Learning to Fall

May 18, 2018

By David Marchant, Professor of the Practice, Dance, Washington University in St. Louis

As we age, we instinctively move more slowly, cautiously avoiding situations and activities that challenge our balance. But what if we’re going about the problem in the wrong way? What if instead of avoiding risk of falls, we need to practice falling, to get really good at it, like it is a skill?

Falling is dangerous and after a lifetime of missteps, trips and spills, we naturally become afraid of falling. And with good reason; every year, falling causes thousands of deaths, millions of injuries and for many elders this causes a downward spiral in quality of life. During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.¹

I am a dancer and a dance teacher. Dancers prize balance and an ability to control body movement. In my beginning dance classes I was taught when losing balance that I should, “fight for balance,” “hold on,” and try to regain “control.” I also learned that if you pick a fight with gravity you get one!

But this isn’t only the story of elite dancers. We are taught our whole life that we need to keep control of everything — of our bodies, our thoughts, our emotions. This outlook of controllability can lead us to believe that everything will be better, safer if we can just make it more routine, more stable, less likely to change in an unexpected, unwanted way.

Ten years ago, I had a surprising moment of insight that uprooted my assumptions about balance and control. I was in the woods, trying to walk along a fallen tree stump like a balance beam, trying not to fall off of it, when I discovered real balance for the first time — hiding in the last place I expected to find it.

I was tense, fighting for my balance, when I looked up and noticed the trees — their branches freely flowing outward in ease. They weren’t trying not to fall, and I thought, “I don’t have balance, balance has me.” I relaxed, and my weight spread out and I realized that paradoxically my balance got more stable when I imagined my body falling outward in all directions easefully. It was like I just fell into balance.

Professionally I perform and teach styles of dancing such as Modern dance and Contact Improvisation that make falling an art — intentional and beautiful. We practice falling until it is as normal as walking. I wondered if such approaches would help people with Parkinson’s disease. In 2008 I teamed up with Parkinson’s disease (PD) scientist Gammon Earhart. We collaborated on a pilot study to teach contact improvisation dancing to people with PD. As you can imagine, people with PD are particularly afraid of falling. Yet with this interactive, unpredictable activity, we literally pushed people to get used to falling, like a game and gradually they became calmer adjusting when off balance. In just two weeks of improvised dancing their balance improved measurably. This made me wonder if fear of falling itself might cause falls.

Like my moment on the tree, fear causes muscle to tighten. It feels like a protective instinct but is really just a learned reaction that ironically makes us more likely to fall. This is because tension interferes with our ability to adjust smoothly when we begin to lose balance. It turns out that trying not to fall is a terrible strategy for balance, and for living. In several correlational studies, the evidence suggests that people who fear falling are predicted more likely to lose functioning, avoid activity, and surprisingly incur more injuries.²

Now for ten years I have been sharing this insight with concert dancers—could just changing a mindset from fear to freely falling improve their balance? The anecdotal evidence for me and so many dancers I have shared this insight with is a clear, yes.

So I am interested to return to working with adults and elders to explore and imagine what a curriculum in “Learning to Fall” might look like. We could experiment with approaches that teach people not to tense up in normal movement, to practice softer ways of going to the ground and getting back up every day, and to incorporate dynamic activities into our life that require improvisation, adaptation and promote mindful movement, rather than rote routines.

What if we could develop a technique to move freely, flowing outward like a liquid, dynamically adjusting continuously. I have been tinkering with some acronyms for such a program. I am still working out the details on what to call it, so let me know what you think.

Going forward, I hope to continue to explore these questions. With careful training and practice, could adults re-learn a new instinctive response, that when faced with losing our balance we could more calmly allow our weight to move and make adjustments? We might more calmly avoid some falls.

As our PD study participants said, “It’s not IF you fall, it’s When.” So when a fall is inevitable and just can’t be prevented, can we learn to land it more gently/less injuriously?

And in our wider lives, could learning to fall give us a new sense of ourselves and a new definition of control, allow us to fear less, to live more freely, not just in our bodies and our activities but in our relationships knowing that we can do better than avoid risk. We can adapt and when necessary, even fall gracefully.

You may read more about my series of studies in Dancing with Disease: A Dancer’s Reflections on Moving with People with Parkinson’s and Memory Loss.

References

  1. Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. DOI: http://dx.doi.org/10.15585/mmwr.mm6537a2
  2. Arfken 1994, Vellas 1997, Finch 1997

This post is part of the “Older Adults & Aging” series of the Institute for Public Health’s blog. Subscribe to email updates or follow us on Twitter and Facebook to receive notifications about our latest blog posts.

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