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Brain-Based Fall Prevention & Preparation.


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Video Highlights

- Learn more about ankle dorsiflexion
- How to use your iPhone's Measure app to assess ankle dorsiflexion
- Exercises to improve ankle dorsiflexion

Are your ankles flexible enough to prevent falls? That’s the question we’re gonna take a look at today, and we’re gonna show you how to use your iPhone to actually get a hard number. If you are new to Z-Health, we are a brain-based education company. We work with elite doctors, coaches, and therapists around the world. And this month, almost coming up in June, we have a fall prevention class called Defying Gravity. And so we’ve been doing a lot of blogs about this recently, and I’m trying to give you some simple things that you can do to test yourself or to test your clients to go, Where is this person sitting in relationship to the likelihood of a fall occurring?

Why is that important? Well, because falls can be fatal. They are, depending on where you read, the second or third leading cause of death from injury around the world. And so we actually take this very seriously. I’ve had a lot of friends, athletes, soldiers, et cetera, who have been badly injured or even died from falls. And so this is something that is kind of near and dear to my heart.

And what we are doing in our course is we’re looking at not only the biomechanics, we’re also looking at the neurology. So we wanna share this, a little bit of this with you because we like to integrate these together.

So what I’m gonna talk about is ankle dorsiflexion. That is basically how far up your toes can come toward your knee. All right?

That’s ankle dorsiflexion. What we see is that as people age, not only do we tend to lose muscle strength and muscle mass, but we also see people lose significant ranges of motion depending on what joint we’re assessing. And this can be really problematic in relationship to falls. When we look at this, what we tend to see is that in an older population now by older, I’m almost 54, so when they start talking about older populations and they begin at 40, that’s a little problematic for me. But when we look at populations between 40 and 70 years old, and we look at people that have fallen versus people who have not fallen recently, and we measure their ankle dorsiflexion, on average, the fallers have eight degrees less dorsiflexion than the non-fallers.

Why is that really important? Well, it’s something that we can actually address. Now, there are a lot of different ways we have to address it, but what we wanna do first is we want to get a number. So life has gotten much easier with some technology. So on your iPhone, and I’m sorry I don’t have an Android, but I’m sure it has something similar, you can open up what is called the measure app. Now, the measure app you can use as a tape measure, but over here it actually has what’s called a level. Now, the level is great because I can just use it like a regular level and it will give me some readings.

In order to do this, it’s best to do it with a friend, like, you know, an IKEA putting together and they say, you need a friend to lift. It’s easier to do this with somebody. But since I’m standing here by myself, I’m just gonna show you the basic setup. The idea is that we’re gonna use what’s called a modified lunge test. So I’m gonna get the leg that I’m testing, I’m gonna put it behind me, and at that point, I wanna make sure that my toes aren’t pointed out or pointed in. I want them basically staying straight. Now, the phone, what I’m gonna do with it, and I’m going to take this and I’m going to place it against the front of my shin, all right? And you can see right now my, my leg is basically relatively straight. It’s actually a little extended, so I’m getting a minus four degrees. Now what will happen is I’m gonna begin leaning forward, and then I’m going to bend my knee. And as I go deeper and deeper and deeper and deeper and deeper into that lunge, I’m trying to see what is my eventual number going to be?

And in this particular case, right now, because of my strange positioning, I’m at about 45 degrees. All right? Now, normally you can do that. Like I said, if someone’s holding this against your leg, you can just get into a comfortable position, hold onto a wall for balance. If your balance is challenged, bend that knee a little bit more. Basically, we’re trying to get you into a position where you can bend as far as possible, and we want to take that number.

Now, my number, when I was looking at it there, I think was around 45 degrees. Here’s your goal. It should be a minimum of 34 degrees, all right? 34 degrees is the kind of cutoff where we begin to see people more likely to fall. Now, there are some other normative data out there, you can look at it, but in general, like I said, anything 35 and above, I’m gonna say we’re probably okay with that right now. You probably don’t need to spend a lot of time doing calf work and stretching and things like that, but it is very, very useful. I found over the years to find numbers for people to give them something to shoot for.

