Fear of falling

By Sean Carey

Remember when your mother or other responsible adult told you as a small child to tie your shoelaces so you would not trip and fall? I do. And I’ve carried out that hard-to-learn-as-a child-shoelace-tying maneuver ever since.

Now, my tying skill is used on a pair of old running shoes, which, with the over-cushioned insoles removed, I find very comfortable for everyday walking. The shoes do though have very long laces.  Even when tied with a double knot, the laces create large loops.

Two weeks ago I was walking along a footpath, shod in my favorite running shoes. Heading in the direction of my local bank, I become aware that the tip of my right shoe is caught in one of the loops of my left shoe. It’s happened several times before, and I’ve always managed to quickly disentangle myself without taking a tumble.

This time I’m not so lucky.

My foot is well and truly stuck. Down I go, breaking the fall with the palm of my right hand. The pain is excruciating, especially as I land on a hard surface composed of small stones. I roll over onto my right shoulder. I am aware that the area around my right eye has just skimmed the ground. That part of my head hurts. I swear a lot, both at the injuries and my own stupidity for not being more careful to prevent something like this happening to me.

A few weeks previously on TV I watched Australian Olympic gold medallist, Sally Pearson, fall after hitting a barrier in the women’s 100m hurdles at a Diamond League meeting in Rome. She landed on her hand. I winced while watching the slow-motion replay. Later, an orthopaedic surgeon described Pearson’s injury as a “bone explosion” in her wrist, which highlights the delicacy of the human hand bones even in very fit young people. Those images, of Pearson sitting on the track in agony, and the information about her multiple broken bones flash through my mind as I lie on the ground.

My question is: have I broken any bones in my hand or wrist? I get up from the floor into a crouched position, turn my palm upwards and see several cuts and grazes. Not nice. I use my left hand to quickly feel my dominant right hand and forearm.

No obvious fracture, I say to myself, though because I’m not an orthopaedic specialist the diagnosis is hardly definitive.

By this time my perception of the world is a bit hazy, not least because I’m experiencing pain coming in pulses or waves. I’m also aware that my mouth is very dry, which I know is caused by the release of stress hormones in my body. I check my head and realize I’m bleeding. But how much? There are few people in the vicinity. I ask a passing middle-aged woman to assess the damage. For both medical and social reasons (where I live), it’s not customary behavior to walk along the high street with blood pouring from a head wound, I should skip the visit to the bank and drive immediately to my local NHS minor injuries unit.

“It’s not too bad,” she says. “It’s more of a graze than a cut. If I were you I would sit down and have a little rest.” A little rest sounds like a good idea. I sit on a nearby bench, aware that I need to shorten the loops on my shoelaces before I resume walking. After all, lightning can strike twice, and I definitely don’t want to risk another fall.

As I drive to the minor injuries unit I recall the words of anthropologist and neuroanatomist Raymond Dart in his 1947 paper, The Attainment of Poise: “…in precariously-poised man that ever-present fear of the livelong day (and of sleeping hours also in many individuals) is that of falling.”

Dart considered fear of falling to be adult humans’ primary fear, upon which other anxieties and phobias are constructed.

I reflect on this perspective before concluding that, while fear of falling must be top of the list, the fear of not being able to breathe must also rank very high (just ask an asthmatic).  Additionally, I judge that while fear of falling might create some of the necessary conditions that trigger a variety of simple or even complex fears in individuals– phobias concerning mice, spiders, answering the phone, or leaving one’s house, for example – it cannot explain social or cultural fears that reflect complex in-group/out-group relationships – fear of migrants among some segments of the population in modern nation states, for instance  – because it’s too neuro-physiologically reductive.

But let’s not throw the physiological baby out with the cultural bathwater.  Looking back two weeks later at my falling experience, I realize that, especially in the first few days after my fall (even though an x-ray confirmed that I hadn’t broken any bones) I was much more aware – hyper vigilant, even – as I went about my everyday business.  I was, for example, far more careful and slow-moving than normal in negotiating public spaces, particularly if there were many people around, in case someone bumped my badly bruised hand, or worse I took another tumble and caused further injury to my hand and head.  Not surprisingly, I also found it impossible to use my right hand for effective flexing or gripping. Therefore I was obliged to employ my left hand for routine activities such as lifting a kettle or using a toothbrush or computer mouse. Kinaesthetically everything felt very strange.

My injuries also reminded me of research by Manchester Metropolitan University’s Ian Loram that fear of falling in humans adversely affects the functioning of the body’s proprioceptors and vestibular apparatus resulting in increased muscle and joint stiffness, especially in the feet and lower legs. That muscle and joint stiffness, in turn, adversely affects sense of balance, awareness of which further increases muscular tension, and therefore generates inefficiency in everyday movement. Paradoxically, this inefficiency can increase the likelihood of a fall, though my guess is that such a temporary deterioration in general coordination is functional in inhibiting the same or other “dangerous” movement patterns.

As the pain and swelling of my hand and head gradually diminishes so too have the neuromuscular consequences and anxiety about another fall. The spring is literally coming back into my step as, for example, I resume using my right hand for tooth brushing and other mundane activities. As for my formerly favored running shoes, they’re on the floor in the hallway of my house. I haven’t had the inclination to put them on again. Funny that!

 

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