Fight Fractures

In the Netherlands, our approach to health care has been dominated by the philosophy that “prevention is often better than cure”. This has led to some innovative solutions to health and social problems, notably in the domains of legalised drug use, explicit sex education and euthanasia.

Dutch researchers are further studying ways of getting the elderly and fragile to better self-manage their condition. A striking example of this philosophy is described by Brenda Groen in her article “Could martial arts fall training be safe for persons with osteoporosis? A feasibility study” (BMC Research Notes, 2010, 3:111). Groen, a researcher at Nijmegen’s Sint Maartenskliniek, has investigated the possibility that people with fragile bones might be less likely to break them if only they could learn to fall over more gracefully -- martial arts style!

As she explains, the risk of hip fractures is particularly high in elderly people with fragile bones, resulting from osteoporosis (low bone-mineral density). Treatments can attempt to strengthen bones but, since 90% of the hip fractures are caused by falls, especially sideways, wouldn’t it be better to reduce the fall’s severity?

Getting the elderly to wear padded hip protectors can reduce femoral impact forces by “as much as 85%”. “However, to prevent hip fractures in everyday life, user compliance is a problem” – the fashion-conscious elderly don’t always wear their bulky hip protectors out and about, let alone in their home. Therefore, Groen reasons that these people ought to be taught how to fall over safely.

“Recent studies indicate that fall strategies based on martial arts (MA) fall techniques reduce impact forces” because the fall changes into a rolling movement that distributes forces over a larger impact site and reduces the amount of energy to be absorbed during impact.

To test the benefits of martial arts training, Groen asked healthy, young individuals without prior experience (23-44 years of age, weight: 55-85 kg, height: 1.71-1.86 m) to perform MA fall training. “For obvious safety reasons” she didn’t ask elderly persons with osteoporosis.

Each participant received two hours individual training, performing sideways and forward fall techniques from the ‘Nijmegen Falls Prevention Program’. Falls began from a sitting position onto a judo mat (4 cm thick) or a gym mattress (25 cm thick), progressing to sideways and forward falls from a kneeling or standing position. A force plate beneath the mats measured the vertical force of impact.

So, what are the key differences between simply falling over and falling with a trained martial arts roll? Groen has already carved quite a research niche out of her studies of falling volunteers, publishing some six other articles in the last three years. Four of these use an identical Figure 1, illustrating the comparative impact points of a stick figure falling sideways that either tries to break its fall with an outstretched arm (risk of broken wrist) or performs an elegant martial arts’ roll.

In her latest report, she helpfully provides a photo series showing a young woman performing MA techniques during forward and sideways falls from a kneeling position. Note the rolling movement, head protection by neck flexion and the use of the arm to stop the rolling movement. “In forward falls, trunk flexion and rotation enable participants to roll over the scapula of the ipsilateral shoulder and diagonally across the back to the contralateral hip region (Figure 1a)”. This may sound easy to Brenda but when looking at her photos, it’s hard to imagine many elderly people (with or without osteoporosis) adjusting a forward fall such that they can tuck their head into one side and land by rolling their whole body over their right shoulder!

By comparison, the sideways fall is straightforward, “Participants roll over the ipsilateral hip to the scapula of the ipsilateral shoulder; this is achieved by flexion, lateral flexion and rotation of the trunk (Figure 1b).” You just have to remember not to stick your arm out to break the fall, since the whole idea is to roll over the (fragile?) hip and then rock to a halt on the shoulder.

Well, after all these falling motions, Groen confirmed something that martial arts’ practitioners have known for centuries, i.e. they don’t get hurt if they roll correctly. The hip impact forces were reduced up to 27% when performed by experienced martial artists and by 17% in young adults after a thirty-minute training session.

“MA fall training may have similar effects for hip fracture prevention to the prescription of bisphosphonates.” Indeed, a trained rolling motion can reduce the force of the initial impact below levels Groen considers likely to cause injury, making it “safe for 84.1% of elderly women”.

In conclusion, “Based on our results, we believe that fall training would be safe for persons with osteoporosis if they wear hip protectors during the training, perform fall exercises on a thick mattress and avoid forward fall exercises from a standing position.”

But are elderly people with osteoporosis actually prepared to take up her martial arts training, even with their hip protectors in place? Groen admits, “The performance of fall exercises by older adults is expected to be less fluent than that of younger adults, caused by a slower reaction time and poorer ability to coordinate muscle actions. This may result in higher hip impact forces.” Not likely to encourage volunteers!

However, “Older adults are expected to have more fear of falling and are more cautious in their performance of the fall exercises, which presumably results in lower impact velocities and, consequently, lower hip impact forces.” You mean, their fear of falling prevents injury?

But then, why fall in the first place? Generally, improved levels of exercise result in better muscular coordination and balance. Perhaps elderly people would be less likely to fall if they had a better sense of balance from training performed in an upright position!

(Foto: iStockphoto / arekmalang)