So they can look at it and go, okay, I’m a 30 degrees on my left and I’m 35 on my right. Well, all of a sudden now, we’re also gonna see this kind of significant difference between the sides, which may play a role in falls with a loss of ankle dorsiflexion. We are more likely to trip on objects. We are also more likely to fall on stairs.

In fact, a lack of ankle dorsiflexion may be the number one predictor that we see of people that fall on stairs, which again, can be even more dangerous than sometimes it’s tripping on a flat surface.

So with that in mind, I wanna go over just a couple of other things from the the brain side of things now, or the neurology side of things.

When we look at the calf, the calf has two heads, okay? This is called the gastroc muscle. And if you look at someone’s calf, you’d normally see a bulge on the inside and a bulge on the outside. So if I was facing away from you, my right hand would be the bulge On the inside left hand would be the bulge on the outside,

and that’s called the medial. What’s on the inside is the medial gastroc or medial gastrocnemius. That portion of the calf muscle is incredibly important for balance, static balance. I’m standing here, eyes open, eyes closed, feet together, eyes open, eyes closed, to prevent me from falling forward, right? To reduce the amount of sway I’m experiencing.

We see a huge amount of activity typically in the medial gastrocnemius. Now, why that’s important is that when we go all the way up the chain in the body, and we look at the neurology of balance, balance, well, we have to be able to see, well, we have to have a functional inner ear. This is called your vestibular system.

Your vestibular system, which is responsible for keeping us level and telling us if we’re tilting, if we’re swaying, very directly communicates with the medial gastrocnemius That was a study published in 2016 that looked at activity in that particular muscle in relationship to vestibular activity. And that that particular muscle appears to be one of the primary targets of our inner ear to help us stay upright.

Now, we then connect that to other studies as people age. Where do we see a huge amount of tension beginning to occur in the medial gastroc? And that’s probably because people stop moving as much. Their inner ear becomes less educated about movement and balance, and the general compensation for that in the human body is to create tension, and where’s that tension going to occur? Well, in part, it’s gonna occur in the calf.

So then we have two problems. Not only is my inner ear not giving me as great level of accurate information about moving through the world safely, but I’m now also getting restrictions in my ankle dorsiflexion because of tension in that medial gastrocnemius, which is going to make me more prone to falling. So we have a lot of different ways that we can address this.

You can go through our blog, go into the search. You know, if you’ve subscribed to the channel, go into the search bar and just put in foot exercises, ankle exercises. I’ve put a lot of them on here. I’m gonna put more as we go forward. You also wanna put in inner ear or vestibular exercises, because when we look at this kind of as a integrated system of neurology and biomechanics, we want to look at both.

Now, additionally, we want to think about, okay, what are some old-school basic ways that I can start to work on increasing the length of the calf musculature, particularly if I’m below 34 degrees? This is where we talk about stretching, believe it or not. Now, stretching is not one of the favorite topics of modern movement people, because most research on stretching shows that muscles really don’t change length very much. It just kinda resets how the brain feels about the the tension.

However, when we look at some of the postural muscles, there is some small research studies that indicate that with prolonged stretching, particularly in older people who are deconditioned, we can change the length, potentially the musculature, and strengthen it. Because what happens whenever we do prolonged static stretching, we get what’s called an occlusive effect. Occlusion means we’re gonna decrease the amount of blood to that area, which believe it or not, can have a huge benefit on increasing strength and also muscle size. So that’s a whole different topic.

Here’s how I would recommend that you go about this.

Whenever we’re gonna work on the gastroc, I like to prefatigue some other muscles first. So because we are trying to create this movement of dorsiflexion, this is created by ankle dorsi iflexors, and those work in competition, if you wanna call it that with the gastrocs. So what I would normally have you do is find something to stand on.

