I've fallen and I can't get up!

In this episode of The Talking Rehab Podcast, Dr. Fred Bagares dives into an often-overlooked but crucial skill—falling safely. Whether it’s young athletes on the basketball court or older adults navigating daily life, understanding how to fall and get up properly can mean the difference between a minor bruise and a life-altering injury.

Dr. Bagares shares his observations from watching kids fall hard in youth basketball games and connects it to fall prevention in aging adults. He discusses key factors in fall mechanics, strategies for fall recovery, and why fall training should be part of rehab programs—even for those without a neurological condition.

Tune in to learn how mastering this basic movement can enhance mobility, prevent injuries, and ultimately save lives.

Episode Timestamps:

🔹 [00:00] - Introduction to the episode: Why falling matters
🔹 [00:30] - Observing kids falling in sports & unexpected patterns
🔹 [01:57] - The mechanics of falling: Direction, recovery, and reaction time
🔹 [04:00] - Falling in older adults: Risks, mortality, and prevention
🔹 [07:02] - How to fall properly: Protecting the head and avoiding wrist fractures
🔹 [09:42] - Strategies for getting up off the ground: Strength, flexibility & planning
🔹 [12:40] - Jiu-Jitsu & martial arts: What they teach us about falling safely
🔹 [14:07] - Why fall training should be a standard part of rehabilitation
🔹 [15:56] - Final thoughts: The importance of movement strategies for all ages

💡 If you found this episode helpful, don’t forget to subscribe, rate, and share! Follow Dr. Fred Bagares for more insights into movement and rehabilitation.

📲 Follow Dr. Bagares on Social Media:
🔗 Instagram: @drfredbagares
🔗 Facebook: @drfredbagares
🔗 LinkedIn: Fred Bagares, DO
🔗 YouTube: Dr. Fred Bagares - YouTube
🔗 Linktree: Dr. Fred Bagares

🎧 Listen now and start moving smarter!

