How To Master The 4 Phases Of A Fall

By: Dr. Beth Templin

Most of the focus on decreasing falls looks specifically at Fall Prevention, or trying to prevent a fall from occurring in the first place. Falls still happen anyway, even with the best training. Because of this, the thought process is shifting towards preparing people on how to fall, otherwise known as Fall Preparedness.

To accomplish this, you need to consider all 4 phases of a fall and ensure you are training all 4 of these areas.

Pre-Fall
This is the time period before you've had a fall. During this phase, you may notice that you are not as steady as you used to be. You may start reaching for walls or furniture for additional support, like a railing when going up and down the stairs. When you go outside on an uneven surface, you may concentrate more on each step you take as you begin to feel less confident.

During this phase, treatment will focus on strengthening the hips, knees, and ankles. It will also work on improving both static and dynamic balance on various surfaces.

Near-Fall
During this phase you actually lose your balance, but can still successfully catch yourself and avoid having a fall. Your balance has worsened, but your balance reflexes are still strong enough to help you catch yourself.

In phase, the focus will be on balance recovery strategies. There are two types: volitional stepping and reactive stepping. Volitional stepping practices taking steps in all directions in response to a command or preset drill. A great tool for this is the Clock YourSelf App. Reactive Stepping occurs when the participant cannot anticipate the direction and must react to being pushed off balance. We use our ActiveStep Fall Simulator to safely and effectively deliver this type of balance reflex training.

Fall Landing
During this phase you've lost your balance, and are unable to catch yourself. The goal of this phase is to learn how to control the fall so you have a safe landing and avoid sustaining a major injury. The only way to improve this skill is to practice falling. It may make you a little anxious to think about practicing falling, but it is a skill that can be taught and mastered over time. Participants start practicing forward, backward, and sideways falls in slow motion, from a low level close to the ground and gradually work their way up to faster speeds and full height fall. We also prescribe exercises to better prepare your body for a fall.



Completed Fall
During this phase, you have landed on the ground and now have the task of trying to get up from the floor. Many older adults lack the strength and flexibility needed to do this successfully, but this can be improved with practice. To be better prepared for this phase, you need to practice getting up and down from the floor. We understand that some may be limited by knee pain, stiffness in their hips, or weakness in their arms, which is why we recommend working with our Physical Therapy team.

Falling can be a frightening and traumatic event in your life, but it doesn’t have to be. We know if you have practiced falling and have a plan for how to get up off of the floor after a fall, it can make the event less scary. Work with our Therapy team to learn the best ways for you to get up off of the floor without help, strengthen your body, and improve your confidence.
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-💗 Dr. Beth

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