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  • Study: 'Safe Landing Strategies' to Reduce Falls Injury Show Promise

    National Falls Prevention Awareness Day, coming up on September 22, helps to focus attention on the importance of reducing the risk of falls and fall-related injuries. How can physical therapists (PTs) and physical therapist assistants (PTAs) help patients develop ways to react if and when those falls occur? One study suggests the use of "safe landing strategies" including elbow flexion, squatting, and a "martial arts roll" may significantly reduce body impact, though more testing needs to be done.

    In a study e-published ahead of print in the Archives of Physical Medicine and Rehabilitation (abstract only available for free), authors reviewed results of 13 studies involving 219 participants who were instructed to react to a fall by employing 1 of 7 landing strategies: squatting during a backwards fall, slightly flexing the elbow during a forward fall, and reacting to a side fall by either rotating forward, stepping sideways, relaxing the muscles, rolling away from the impact point (martial arts roll), and "martial arts slapping," which involves slapping the falling side arm on the ground after a martial arts roll. Researchers then measured fall velocity and impact force in various body areas such as the hips and compared these with forces recorded in falls that did not employ these strategies.

    Here's what authors of the current article found when they gathered the results of the studies:

    • Squatting during a backwards fall reduced impact velocity of the wrist by 11% and the hip by 18%, and lowered the impact energy of the hip by 44%.
    • Elbow flexion during a forward fall reduced impact force of the elbow by 40%, the shoulder by 26%, the wrist by 26%, and the hand by 14%. Impact velocity of the neck was not affected.
    • Among the side fall strategies, martial arts rolling was the only strategy that significantly decreased hip impact force, with a 25% reduction. Both martial arts rolling and relaxed muscle reactions reduced the impact angle of the trunk by 60%. Martial arts slapping did not have an effect on any of the impacts measured.

    While encouraging, the results are somewhat limited not only by participant size, but by the nature of the studies themselves: average participant age was under 30 in 12 of the studies, and 8 of the 13 studies were based on self-initiated falls, either from a kneeling (6 studies) or standing position (2 studies). In the remaining studies, participants were released from a tether while standing, with 1 study telling participants in advance when the tether would be released.

    Authors point out that proper execution of these strategies "depends on muscle strength and early initiation of the techniques"—2 factors that may be problematic for an elderly individual who experiences a sudden fall. "It is debatable whether these fall techniques would be both effective and suitable for older adults," they write. "It is important to note that some protective responses have associated risks that might lead to adverse consequence when performed inappropriately."

    Still, authors believe the impact differences noted in the studies do warrant further research into whether the effectiveness of the strategies is generalizable to the most at-risk population, and how these strategies affect fracture risk. However, they add, getting at those results will require studies that use "innovative methods to simulate real-life falls."

    APTA offers a wide variety of resources on falls prevention, including a clinical summary on falls risk in community-dwelling older adults, a practice guideline on the assessment and prevention of falls, tests and measures related to falls, a Physical Therapy-published clinical guidance statement from the Academy of Geriatric Physical Therapy, an online community for PTs and physical therapist assistants interested in falls prevention, and a balance and falls webpage.

    Spearheaded by the National Council on Aging (NCOA), Falls Prevention Awareness Day was created to highlight what NCOA describes as the leading cause of injuries among older Americans. An estimated 2.5 million falls-related injuries are treated annually, including 734,000 hospitalizations. Nearly 22,000 Americans die from injuries related to falls.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • Great article! We work with Parkinson's patients and do rolling/falling drills on a regular basis as part of our exercise curriculum, even with our Level 3-4 (more advanced, later stage PD) classes. Average age is 65, we have 240 PD participants in our facility. We also have 250 affiliate locations who follow the same curriculum. If an opportunity for another study comes up, we may be able to help! Here is an example of our rolling drills ... hope you don't mind the silliness :) https://www.youtube.com/watch?v=-q7WmqiZ1ps&index=8&list=PLqM51Sy0e1R249ve8FlZS-2BOTSKcQ7S-

      Posted by Chris Timberlake on 9/14/2016 10:03 AM

    • As a rehab therapist, I believe that my time with Parkinson's patients is best spent PREVENTING falls by focusing on intensity and amplitude. As a last resort, and if I had exhausted all other options, teaching my patients "ideal falling practice" could be of some benefit. However, I believe that benefit to be minimal. After the often scary, instantaneous, moment of falling when recollection of why, how, when, is difficult it would be impressive if a patient could fight natural instincts/protective reactions and fall with elbows bent, in a squatted position, and roll when they hit the ground. If our patients were able bodied enough to perform the 3 items mentioned above and their memory/problem solving skills were developed enough for motor implementation, I would argue that they are not a fall risk anyway. Additionally, how do you teach a patient when to fall and bend elbows, squat, and roll and when to put out their hands. How many patient's have we had that prevent a fall by sticking out their hand and grabbing a chest of drawers, catching a wall, or grabbing a grab bar at a distance? Reminds me of one patient who swore to me, straight-faced: "my poor balance is ok, trust me... I'm a very good faller."

      Posted by Konrad on 9/14/2016 2:28 PM

    • Chris, your youtube video only had rock steady drills. Do you have a video with actual "fall rolling strategies"? THANKS

      Posted by Deborah on 9/14/2016 7:24 PM

    • I am very interested in this study and other related studies regarding the effectiveness of fall training. I am an OT student working my research project and was planning on studying the effectiveness of landing strategies before I found this meta analysis. Does anyone know of any studies that have come out since the publication of this meta analysis?

      Posted by Irvin LJ Eisenberg on 8/23/2017 12:40 PM

    • I am a long-time Tai Chi instructor and coach of the Ohio State University Shuai Chiao (kungfu wrestling) Club. I have been teaching seniors a concise program of falling skills for over five years. My opinion, backed by experience, is that simple motor skills for safe falling can be taught to the elderly with good results. The mere action of controlled falling (down onto very thick and soft crash-pad mats) over and over greatly reduces the fear of falling itself. With only one partial pilot study, this is not an "evidence-based" program, yet. But I do have over a dozen anecdotal survival stories from students in their 70's and 80's who came through potentially fatal ground-level falls with minimal injuries.

      Posted by Mike Grigsby on 11/11/2017 11:10 PM

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