It can be a little pillow. This is a shot shield, shot filled bag. It’s heavy, so it’s a nice little platform. So I would just stand here and I would do some toe raises. All right. So as I do the toe raises, I’m going to try to do enough that my leg becomes a little bit fatigued.

We’re not trying to go to exhaustion here, but for most people, somewhere around 20 or 30 repetitions of a comfortably paced toe raise, you’ll start to feel a little fatigue building up in the front of your leg. Once you have that, you’re then going to reverse your positions. So since I’m right now, let’s say this leg had been 30 degrees.

I’m going to begin working on the gastroc on this side. I’m gonna elevate my toes on something. We don’t want it to be too high, right? You’re not gonna put it against the wall right now. I’d like for it to be maybe 10, 15 degrees at most, and then gonna get into a lunge position in front of it. Now, here’s the kind of main thing I want you to take away. In order to do this, to focus on the gastrocs muscle, you need to lock your knee and actually kind of maintain a relatively firm lock of the knee so that as you begin moving forward into the stretch, you’ll really start to feel that up toward your knee. All right, so you’re feeling it in the calf.

Ideally, you’re going to manipulate your foot positions to feel more stretch in that medial calf. Most people, if this is their foot, if they turn the toes inward, will find that they get a little bit more stretch in that medial gastroc. So for me, if I turn my foot inward, lock my knee back again, step into the the stretch, it increases it a little bit.

Now, this is, again, somewhat based off how your anatomy attaches. One thing that you can do is you can now take the arch of that foot and drive it to the floor a little bit. So I’m gonna now basically be taking my foot and rolling it in a little bit like that, roll it in, slide in a little bit more deeply into the position. And if I really hold the knee lock and I keep rolling that calf in and I lengthen my body, now I’m getting a really nice stretch into that medial gastroc. When you get into position, you need to hold it about 45 seconds to a minute, take a 30 second break and repeat that three or four more times.

What we’re seeing in the research right now is to create these length changes, we actually need to accumulate somewhere between 10 and 15 minutes of stretching per day, at least five days a week. I know that’s a lot, that’s a lot to consider. It’s a lot to take on. The nice thing is that this isn’t a super active thing that you’re doing, so you can watch TV while you’re doing it. You can recreate the same thing with a strap or a belt. So the whole idea is that we need to accumulate some time every day trying to re-lengthen that gastroc. What I would recommend is you do two weeks of work, go back, grab your phone, and retest. Remember, you’re trying to get above 34 degrees, and what you may notice as you do that is you’re also doing other kind of balance testing. You may find that as you increase the length and strength of your calf musculature, all of a sudden maybe your single leg balance with your eyes closed or gets better, or you find that going up and down stairs feels more comfortable, right?

It depends on the age, depends on who you’re working with, who you are, I guess, normative number that you can shoot for. We know that if you’re below that 34 degrees, your risk of falling goes up. Not only falling forward, falling on stairs, but also falling to the side, which can be particularly dangerous as people get older, and where we start to see a lot of problems with broken, fractured hips.

On top of that, as I mentioned, make sure you check out some of the videos on the vestibular system. ’cause like I said, we can never separate biomechanics from neurology. It’s an integrated system, and we need to make sure that we’re working on both sides at the same time if we wanna create maximum effect. All right. Hopefully you found this interesting.

If so, make sure to subscribe to the channel. If you are a movement professional, you’re interested in integrating brand-based training into what you do, make sure to look in the description for a link to our free mini course. It’s six hours of online education plus an ebook, which is about a hundred pages, and just introduces you to some of the ideas of how do we integrate the eyes, the inner ear, joint mobility, strength, et cetera, into what you’re already good at, so that we can begin addressing more complex issues by ensuring that you are doing great neurologic exams and not forgetting systems that can play a big role in how people proceed. All right, so hopefully you enjoyed this and you’ve been enjoying all this information on fall prevention.

We’ll be back very soon with more info. Have a great week.

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