Please don’t wait until you fall to speak to your medical provider about an assessment and physical therapy. Fear and avoidance can limit you and increase your risk rather than protect you.
Physical therapist Sharil Cass, PT, DPT, NCSDespite what 1980-era “I’ve fallen and I can’t get up” commercials may have implied, falls are not a normal part of aging, even in icy conditions. Yet each year, plenty of Monadnock Region residents end up with bruises or worse after taking an unexpected slide.
“In terms of slips and falls, prevention is key,” says Vivek Venugopal, MD, an orthopaedist who specializes in knee and hip reconstruction at Cheshire Medical Center. “These injuries happen in the blink of an eye and can significantly alter your life and lifestyle. Common injuries we see in the winter are broken hips, broken wrists, and sprains and strains.”
According to Sharil Cass, PT, DPT, NCS, in Cheshire’s Outpatient Rehabilitation department, the first step of fall prevention is assessing your everyday health, including your strength, balance, and level of fear around falling. Cass is a board-certified neurologic clinical specialist in physical therapy who primarily works with patients experiencing balance and neurologic deficits.
“Please don’t wait until you fall,” Cass says. “If you are already limiting any of your daily activities due to balance, strength, or mobility concerns in any weather, please speak to your medical provider about an assessment and physical therapy. Fear and avoidance can really limit what you do and increase your risk rather than protect you.”
Cass stresses the importance of year-round healthy exercise that includes strength, mobility, and balance training. She also offers answers to some of her patient’s most frequently asked questions about slips and falls in winter weather.
How can I make my environment safer to prevent winter falls?
“Ensure you have supportive footwear with good treads,” Cass says. “A newer product my patients like is Arctic Grip footwear, but a good alternative is a pair of boots with removable spiked ice cleats. I recommend spiked cleats over those with coiled wire for anyone concerned with balance.”
Outside the house, Cass recommends keeping walkways clear and salted and managing snow piles next to walkways that can melt and then freeze into sheer ice.
Inside the house, ensure floor mats stay flat. Keep shoes in a boot tray to prevent melting ice from pooling, creating a wet, slippery floor. And either sit down to change your footwear as soon as you enter a building or wipe your feet thoroughly; wet boots on a smooth floor can be an unexpected hazard.
How do I plan ahead to avoid injuries from winter falls?
“Get your eyesight tested regularly,” Cass says. managing eye health is important. Changes in vision effect your ability to be aware of obstacles and avoiding obstacles around in your environment,. reduces peripheral vision, causing people to be easily caught off guard. Scanning 6 feet ahead for hazards is just as important as watching the placement of your feet with each step. Noticing snow texture variation over a covered curb or pothole can make all the difference.
“If you never played sports, practice falling onto your bed so your body knows the best way to react when you lose your footing,” she says. “You want your body to automatically react by tucking and rolling as you fall to distribute the force and protect your head and wrists.” If you are nervous about practicing falling onto a bed or soft surface, Cass says to contact your medical provider so you can learn while supervised by a physical therapist.
“Give yourself plenty of time to get where you are going so you are completely present and not rushing,” Cass says, “and use any supports available, such as handrails, walking sticks, and bracing yourself on a car door.”
How should I move my body to avoid slipping on ice?
“Walk like a penguin,” Cass says with a smile. “Use flat feet to walk with short shuffling steps that move your weight from side to side instead of forward or backward.”
Also, use flat feet and direct downward force to get out of your car, swinging your feet out together and standing on both at once. This avoids any horizontal outward force that can cause you to slip.
What should I do if I slip or fall?
“Breathe deeply and assess your condition before you make any move. If you feel severe pain, there is a body part out of place, if you have hit your head or are bleeding significantly, call for help instead of trying to move, as long as you are out of immediate danger,” Cass says.
Cass recommends never stepping outside without a cellphone or med alert with GPS. “You never know when black ice under a snow dusting could catch you off guard and strand you in the cold.”
“If you determine you are not severely injured, roll onto your side so you can get onto your hands and knees,” she says. “It's likely you may slip a second time while trying to get up, so crawl to a sturdy support you can use to help pull you up, such as some steps or a car.”
When should I seek medical help for a slip or fall?
Cass says if you are unable to stand or walk with your full weight, you should call your doctor or visit Urgent Primary Care Visits for an assessment.
Seniors should always seek a medical assessment after a fall, even if they feel relatively unscathed and only suffer some bruising.
Why?
“Even if you didn’t hit your head, seniors are at a higher risk for head injury caused by hitting their head after a fall. from torn blood vessels,” Cass says. “Being medically assessed and ensuring someone checks on you over the next few days is especially important if you live alone. Any signs of confusion or headache following minor falls should be taken seriously and assessed by a doctor.”
If you are below retirement age and 48 hours of icing—20 minutes on, 20 minutes off—and elevation take care of your symptoms other than bruising, you are likely in the clear.
However, at any age, if your mobility, strength, or ability to bear weight is still affected after 2 days, call your primary care provider’s office or walk into Urgent Primary Care Visits for an assessment that may include an appointment with an orthopaedist.
“It is not always the impact, but sometimes the twisting and wrenching that can cause musculoskeletal injury during a fall,” Venugopal says. “Cheshire’s Orthopaedic team is here and committed to explaining your injury and treatment options in a way you understand while providing the highest quality care to get you back to your life and the activities you love.”
Urgent Primary Care Visits are for existing Cheshire Medical Center patients and do not require an appointment and are an excellent alternative to Cheshire’s Emergency Department if your injury does not threaten life or limb. Learn more about Primary Care Urgent Visits, open 365 days per year at cheshiremed.org/urgent.
Most insurance companies require a referral to Cheshire Medical Center’s Outpatient Rehabilitation team, so call your primary care provider to address balance, strength, or mobility issues that could increase your risk of falls.
Cheshire’s Orthopaedic department has recently grown to include 6 surgeons supported by a team of PAs. Ask your insurance company if you need a referral to see an orthopaedist to assess bone or joint pain, or talk to your primary care provider.