Transcript

0:00

What is rehab or rehabilitation? My name is Fred Begaris, a board-certified sports and spine medicine physician in Virginia Beach, Virginia. After 10 years of practice, I still find musculoskeletal medicine both fascinating and challenging. This podcast is about the lingering thoughts and questions I've had after residency and fellowship. My hope is to spark discussion, challenge dogma, and share my experiences in musculoskeletal medicine. Welcome to the Talking Rehab Podcast. My son has really been getting into basketball recently. This is his first organized team sport. My children have done primarily jiu-jitsu growing up, but he really enjoys basketball, so he's been doing a lot more training in addition to playing games. I grew up playing basketball myself. I was more hustle than actually good, but it was very interesting this past weekend watching him play because what I noticed was a lot of the kids there, they fall a lot, and some of it is obviously due to some inexperience, aggressive play, things like that. I know with watching pro sports, they like to try and draw the foul, so they go in and put themselves into situations where it's difficult for them to actually land, which can cause people to trip and fall, but this seemed a little bit more unusual to me, particularly since these are young kids. Inexperienced, but at the same time, I just don't ever recall them falling down a lot, and they were falling very hard. I remember a couple of weeks ago, one of the kids fell down and essentially just smacked face first, and this is really the impetus of today's episode. Falling and learning how to fall is a very important and life-saving skill. We think of people falling later in age, and there can be a multitude of reasons, but learning how to fall is a lot more nuanced than people realize, and that was very, very apparent to me watching these kids this past weekend. One of the first questions when someone falls that I ask is, which direction did they fall? Did they fall forward? Did they fall backward? If someone falls forward and essentially face plants, I interpret that as an unprotected fall. Again, we're not assuming that this is someone being shoved or anything like that. Let's say that someone trips on the sidewalk, like a little bit of the sidewalk is elevated and someone trips, you can fall forward, but usually people will have a little bit of reaction, some sort of recovery where they will stumble a little bit forward. They'll maybe fall to their knees. If they don't get to their knees, they'll use their hands to protect them, and worst case scenario is that they end up breaking their wrist and or they land primarily on their face. Certain populations are really prone to this. I remember a series of patients I've had in the past where they had a history of Parkinson's disease, and Parkinson's is a degenerative motor disease, and people have a difficult time controlling their body, and a lot of times Parkinson's patients will fall forward, and they just don't have the motor ability to actually react, and so their falls can be pretty severe. As a result, falling the older that we get carries pretty significant, not just risk or fracturing something, but actually dying. If you fall, you break your hip. Your mortality, the older that you are within the year, goes higher and higher. Learning how to land, learning how to protect yourself, learning how to recover is really very important. When someone actually starts to lose their balance, when I watch them, I look for their ability to recover. You imagine if you're on an ice skating rink. I don't ice skate myself, so I know this pretty well, but as soon as you start to fall, you actually have a little bit of reaction, maybe even some overcorrection. And that correction should allow you to find your balance, and then you can continue on. But sometimes people will overcorrect, they fall backwards, they fall forwards, and down they go. But there should be some amount of reaction. Some people have minimal to no recovery. So there's kind of an early stage where it's you automatically correct, and then there's the actual motor component to actually, let's say you're starting to fall forward. What is your next move going to be? Are you going to be able to move your foot to catch yourself? And if not, what's going to happen? So when someone actually falls down, there are other things that I particularly pay attention to. Not necessarily, let's say that you are past the recovery stage, you know you're heading down. How do you actually know how to fall? You know, falling backwards, falling forwards, you typically don't like to use your hands to plant. If you can, you can try and tuck your chin and roll onto maybe your shoulder. That way you at least prevent yourself from hitting directly your face or even the back of your head. But let's say that you can't, you hit the ground. You know, what are the next steps? How do you get up off of the floor? You really have to kind of think about what are the components to actually getting off of the floor? It's not just strength. And again, that goes back to this past weekend where I noticed that these nine to 13 year old kids watching them get off the floor. For them, it was pretty easy, but there's a lot of things that go into it. First of all, if you fall forward, and let's say that you are older in age, you have to get yourself organized, which is what's called what I call motor planning, you have to have the ability to know where your body is in space. Let's assume that you fall face forward, and you're completely flat. On some level you have, if you're not injured, you have a couple different options, you can try and go to from laying flat to going into a quadruped position. So almost like you're on all fours on your hands and knees. From there, you have to start to get from all fours position to let's say if there's nothing to grab onto, you have to try and find a way to get one foot flat. And so you can start to make your way coming up. But if you're next to something, you have to use your arms, your hands to maybe pull yourself up. That's certainly one strategy. Now, let's assume that you fall backwards, and you're now completely flat on your back. What are the different strategies that you can get up? Some people can do a complete setup and start to work their way up from there. Again, using their arms to grab onto something or getting onto your knees and then working your way up from one foot on the ground to two feet on the ground. But if you're not able to do that, how do you recover from there? Usually people will, if they can't get off of the ground, and they will roll onto their side and find a way to