Saturday, February 18, 2023

Falling down




I'm not talking about the movie with Michael Douglas. This is about surviving a fall.

I sorta liked the cosmetic effects of the fall-before-last, especially with a cap. It looked really sinester and gothy...like a super-villain, but that isn't eye shadow in the picture above.

If you hike long enough, you're going to take some falls. There are five points to keep in mind.

1) Stay healthy. You come through specific injuries and illnesses better if you're generally healthy.

2) It's better not to fall, than to have ever fallen at all. Learn how to prevent falls.

3) Like I said, if you hang around long enough you're going to fall. That's a result of the precarious, two-legged stance our ancestors adopted. Learn how to fall right...that is, learn how to minimize the damage when you fall.

4) Know what to do while you're lying there after a fall. It's easy enough to aggravate the injuries you've already taken in a fall or to pick up a few more.

5) Know how to take care of yourself after a fall.

It's February in Denver and this is what our sidewalks look like. The snow is obvious. The black ice is almost invisible and will take you down if your center of gravity shifts just a tiny bit off your vertical axis, but I'm not about to stay inside during the winter, especially since that's my best hiking season.

My first day in Colorado, Christmas 2013, I walked to a nearby park and was reintroduced to black ice. I lay on my back and looked up at the sky while the crows laughed at me. Since then, I've slipped on ice once while shoveling the driveway.

The main thing that usually brings me down is fatigue. When I'm tired, I get sloppy and I don't pay attention to what I'm doing. I'm 69 now and am pretty much always tired, so I have to remind myself to pay attention. Even a ten minute rest can make a big difference.

Another thing is dehydration. I live in a desert state. The humidity is traditionally low as is the air vapor pressure. It sucks the moisture right out of you. Where ever you are, though, it's easy to lose too much water. Lose too much blood volume and that's called shock. It makes you fall down. The body also uses water in it's chemical reactions...for processing energy sources, for repairing damage, for regulation your body temperature, for just about everything. 

Take water with you when you hike. Don't wait until you're thirsty to drink. Drink a little frequently. If your urine is colored much at all, you're not drinking enough.

Eat while you're out. Sugar is a fast energy source. Glucose is the best sugar...if you can find it. Sucrose breaks down into glucose and fructose and fructose isn't effectively used for energy production in the body, so it's half as useful. Fats are like time released energy. Honey and dried fruits are good sources of glucose and nuts are good for fats, so carry a bag of trail mix.

Fall prevention is complex, just about everything you do and how you do it goes into the prevention of falls. In the development of the SAFE (Self-Awareness of Falls in Elderly) test, four factors were found to be important for elderly people to prevent falls (Meei-Ling Shyu, et al., Development and validation of the self-awareness if falls in elderly scale among elderly inpatients, Clinical nursing research 27 (1), 105-120, 2018, abstract https://scholar.google.com/scholar?hl=en&as_sdt=0%2C6&q=fall+prevention+environmental+awareness&btnG=#d=gs_qabs&t=1674935233407&u=%23p%3DlW5gzcWX1K0J)

 Of course, it's a life or death issue for the elderly, but anyone who spends much of their time on their feet need to be aware of these factors. They are 1) awareness of activity safety and environment, 2) awareness of physical function, 3) awareness of medication, and 4) awareness of cognitive behavior. There are a few things that can decrease your chances of falling based on these factors.

First and foremost, occasionally take stock of your surroundings. Two of my worst falls were caused by crumbling material under my feet. In both cases, I was very tired and was not paying attention. You should be sensitive both of what's going on under and around your feet and also what's happening around your head. A friend was once talking so much on the trail (and wearing a baseball cap that obscured his upward vision) that he missed the stout limb that crossed the trail at head height and flat knocked himself out. Using all your senses on the trail and keeping that voice in your head at a minimum will ensure that you don't miss interesting things on the trail, and that you notice things that can put you quickly on the ground.

If you start each step with the initial pressure on the ball of your leading foot (contrary to what the Boy Scout Manual tells you, don't be a heel striker), you will be more aware of what your feet are doing and make adjustments if something goes wrong. 

Check it out. Take a nice broad step and come down on the heel of your leading foot. Freeze in mid stride. Where is the pressure on your feet? It's pushing your feet apart into a split. Swivel your feet around. Your back foot is pretty firmly planted but your forward foot can turn a little from side to side. 

Now try again but come down on the ball of your leading foot. The pressure is pulling your feet together. Also you can turn your leading foot in a wider arc, swiveling both your heel and the bottom end of your lower leg. If you make a misstep, you will want as much freedom of motion in your feet as possible to recover.

Be aware of your center of gravity...where do you feel the downward pull of the earth most. It will be somewhere around your navel, but it shifts around while you walk and the further it gets from the midline between your hips, the more unsteady you'll feel. The more aware of where your center of gravity is, the more instinctually aware of your stability you will be. 

