Shuffling While Walking
Shuffling (not clearing of the feet when someone walks) can be caused by several issues. All potential causes need to be investigated as this is a major contributor to falls. If you or your loved one is catching their feet, this is what we’re talking about. The main thing you’ll notice is an audible scrape when the foot is being dragged across the floor. I overheard another therapist tell a patient (who was wearing tennis shoes on a wood floor) “I don’t want to hear a basketball game while you’re walking.”, as there was an audible “chirp” every time their foot made contact with the floor.
Causes
Some of the main causes of shuffling are decreased ankle range of motion, decreased leg strength, improper footwear or an altering of one’s center of balance. Some seniors, as they age, tend to start leaning or pitching forward. This can be due to several reasons, (such as tight muscles, spinal changes, etc…) and when this occurs it becomes more difficult to swing the leg all the way through while walking. Some older adults will “catch” their toe at that point. Again, this significantly increases a senior’s risk of a fall.
Another causative factor is a loss of flexibility. When we sit, the muscles at the back of our knees (hamstrings) and the muscles at the front of the hip (psoas major) are shortened. If you or your loved one sits for long periods of time, these muscles can actually become shortened or contracted. To visualize this, imagine you’re standing but partially in a sitting position with bent knees and leaning forward. This throws your center of balance forward. When you try to take a step you are much more likely to shuffle your feet or catch them on something. If your loved one is exhibiting this, bring it to their attention. If they cannot self correct this, consult their physician as physical therapy, medications or sometimes even simple exercises can help correct this.
Another potential cause of shuffling is Parkinson’s disease or Parkinsonian type conditions. This is often accompanied by a shorter step length and what some in the medical community dub the “Parkinson’s Shuffle.” While this is an unflattering term, it is used because this is one of the main signs people exhibit with Parkinson’s Disease. We’re not saying because you shuffle, you have Parkinson’s, but all potential causes of shuffling need to be examined to determine the cause.
Proper Footwear
Foot wear was noted earlier and improper footwear can be a causative factor in both shuffling and falls. I have several clients that go barefoot at home, and unless they’re a Type II diabetic with neuropathy, I don’t usually have a problem with this. What I do see that can be an issue are people wearing only socks (I know they make “non-skid socks, still not a fan…) esp on wood or tiled flooring. Many like to wear “slides” or a slip in shoe with no backing. It’s very easy for your foot to come out of or to partially kick one off while walking, causing a stumble or worse a fall. If shoes are worn in the home it is recommended that the shoe has a back to help keep it on. We have no affiliation with ”Skechers” brand shoes, but I’ve had several clients with their new “Slip-Ins” (trademark by Skechers), and they really like them. They’re easy to put on and they stay on. That might be a good choice for shoes to be worn in the home. I’m not advocating for any particular type of shoe or recommending you or your loved one go barefoot. Simply stating that socks alone and open heeled shoes do increase fall risk.
In closing, people that shuffle are at a much higher risk of falling. If you or your loved one is shuffling, please get with your physician or physical therapist to help determine the cause. Often, some simple exercises and improved flexibility will take care of the issue. Regardless, all causes of shuffling need to be investigated to help reduce fall risk. And since falls are responsible for 75% of all senior citizen injuries, addressing this issue can go a long way.
Leading Causes of Falls in the Elderly, Part 1
Muscle Weakness and Balance/Coordination Problems Due to Lack of Physical Activity
Although I’ve been back in home health for 5 years now, I owned my own outpatient PT clinic from 2009-2019. I loved doing outpatient therapy. I got to meet many interesting people and I enjoyed working with those that were motivated to improve whatever situation they were facing. We treated many young adults and teens that were injured in athletics/sports, but my favorite population was the “over 65” crowd. Selfishly, I loved the life lessons I would learn. I loved hearing stories from veterans of both WWII and Vietnam. Stories of people that had lived abroad or traveled the world. And I loved this population as they would improve rapidly with the interventions we would offer in the clinic.
Many of the issues facing this population were sedentary lifestyle issues. By that I don’t mean that they lived lifestyles that were “wrong” (whatever that means), but rather as they were aging, they’re levels of physical activity declined. General strength declined. Flexibility declined. Balance declined. Muscle coordination declined. As an example I would always ask any (over 65) client I was working with, “When was the last time you got down on the floor?” Surprisingly about a third of the responses were positive. “I get down on the floor every time my grandchildren are over.” However approximately 2 out of 3 would say “I never get on the floor.” or “I’m afraid I won’t be able to get back up.” My favorite response of all time was “Do you mean voluntarily?” I had to laugh, “Yes, voluntarily, when was the last time you got on the floor?”
Getting Down On The Floor
Getting down on the floor seems so simple. It is not. You have to have back, hip, ankle and knee flexibility. You have to have the strength to lower yourself down and to push back up off the floor. You have to have the coordination to sequence the act of getting up.
This might be the place to start. If you or your loved one is scared of getting down on the floor, it might be time to consult a physical therapist who can teach you safely how to perform this, and perform this as an exercise. If someone is severely debilitated or depends on a wheelchair and ramp to get into and out of their home, this may not be realistic. However if you’re considering adding grab bars around the toilet and into your shower to improve safety, it might not be a bad idea. I can’t back this next question up with a scientific study, but ask yourself this: Who is more likely to fall? The person that gets up and down off of the floor 10x a day (performed as an exercise.) Or…the person who never gets down on the floor?
Exercise Options
I’m not saying this is the only exercise that can or should be performed for fall prevention. There are a host of things that can be done. Participating in group exercise classes at the gym or senior center are an excellent and low cost way to reduce fall risk. Most gyms now offer Tai Chi classes aimed at the older population due to Tai Chi’s excellent history of improving balance and coordination. Home Health Physical Therapy/Occupational Therapy or an in-home personal trainer can develop a home exercise program to help reduce fall risk. (If your loved one has medical conditions or a history of falling, it might be better to at least start with PT or OT). Swimming or water aerobics are both excellent ways to improve flexibility and conditioning.
A sedentary lifestyle contributes to muscle weakness, reduced flexibility, and diminished balance/coordination, any of which increase the risk of falling. That is the main point we want to get across in this blog post. Increasing activity levels is one of the, if not THE, most powerful tool we have to combat increasing fall risk in our older population.