You won’t be surprised that in 40 years living with multiple sclerosis (MS), I have fallen dozens of times. Until recently, falls seemed no big deal; I’d just get back up. I wish I had learned back then what I’m writing in this article now. After years of MS progression, there came a time when I couldn’t get up from a fall without help. Aging and living in chairs most of the time, my bones weren’t bearing weight, and they got thin.
In 2019, my mobility scooter tipped over, and I crashed to the floor. This time, it was serious. Thin bones led to a fractured pelvis that kept me in bed for 2 weeks. Now, I take falls much more seriously, and not falling has improved my life.
How MS Causes Falls
MS sets us up for falls. Leg weakness is one way, and upper body (core) weakness is just as important, because we can’t balance as well. Foot drop, when our toes drag on the ground, sets up falls over carpets or any tiny obstacle. Spasticity (stiffness) makes it harder to keep balance or negotiate stairs, and numbness can make it hard to feel a fall coming on.
If we have urinary or bowel symptoms and need to rush to the toilet, we might get careless and fall. I had to learn not to wait until the last minute to go.
MS fatigue causes falls, when we can’t make a move we could normally make. MS cognitive (thinking) problems make us do stupid things, like not realizing how high a step is or how far away something is. If you’re like me, you can usually sense when your body can do something and when it can’t, but when we are too warm or not thinking clearly, we make mistakes.
MS bodies tend to be weaker when we’re warm. A lot of times you can start out walking or cleaning or whatever, but when your body warms from exercise or because of the weather, you suddenly can’t do it, and you fall. I find it important to stay aware of when I’m getting warm, and do less at those times. Try to keep cool.
Senior citizen groups like the National Council on Aging (NCOA) always recommend making homes safer. Get all the clutter off the ground. No throw rugs. Put in handrails and grab bars in bathrooms and hallways. Use a shower bench or chair for bathing if you need it. Make sure lighting is adequate. I have tried to mind these safety tips, but sometimes I forget. My wife has a bad habit of leaving shoes on the floor where I can trip over them.
Homes and workplaces often have electrical cords on the floor, or high shelves, or those annoying thresholds in doorways that can trip us up. Outdoor environments can be risky, too, with cracked sidewalks, holes in the grass, curbs to get up and down.
In moving safely, there’s no substitute for being careful. The more focused and aware we are of our bodies and surroundings, the safer and happier we will be.
My #1 advice for not falling is: Take your time. Before MS, I could put my feet on the floor and stand up right away. But MS slows down the nerve conduction. It might take a few seconds or a few trials of pushing up before the nerves kick in, and if I skip that step, there may be no leg strength to hold me up. Sometimes, bodies seem to need time to remember how to do something or figure out how to deal with a situation, like getting out of a bathtub.
Balance Between Confidence and Caution
The National MS Society says we need to balance being cautious and confident. Many people will cut back their lives after a fall, much more than they need to. If we stop doing everything, we will lose mobility faster and have a lower quality of life. If we’re too inactive, our bodies get out of shape, causing weakness beyond what MS causes.
Balancing caution and confidence means things like taking your cane or walker with you, even if you don’t need it, just in case. Go places, but always have a plan for how you will get back if you get warm or fatigued. Don’t pretend nothing could go wrong, but don’t let embarrassment over trips and slips keep you from doing things.
Above all, don’t be afraid to use mobility devices as needed. I’ve used so many. I walked with a cane, then a quad cane, then with two canes – that was kind of fun – then a walker with a seat, and now mobility scooters. I’d rather not have to, but it’s way better than staying home in bed.
Be aware that you can still fall with mobility equipment. I have fallen from scooters when they tipped over or when I lost my balance. Now I have armrests on my outdoor scooter for additional support. Some scooters are more stable than others. Lighter three-wheeled scooters fall over more easily than heavier four-wheeled ones, though three-wheelers have advantages, too. If your upper body gets too weak, you might need a wheelchair to get more support than a scooter gives.
Before using a cane or walker the first time, or for choosing a scooter or wheelchair, please work with a professional. Get help to choose the right one; get fitted and trained how to use it well. There are tricks to using all those aids.
There are also treatments such as nerve stimulators or special shoes for foot drop. They never worked for me, but some people swear by them. You may be embarrassed to use mobility aids, but realize that other people will probably admire you for your courage. Remember to take your mobility aid with you even on a good day. Carrying a cane and not using it is better than suddenly needing it and not having it.
Strengthening the Body
The National Institute on Aging (NIA) says the most important thing is to stay physically active. I think core strength is super-important, because without it, we can fall even from a sitting position. Trying to keep our posture straight as possible protects against falls and has other health benefits.
In my opinion, all kinds of stretching and strengthening are helpful. A daily (or 4 times a week) exercise program will prevent falls and will make recovering from them easier. Please see a physical therapist every year or two to keep your program up to date as your body changes.
It might go without saying, but people with MS shouldn’t climb ladders or get up on chairs to reach things. Falls from heights are much more dangerous than falls on level ground. The A physical therapist or occupational therapist’s checking out your home and your daily habits for falling risks can help you make things safer
NIA advises us to learn about the safety effects of our medications. Sleep meds are known risk factors for falls. They also suggest limiting alcohol intake.
Watch These Videos
To prepare for this article, I watched three parts of an eight-part video course called Free From Falls from the National MS Society. They’re short (8 to 18 minutes), easy to follow, and I wish I’d seen them years ago. I’ll watch the others soon.
The first video says, “Falls can be life-changing, increasing dependency and limiting activities, causing social isolation.” We don’t want that. We want to avoid falls, and we want to learn healthy, thoughtful ways to respond to them. These are achievable goals.
To connect with other people living with multiple sclerosis join our MS Facebook Support Group.
Photo Credit: R.Tsubin / Moment via Getty Images
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