I’ve Fallen, and I Will Get Up!

This first Tall Spine Blog of 2025 is coming out as I’m on a cross-country flight to visit my mother in Florida. She is a vibrant 87-year-old who still lives life to its fullest. One of the reasons for my trip is to check in with her about a recent fall she had where she knocked out some teeth, bonked her head, and got an elbow fracture that necessitated surgery – yikes, just that. She’s recovering just fine and planning to get right back to her usual and customary activities. Just like she did after she broke her leg falling off some exercise equipment in 2023. She would like me to think that there was something erroneous in the store parking lot that caused her recent trip and fall, just like there was something awry with the exercise equipment that got in her way in 2023 that caused her to fall then. Both incidents resulting in a surgery, but fortunately, neither is causing any permanent damage – except possibly the realization that activities need to change with age.

That’s it – besides a social visit, I have an objective to speak with my mom about her increased risk of falling at her age. We all have this risk. Not a big deal when you are young and flexible, but age brings with it a loss of flexibility and increased recovery times.

The neuroanatomist in me is going to try to bring reason to the predictable defenses she will try to make about a series of falls being random events that could happen to anyone rather than a product of aging. I’m hoping to get her to accept what we all need to accept, that we need to change our activities to match our bodies abilities. Simple fine tuning is in order because the risk of falling increases with age in part because a function of your nervous system called proprioception becomes less effective.

Proprioception is the body awareness sense. It refers to your body’s ability to sense the position of its different parts in space. There are sensory receptors in all of our muscles, tendons, and joints that send positional information to the brain. Your brain interprets these and then responds with motor impulse to help you maintain balance and coordination.

Genetic and epigenetic factors influenced by health and activity level will give variance to the degree of change in each of us, but some decline in proprioception is inevitable. I love to surf with my son. This year I switched to paddle boarding in the waves to eliminate the need to get up onto the board. I just paddle to it. I blame not being able to swing around a stiff knee, but some of this has to do with coordinated movements.

The initial trigger to natural proprioception decline relates to a combination of decreased sensory receptor sensitivity in your stiffening muscles, tendons, and joints. These tissues have sensory receptors called Golgi Tendon Organs situated at connections between muscles and tendons that measure force and activity of the area and transmit this information to the brain. The brain combines this information with information from your visual system and your vestibular system to get an understanding of where that part of your body is in space. Balance is a product of your brain interpreting this information simultaneously with every muscle, tendon, and joint in your body, and then delivering a motor response to activate the appropriate flexors and extensors to keep you standing. You are the conductor of this symphony orchestra.

The combined effects of declining proprioception, muscle weakness, and joint stiffness contribute to an increased risk of falls in older adults. A loss of accurate proprioceptive input can delay reactions to shifts in balance, making it more difficult to prevent or recover from a fall. The best way to compensate for this decline is to keep your vision tuned*, stretch regularly to enhance flexibility**, and include strength training in your exercise program for muscle tone***.

So yes, I will have a great time visiting my mom. I will get to observe her in her environment and hopefully make some positive suggestions to keep her vibrant and healthy.

Until next time,

Jeffrey Larson, MD
The Tall Spine

*Protip: Reliance on Vision: As we age we rely more heavily on visual cues to maintain balance and spatial awareness, compensating for proprioceptive declines. Impaired vision compounds balance and movement difficulties.

**Protip: Joint Stiffness: As we age, connective tissue, cartilage, and ligament flexibility decreases. This leads to reduced joint range of motion, making it more difficult to sense joint position accurately. Stretch every day, in fact, do it first thing after you wake up so you don’t ruin your day!

***Protip: Muscle Weakness: Age-related muscle atrophy (sarcopenia) and decreased muscle strength make it harder to maintain postural stability. Weak muscles have less ability to respond to proprioceptive feedback, further impairing balance and coordination. Ask your doctor about physical therapy options to learn a home exercise program. Somehow, figure out a way to exercise and include muscle strengthening.