It's harder and harder to stand upright as you're center shifts away from your midline, but you can shift it as far up or down as your knees will allow, and moving it down will also increase your stability. Even a slight crouch will improve your footing on ice or mud.

The two biggest problems with our bipedal stance is how narrowly we can shift our center before we fall, and how much of our weight is on such a small area. In other words, the more friction we have with our support, the less we slide and all our friction is between our two feet and that surface.

I've often increased my contact with the Earth by moving on all fours (a new word has appeared for that. We used to call it "crawling". Now it's "quadropics".) You can either crawl on your hands and knees (or toes) or flip over and crab walk. If you start to slip, you can lower your body to the surface and get even more traction.

How are you feeling? Body discomfort is a huge distraction so an active lifelong learner should maintain good health and should avoid walking on an empty stomach. Simple sugars in dried fruits provide bursts of energy when needed, fats like in nuts and meat snacks and starches in grains provide a time-release effect, and proteins (hard boiled eggs, meat snacks, nuts, cheese) provide some energy but also body maintenance function. Breads, chips, candy are fun but they don't make a good trail food. 

And stay hydrated. You need water, but you also need electrolytes - sodium, potassium, and calcium. Electrolyte (not sports) drinks are good, but so is milk. The problem with milk is that, if you carry whole milk on a hike, you might find that walking motions will effectively churn it to butter.

I had a friend that decided that sweetened condensed milk would be a perfect trail food. Sugars, starches, electrolytes, protein, all in a convenient can. It took about five minutes to come back up. You don't want rich, greasy, or very spicy on the trail. Gastrointestinal problems will quickly dehydrate you.

And get enough sleep before a hike and rest during a hike. Most of my falls have occurred because of fatigue. Fatigue is a big distraction.

The first rule for fall prevention is "pay attention!" If you're a lifelong learner, that shouldn't be a problem, you're all ready soaking up your surroundings. But you should especially be aware of hazards. Loose pavement and gravel have taken me down much more often than ice or mud.

Don't just use your sight. Use all your senses. Black ice is almost invisible. It's snow and ice that has refrozen into an almost featureless surface. But if you step on it, you will certainly feel it. If there's even a chance that there's ice around, swivel your foot around before committing to a step.

Things that startle you also distract you. You'd feel pretty foolish if you jump back from a snake just to land on a pebble, turn your ankle, and fall. But most snakes have a strong, recognizable musk. If you notice a snake before you see it, you won't be startled.

Again, use all your senses.

Now, what do you do if you fall? You usually realize that you're falling and can plan how you fall. The following points are taken from How to fall without injury on the Harvard website (https://www.health.harvard.edu/staying-healthy/how-to-fall-without-injury).

1) Fall forward. You'll have more control and it will be less likely that you will bang the back of your head. I will add that, if you're on stairs or a steep incline, fall up the grade and not down. Walk so that, if you fall you'll fall the right direction.

2) Try to fall sideways. You're going to take more damage if you fall on your face or the back of your head.

3) Grass, dirt, or snow doesn't hurt nearly as much as concrete or ice. Aim toward the soft stuff.

4) Fall away from other people or sharp stuff.

5) Swing your arms to direct your fall.

6) You want as little impact on your head as possible. Twist your shoulder to cushion your head.

7) Lower your center of gravity by bending your knees and keeping your feet down. The lower you are, the softer you fall. If you're walking on ice or mud, squat slightly and stay on the balls of your feet.

8) Relax as you go down. The Harvard site suggests that you "fall like a sack of beans."

9) Fall on your more padded areas, your butt and thigh.

10) Roll as you fall. This is something martial artists learn while training. It spreads the impact over a larger area.

Now, what do you do after you fall? Do you remember your first aid training? Uh...have you had first aid training? Never mind, the Three C's are Check, Call, and Care.

The first thing to check is whether you're in harm's way. If you're in traffic or in danger of falling further, get out of harms way. Don't worry about causing more damage.

If you fall in a safe place don't move. Go over the check list. Start at your head. Does anything hurt there? Are you dizzy? Is your vision affected? Are there any weird smells? Do you taste or smell blood?Then go to your neck and spine. Any pain? Wiggle your fingers and toes. Can you move them? Can you feel them. Any serious pain in your limbs or your torso? 

You want to make sure there are no broken bones, nerve damage, or damage to any vital organs before you move and then move so as not to cause any more damage.

If there's no serious damage, you can move to a more comfortable position. If there does seem to be something seriously wrong, call to someone for help or, if you have a phone handy, use it. Get help.

If there's no one available, that's when that first aid training (and/or wilderness survival training if you frequent the woods) will be useful. Just in case you didn't catch it, I'm recommending that you take first aid training. Sometimes it only costs the time it takes to go to the classes but, even if you have to pay, it's usually not much.

The rest is down time. Take it easy and heal up. Rest, drink plenty of water, eat well, and take antiinflammatory drugs as directed to reduce pain and inflammation.

Take care of yourself. The goal of active, lifelong learning is to learn and to enjoy life, not to kill yourself.