Falls prevention and balance training to keep you steady

Feeling unsteady on your feet can quietly shrink your world. You might avoid the stairs, stop walking to the shops or turn down invitations because you are worried about falling. Falls prevention physiotherapy aims to reverse that, building the strength, balance and confidence you need to keep doing the things you enjoy.

Falls are common, but they are not simply an inevitable part of getting older. The World Health Organization reports that adults older than 60 suffer the greatest number of fatal falls worldwide, yet many of the risk factors behind falls can be changed. At Tylurs com, our physiotherapists combine a careful assessment with evidence-based strength and balance training and practical advice for your home.

Why falls happen: common risk factors

A fall rarely has a single cause. Usually several factors add up, so effective falls prevention tackles as many of them as possible, and each one you reduce can lower your overall risk. Common risk factors include:

• Muscle weakness, especially in the legs and hips, which makes it harder to recover your balance if you trip
• Balance and walking problems, including slower reactions and short, shuffling steps
• Medicines that cause drowsiness or dizziness, or that lower your blood pressure when you stand up, particularly if you take several
• Eyesight problems, such as cataracts or an out-of-date glasses prescription. Some people find bifocal or varifocal lenses make steps and kerbs harder to judge.
• Foot problems and footwear, including painful feet, reduced feeling in the feet, and loose slippers or backless shoes
• Home hazards, such as loose rugs, trailing cables, poor lighting and cluttered stairs
• A previous fall, which is one of the clearest signs that another could happen
• Long-term conditions that affect movement, such as arthritis, Parkinson’s disease, stroke, diabetes or dementia
• Other factors, including dizziness, needing to rush to the toilet, low mood, not drinking enough fluids and alcohol

The NHS guide to falls describes many of the same causes. If a condition such as Parkinson’s or a stroke affects your balance, our neurological physiotherapy service can combine both approaches. Painful joints play a part too: if knee pain or hip pain is making you walk less, treating it, sometimes with manual therapy alongside exercise, is part of lowering your falls risk.

Your falls prevention assessment

Your first appointment focuses on understanding your personal risk factors and how you move. Your physiotherapist will ask about any falls or near misses, including where and how they happened, as well as your health, medicines, eyesight, feet and home, and the activities you want to keep doing or return to.

We then look at how you move, using simple, well-established tests such as:

• Timed Up and Go: we time how long it takes you to stand up from a chair, walk a short distance, turn, walk back and sit down, while watching how you move
• Standing balance tests: holding your balance with your feet side by side, then with one foot half in front of the other, then heel to toe, and on one leg if it is safe to try
• Chair stands: how many times you can stand up from a chair in a set time without using your arms, a simple measure of leg strength
• Walking observation: your step length, speed and turning, how you manage different surfaces and how you use any walking aid

These tests are not about passing or failing. NICE’s falls guideline advises against using falls risk prediction tools that give you a single “risk score”. Instead, we use the results to identify which parts of your balance and strength need work, and to give us a baseline for measuring your progress.

Checks to ask your GP, pharmacist or optician about

Physiotherapy works on strength and balance, but good falls prevention often involves other professionals too. Depending on what we find, we may suggest that you:

• Ask your GP or pharmacist for a medication review, especially if you take several medicines or feel dizzy or drowsy. Never stop or change a medicine without advice.
• Book an eye test with an optician, even if you think your sight is fine
• Have your hearing checked if it has changed
• Talk to your GP about dizziness or blackouts, your blood pressure when you stand up, and your bone health
• See a podiatrist about foot pain, corns or reduced feeling in your feet

With your consent, we can write to your GP to summarise our findings.

Falls prevention exercise programmes that work

The strongest evidence for reducing falls is for exercise programmes that challenge your balance and build leg strength, done regularly and progressed over time. The World Health Organization includes gait, balance and functional training, as well as Tai Chi, among the interventions it lists for preventing falls in older people.

One of the best-known examples is the Otago Exercise Programme, developed in New Zealand. It combines home-based leg strengthening and balance exercises with regular walking, and a trained professional prescribes the exercises and gradually makes them harder. Group programmes built on similar principles are also widely used.

NICE guidance says falls prevention exercise programmes should be:

• Delivered by appropriately trained professionals
• Progressive and tailored to your needs, preferences, goals and abilities
• Focused on balance, coordination, strength and power
• Reviewed regularly, and run for long enough to help you build lasting activity habits

We build your programme on these principles. The benefits take time to appear, so expect to keep going for several months, and to carry on with a maintenance routine after that.

Progressive strength and balance exercises for older adults

Your programme starts where you are and moves forward as you get steadier. The examples below show how balance training and strengthening typically progress. Please do not skip ahead: your physiotherapist will tell you when you are ready for the next level.

