Step Up Your Ground Game

The potential for falling is a constant threat in our daily lives. From the wet spot on the bathroom floor, to the missed step at the base of the stairs, and the pesky cat that is always underfoot, it is amazing we can make it through the day unscathed. While my daily struggle with my wife’s beloved cat is a nuisance, these threats become more serious with age, as our balance, strength, and mobility to overcome these falls decreases. 

10,000 Foot View:

The threat is real, folks: In the United States, 1 in 4 adults over the age of 65 fall each year and it is a leading cause of fractures and injury-related deaths, in this age group^1-4. Additionally, falls in this age group account for approximately 60% of all injury-related emergency department visits.² When do we lose the ability to safely and efficiently get down to the ground? More importantly, can we relearn this skill?

My Muse:

As per usual, I look to Amelie for guidance on all of my burning questions. My nearly 4-year-old daughter accumulates an astounding number of reps navigating the ground each day. I marvel at the effortless manner in which she lowers herself to the ground in a seemingly endless variety of Calisthenic movements. Through hundreds of daily repetitions, Amelie has developed a virtuoso ground routine that includes seamless transitions between splits and squats, rolls and crawls. As I admire the proficiency of Amelie’s movement, I reflect on how much she has developed and on my lessons learned from the world of motor learning. ***Check out my previous blog post, Coaching and Life Lessons from Amelie, for the skinny on this topic.

A strong ground game cannot be restored overnight – it will take MANY repetitions of purposeful movement, that are salient, specific, and build in intensity. Why not use this approach in the clinic, while simultaneously addressing the impairments associated with our patients’ most common injuries?

 

The Movements:

In an attempt to channel the growth mindset of the toddler/preschooler, The Jackson Clinics-Skyline utilizes a daily movement practice that encourages you to get down to the ground, improve your body control, and reacquaint yourself with all of the dust bunnies in the corner of the room and lost Peppa Pig paraphernalia under the couch.

Ground Transition Options: ***All of these options can be performed with use of upper body support on a secure surface, for additional support. Rule # 1 - No falls. Rule # 2 - Don't break rule number 1!

Lunge Strategy:

Squat Strategy:

Four Point Transition:

Two Point Transition:

While you are down there, why not spend a couple of minutes mobilizing your whole body with the following movement series? We use some variation of this sequence with virtually every patient in the clinic. Whether you have knee pain, hip stiffness, back pain, shoulder weakness, this movement series does not discriminate! The ground rocker sequence is a veritable “Swiss Army Knife,” of movement practices. So, without further ado, here it is:

Ground Rocker Series:

Quadruped Sit Backs:

Adductor Sit Backs:

Z Sit Rotations:

Z Sit Stretch:

Lunge Rockers 1-3

The Prescription:

1. 20/20 rule – Every 20 minutes, step away from your work station and practice one of the lowering options for 20 seconds.

2. Brush your teeth, brush your body – We brush our teeth at least twice daily to get rid of the gunk from our mouth. Why not do the same for the rest of our body, and undo the stiffness that we feel in our joints? Spend 3-5 minutes in the morning and evening exploring the ground rocker sequence.

3. Progress the demands – Seek out ways to make these movements more challenging. Schedule an appointment with us if you need help!

 

The Take Home: Falling is Scary Business!

1. Actively work to mitigate the risks associated with falling by reacquainting yourself with one of the first skills you learn as a child – lowering and rising from the ground.

2. Restore lost mobility, coordination, and body control through daily exposure to a ground-based movement practice.

3. Check the work of your house cleaning crew through daily, under the couch inspections!

 

References:

1. Tromp AM, Pluijm SMF, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001;54(8):837–844.

2. Bergen G, et al. Falls and fall injuries among adults aged ≥ 65 years—United States, 2014 MMWR Morb Mortal Wkly Rep 2016 65 37 993 8

3. Centers for Disease Control and Prevention. Welcome to WISQARS (Web-based Injury Statistics Query and Reporting System). 2018. https://www.cdc.gov/injury/wisqars.

4. Bhasin S, et al. A randomized trial of a multifactorial strategy to prevent serious fall injuries. New England Journal of Medicine. 2020;383(2):129-140. doi: 10.1056/NEJMoa2002183.