The Physiology of Falling 

Once upon a time, at a beautiful moment in history, you were born.  After a few months calibrating to your new environment, you began to sit up. Then, you began to crawl.  And finally, you took your first steps.  Awkward and imbalanced as can be you go from walking, to running, to jumping, walking on your hands and possibly playing sports that require you to do all of the above!

It’s quite fascinating to watch the motor development of a child from one day…one month…one year to the next.  Possibilities expand at every juncture, and along with them, come the joys of independence and freedom.

The risk of falling that surrounded our every movement – gone – gone with the wind.

Fast forward 60 or so years.  After decades of mastery, often depending on how well you take care of yourself, imbalance may start to set in once again. 

But, why…is this some sort of cruel joke or “circle of life” thing…is everyone’s plight to revert to the motor control of our early youth as we age?

When I hear people describe aging in this way I cringe because by no means is it suppose to be this way!

In the US, we have redefined “usual” aging by what appears to be normal (i.e., what we see with our eyes happening most frequently).  But just because certain physiological changes are inevitable with aging doesn’t mean that you are doomed to start falling again.  An abundance of research demonstrates without a doubt that your physiology is not to blame.  Once again, as we’ve discussed before, it’s the choices you are making, as you get older, that you must examine for the answers.

But, before we dive into how your choices can indeed impact your risk of falling, it’s important to establish the fundamental ingredient to healthy human physiology throughout the lifespan.  MOVEMENT.

Movement is something that we take for granted during adolescence because it is so normal.  But, without movement our bodies don’t develop in a healthy way.  Without movement we wouldn’t ever learn to crawl, walk or run.  And, without movement we wouldn't gain mobility, balance, stability or strength. 

In simple terms, movement, as it pertains to physiology, is what we study and research most as exercise physiologists.  Much of the complexities of this subject matter begin with simple observation. 

As a father or three children under 10, I can proudly say that I have witnessed the miracle of child development firsthand.  Over the past 10+ years specializing with aging, I have also seen the flip side of the coin.

As it goes, my youngest, Dylan, age 7 months, is also my most active.  He just started crawling a couple weeks ago and we can hardly contain him!  If there’s one certainty in this early stage of his development it’s that he is going to fall – a lot. 

Amazingly, as he grows stronger, he gains more mobility and balance…and as this happens, falls will occur less and less.  Within just a couple of years, falling won’t even be a concern of his. His extremity strength will align with his core strength, enhancing stability and allowing him to easily hold his body upright.  His nervous system will become finely calibrated with his mechanoreceptors, which send movement-oriented feedback to the brain, allowing him to even engage in an increasing amount of dynamic movement without falling.  For approximately the next 40 years, he probably won’t even think about falling, let along be afraid of falling.

After age 40, things begin to change, physiologically.  Anabolic (muscle building) hormones start to shift downward, and for the first time in over four decades you will start losing muscle mass and strength.  By the time you hit 65, if you aren’t directly engaged in strength activity on a regular basis, you’ll have likely lost about a third (~33 percent) of the strength you enjoyed and took for granted in adulthood.  For the average person – both men and women – this is more than enough strength loss to create a substantial physiological imbalance.  All of a sudden (it feels like) you have “lost your balance” and have gone back in time.  But falling, as an adult, is much scarier than it was as a child, when you weren’t aware of how hurt you could get.

Of course there are other several other factors that influence falling, as we’ve discussed previously.  But, strength loss, we believe, is the most significant contributor to falls across the population – especially in the US where strength activity rates are among the lowest in the world (>10 percent). 

As I alluded to earlier, strength loss is not a physiological inevitability that you are powerless against.  It’s really more a matter of the choices you are making.  The good news is that it is never too late to regenerate your strength, and therefore it’s never too late to significantly reduce your risk of falling!