at the same time — carrying something in your hand, talking, answering the phone, hurrying to open a door.

A misstep happens in an instant. But what it reveals is not the circumstances of that instant alone.

One More Thing to Consider Alongside It

Some people are taking several medications at once.

International guidelines addressing people who fall frequently also say to review every medication being taken, without exception. Among those medications, some affect one of the three sources described above, and others affect how the body regulates itself when standing up.

What I am saying is not that you should reduce your medication. That review is something to do together with the doctor who prescribed it, and the same guidelines say this should be looked at by several people together, with information shared among them. But if frequent falls are treated purely as a matter of leg strength, this item drops out of the question entirely. It means this is one of the things that must be considered alongside everything else.

Where to Look First

When you cannot recall the moment you fell. When your mind seemed to go blank, or you feel you briefly lost consciousness. There are cases where a loss of consciousness and collapse is remembered only as a fall.

When you fell with nothing to trip over. When falls have suddenly become more frequent over a few weeks. When weakness appears in one arm or leg, speech becomes slurred, objects appear doubled, or one side of the face droops. When you hit your head in the fall or could not get up on your own.

In these cases, the cause of the fall has to be identified first.

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If you treat frequent falls as a matter of leg strength alone, there is only one place to look. If you treat it as something several strands take part in together, there are several places to look. Has what comes up from the feet grown unclear? Does it happen only in the dark? What were you doing when it happened? Do you ever feel briefly light-headed when standing up? This is the same way of looking as why I examine the foot when the back hurts.

I do not hear "I fell" as a story about leg strength alone.

Stumbling once at night does not mean your legs have grown old. It means that in that instant, the whole share the eyes had been carrying dropped away, and there was too little time for the rest to take it up.

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)