actually start to work their way up. This will require a certain amount of range of motion and strength from your upper body and your legs. So if you can, you can start to work your way up onto an elbow. So you're kind of laying on your side. And then you can start to put plants your feet on the ground. And from that position, you can either rotate into an all force position or start to get up off the ground. So those are just some really very crude examples of how to actually get off of the ground. It's a really very important skill that we lose with time and age. You can remember, or if you've ever seen a baby, when they go from sitting to standing to walking, there's a natural progression. But if you notice the way that babies fall, they tend to fall backwards and onto their bottom. That is a really very protected position for the most part. And when they get off of the ground, they usually use their hands in order to get themselves up. They don't usually go on all fours and then just stand up. If they can help it, they'll try and find something to try and grab onto to assist them. All of that is kind of the learning part of falling and getting up. With age and time, we lose that creativity because we don't simply get on the floor anymore. We tend to sit in our chairs or couches. But thinking about the last time you sat on the floor and got up off of the ground. It sounds really simple, but if you are in your 70s or 80s, when was the last time that you felt comfortable laying down or even sitting on the floor and being able to get up off of the ground? Sure, we can chalk it up to maybe we're older, we have some aches and pains, or we're just generally weaker. Nevertheless, you do have to have a movement strategy. And I'm a big proponent of of incorporating fall prevention and fall recovery into the daily exercises. Of course, every if you can move and exercise, that's great. But even in my clinic, I like to try and put people on the ground and just see how they get up off of the floor. That tells me a lot, you know, with with respect to how people can troubleshoot and how creative they can be when when they are put on the spot. Again, this is a very controlled situation where some were there in my clinic and they fall onto a mat. You can imagine if someone falls on the ground outside in the parking lot, maybe they're they're hurt, maybe they're concussed, maybe they're bleeding, they still have to be able to get off of the ground. It's really, really very important that maybe the phone is inside of the car, it's not within reach, they have to get there. And it can be a matter of life and death. As a physician, there's countless, countless stories of people being found in their house for hours on the floor because they were not able to simply get off of the ground. And again, it's not necessarily that they weren't just strong, but some folks just, they just could figure out how to do it. It's very humbling. I think people under the amount of effort and neurologic patterning that goes into getting up off of the ground until you're actually there, it can be quite scary from a community resource and even physical therapy standpoint. I don't know it's necessarily a normal skill that's trained outside of someone that is a spinal cord injury patient. I know with spinal cord injury rehabilitation, it's a very common skill that's taught. But when I send someone with, let's say knee pain, back pain, just even shoulder pain, I don't know if floor recovery is necessarily tested in the clinic. Because when I've talked with some of my physical therapy colleagues, how often they incorporate fall recovery into like a shoulder or knee program, most of them have said no, because the person has walked in and that's not necessarily the body part that they're working on. But I've made it a point in my clinic to do exactly that. Because I think that from a rehabilitation standpoint, I learn a lot about where people's weaknesses are when they do not know how to get off of the ground. Or let's say they have knee arthritis, and they're trying to figure out how to get off the floor without putting pressure on their knee. Because if they can't kneel on that painful knee, they have to have a different strategy on how to get up off the floor. And sometimes you have to have that kind of awareness that this knee doesn't work very well. So I have to use my other physical attributes to use my other limbs in order to recover. And I can't emphasize this, this is really kind of a life or death situation. I think about this all the time, when it comes to my patients. And I hope that this will hope become a common skill that's going to be taught in the rehabilitation community outside of stroke patients and spinal cord injured patients. Those populations obviously are at a higher risk. But we're all at, we're all at risk, the older that we get, and the less active we become. It's very, very important. But anyhow, I wanted to talk about this. Hopefully this was an interesting episode for you guys. This is the kind of stuff that I like to talk about because it's not really discussed. It's one of those things that I think we take for granted, the ability to go off the ground. It seems so simple, a skill we learned as a baby. But you know, the older that we get, if it's like any other skill, if it's not practiced, it's lost. And sometimes when you're on the ground in a in your own house, remembering how to do that skill, sometimes it's like riding a bike. But sometimes it's not. I just wanted to share this this particular episode with you guys after watching all these young kids flopping all over the ground. So just to recap, you know, falling and recovering is really very, very important. The initial part when you start to lose your balance is you have to learn how to recover. Once that you know that you cannot recover, meaning that you're not able to prevent the fall, you have to learn how to actually fall. Once you're actually once you are on the ground, then you have to figure out how to get up. You know, these are some skills that are first and foremost in judo and jujitsu. I am a huge advocate for jujitsu. I love I love the sport. I love the art. I actually think it applies a lot to us, in particular, as we age, because it encourages not only movement, but it also forces people to be creative with their bodies and how they move and learning how to take a fall and learning how to get up off of the ground. Those are key skills in life. And I think it needs to be practiced. So hopefully this this gives you guys something to think about. Have a good rest of your day. Take care. Thank you for listening to the Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.