Level	Balance exercise	Strength exercise
Starting out	Stand with your feet together, holding a kitchen worktop	Sit to stand from a firm chair, using your hands if needed
Building	Stand with one foot half in front of the other, fingertip support only	Sit to stand without using your hands; heel raises holding on
Progressing	Heel-to-toe standing, then heel-to-toe walking beside a worktop	Slow step-ups onto a low step with a rail; side leg raises
Advanced	Stand on one leg; walk while turning your head side to side	More step-up repetitions; slow, controlled squats to a chair

Safety points for exercising at home:

• Always exercise next to something stable, such as a kitchen worktop, and ideally when someone else is at home
• Wear supportive, well-fitting shoes rather than socks or slippers
• Stop and sit down if you feel dizzy, faint or unusually short of breath, and tell your physiotherapist; if you develop chest pain, call emergency services
• Some muscle tiredness is normal; sharp or lasting joint pain is not

Physio tip: Pair each exercise with a daily routine. Heel raises while the kettle boils, or a few sit-to-stands during the adverts, are much easier to remember than a separate workout.

Home safety checklist

Small changes at home are one of the simplest parts of falls prevention, and they can remove many everyday hazards. Work through this checklist room by room:

• Floors: remove or secure loose rugs and mats, keep cables out of walkways and clear clutter from the floor
• Lighting: use bright bulbs, keep a lamp or switch within reach of your bed and use night lights along the route to the toilet
• Stairs: fit sturdy handrails on both sides if possible, keep steps clear and make sure the top and bottom are well lit
• Bathroom: use non-slip mats and fit grab rails by the bath, shower and toilet; a shower seat can help
• Kitchen: keep everyday items between waist and shoulder height, so you do not need to climb or bend low
• Bedroom: sit on the edge of the bed for a moment before you stand up, especially at night
• Pets: keep track of where they are when you are moving around; a collar with a bell can help
• Help at hand: keep a phone within reach, or wear a personal alarm, so you can call for help if you fall

A home hazard assessment, often carried out by an occupational therapist, can pick up further changes, and we can advise when one might be worthwhile.

How to get up safely after a fall

Knowing what to do if you fall reduces panic and can prevent a long wait on the floor. If you are not hurt and feel able to get up, the NHS advises a slow, step-by-step approach:

1. Stay calm, lie still for a moment and check yourself for injuries.
2. Roll onto your side, then push up onto your hands and knees.
3. Crawl to a sturdy piece of furniture, such as a chair or bed.
4. Holding on with both hands, bring one foot forward so it is flat on the floor.
5. Push up slowly, then turn and sit down. Rest before you do anything else.

If you are hurt or cannot get up, do not force it:

• Call for help using your phone or personal alarm, or shout or bang on something to attract attention
• Keep warm, for example with a blanket, coat or towel within reach
• Keep moving your body gently, and change position about every 30 minutes if you can, to protect your skin from pressure sores

In the clinic, when it is safe to do so, we practise getting down to the floor and back up again with you, one stage at a time. Knowing you can get yourself up again is often a real boost to confidence.

Fear of falling and rebuilding confidence

Worrying about falling is very common, whether or not you have fallen, and it is completely understandable. The trouble is that it can start a cycle: you move less, your muscles weaken and your balance worsens, which makes a fall more likely. That is why rebuilding confidence is a core part of falls prevention.

Physiotherapy helps break that cycle by:

• Starting with exercises you feel safe doing, then gradually increasing the challenge
• Practising the situations that worry you, such as steps, kerbs, busy pavements or getting in and out of the bath
• Checking that your walking aid, if you use one, is the right type and height
• Setting small, achievable goals so you can see and feel your progress

If fear of falling stays high even as your balance improves, NICE suggests considering cognitive behavioural approaches (talking therapies that help you change unhelpful thoughts and habits), and we can discuss this with you and your GP.

When to seek urgent medical help

Call emergency services if, after a fall, someone:

• May have injured their head, neck, back or hip, especially if they are drowsy, confused or vomiting, or take blood-thinning medicines
• Has severe pain in the hip or groin, or cannot put weight on a leg, which can be signs of a broken hip or other fracture
• Cannot get up from the floor
• Blacked out before or during the fall
• Has possible stroke signs, such as one side of the face drooping, weakness in one arm or slurred speech

Get urgent medical advice the same day if you are in pain, injured, or feel unwell or dizzy after a fall. See your GP after any fall, even without injury, or if you feel increasingly unsteady, because falling can be a sign of an underlying health problem.

Book falls prevention physiotherapy at Tylurs com

Whether you have had a fall, a near miss or simply feel less sure on your feet, acting early can help you stay active and independent for longer. At Tylurs com, our physiotherapists will find out what is behind your unsteadiness, build a programme you can follow at home and help you feel confident on your feet again.

If a recent joint replacement or other operation has left you unsteady, our post-surgery rehabilitation service can build balance work into your recovery. Our guide to preparing for your first physiotherapy visit explains what an initial appointment involves.

When you are ready, book a falls prevention assessment, and feel free to bring a family member along.