Would you believe that the pace of your walking can tell health care providers something about your mortality? Research has shown that gait speed in older adults is a better predictor of mortality then age, gender, chronic diseases, blood pressure, Body Mass Index and hospitalizations combined. That why is Gait speed is being dubbed the Sixth Vital Sign, and all therapists test this on your visits for therapy. Walking slower increases your risk for falling, which we know is a bad thing for elders. In Physical Therapy we encourage increasing your step length and velocity while walking even if this means using a cane or rollator walker. Emphasis on bigger arm swing can also help make you move faster while walking as the feet follow the hands. Music while walking can help you move faster because you can time your steps to the beat, Try it!

Can your feet have something to do with causing you to fall? YES! Persons with neuropathy, foot deformities such as hallux valgus (bunion), or pronation (inward roll of foot), those with foot pain or decrease flexibility of the feet have been shown more likely to fall. Improving your flexibility and strength of your feet can help with pain and deformity. Calf stretches against a wall or hanging the heel off the bottom step to stretch the Achilles are helpful in increasing mobility of the feet. Toe raises off the floor or a step can help build calf and foot strength and both are shown to reduce falls. Practicing single leg balancing on floor or carpet with a goal of maintaining for 60 seconds can improve strength and proprioceptive awareness which has also been shown to reduce risk of falling. Proper shoe wear to correct or support your deformity is very important as well.

Posture is very important in good musculoskeletal health and is important in reducing the incidence of neck pain. The most common activities that cause neck pain are computer work and driving. In both of these activities we have a tendency to lean forward with our head and project the chin forward, placing undue effort on the posterior muscle groups of the cervical and thoracic spine and can lead to radiculopathies, disc herniation and headaches. In therapy we focus on educating how to reduce these stressors by facilitating better muscle and body alignment during sitting tasks. While driving I suggest the rear-view mirror trick. Get into your car and sit up straight with the steering wheel a distance away that allows slight bend of the elbows, bring your head back against the head rest and see if that is comfortable or at least if your ears are in alignment with your shoulders. Then set the rear-view mirror position properly for yourself. When you are driving you will find that you won’t be able to see in the mirror if you start slouching and this can remind you to find the better position again. Listen to your mother and sit up straight!

Good Vision is something we take for granted and as we age vision does decline therefore it is important to have regular vision exams. Vision is important in good balance since it is one of the three systems that work together to help us achieve good balance-Vision, Vestibular and Proprioceptive systems. Impairment in vision can include poor acuity, diseases such as macular degeneration, cataracts and issues with contrast sensitivity. When this system is impaired the other systems work harder to compensate and can increase your risk of falling. Multi focal lenses such as progressive and bifocal lenses can affect depth perception when climbing stairs or changing surfaces from floor to carpet and increase fall risk. I educate patients of the risks and often recommend having a pair of computer glasses or “readers” instead of bifocals. Proper lighting at dusk and evening is also essential to assist the visual system for working more efficiently.

BPPV season

During my many years as a provider of expert Vestibular rehabilitation for the treatment of BPPV (Benign paroxysmal positional vertigo), I have seen a common trend of increased visits associated with the seasons. I believe that we see more patients with BPPV in the Fall and the Spring months. Since BPPV is recurring I commonly see patients with episodes at the same time each year which could be related to allergies associated with change of season but also cold and flu seasons correlate with these times of the year. Recently some vestibular research from University of Pittsburgh found that in BPPV patients, serum Vitamin D levels are lower and there is an abnormally high incidence of osteoporosis. In a prior study from Boston Massachusetts they found that vitamin D deficiency increases during the winter months reach its low point in early spring(March-May).Further research needs to be done in this area but the good thing is we are very effective in treating BPPV no matter what the season.

Medication and dizziness

In the clinic when we see a patient for vertigo or dizziness we are trying to assess what system the problem is related. True vertigo is associated with change in position triggering dizziness and room spinning, though commonly patients report lightheadness with movement. The question is commonly asked “could this be related to my medicines?” It is true that on the list of side effects “Dizziness” is usually the first symptom listed for most medications. This is often associated with drops in blood pressure or effects on heart rate and is more of a blow flow regulation than an inner ear triggered event. If you think your medication or combination of medications is causing you symptoms than I suggest talking with your pharmacist since they are the health care provider best trained to answer your questions and work with your doctor on finding the best medication for you.