Some tumbles are more serious than others. Before you start exercising again, get the answers to these questions.
Falls are the leading cause of injury among older Americans, with one in four taking a tumble each year. Getting regular exercise is one important way to reduce your risk, according to the National Council on Aging. But no one is totally immune.
“As you get older, you might not be able to see obstructions as easily, or you might become a bit more unsteady on your feet,” says Thomas Weida, M.D., a geriatrician and chief medical officer at the University of Alabama College of Community Health Services. “It’s also more common to develop orthostatic hypotension, a condition in which your blood pressure drops when you stand up, or to have illnesses like Parkinson’s disease that may affect your balance.” And it’s not unusual to simply trip on a loose throw rug or damp bathroom floor.
No matter the cause, falls can lead to serious injuries. Many people end up with hip, rib, shoulder, or wrist fractures. Other possibilities include a rotator cuff tear (the tendon that’s supposed to attach the muscle to your bone gets pulled away) or subdural hematoma (a blood clot in the space between the brain and the dura, its outer covering).
Unless you’re lucky enough to simply walk away with some mild bruising, chances are you’ll require some type of treatment and will need to wait out a recovery period. But if you’re someone who is used to being active, you’re likely not content sitting on the sidelines indefinitely. That’s understandable, but it’s not a good idea to return to your old routine without first having a detailed conversation with your doctor. Here are some key questions to ask.
Question 1: Do I Need Additional Treatment?
If your injury was at all serious, hopefully you sought medical care shortly after it occurred. Was that treatment the end of the line, or are there extra steps you need to take to complete the process? Sometimes it’s not only a matter of treating the particular issue—like a broken wrist—but also about working with your doctor to determine what caused the fall in the first place.
“Whenever an older person falls, I ask them why or how it happened,” Dr. Weida says. “Often they say, ‘I just ended up on the floor.’” That may be a sign that you didn’t trip on something and that there’s an underlying health issue that needs to be addressed. For instance, you might have atrial fibrillation (a heart rhythm disorder) or maybe you had a mini-stroke. These types of issues need to be identified and properly treated before you can be cleared for exercise.
Question 2: Do I Need Physical Therapy?
For broken ribs, physical therapy probably won’t help, because you pretty much need to wait it out, Dr. Weida says. But if you fell because you have a balance problem, physical therapy could be crucial to getting you back on your feet—and keeping you there.
“When patients are referred to me for balance issues, part of my evaluation involves determining if one leg is weaker than the other,” says Melanie McNeal, a physical therapist and orthopedic clinical specialist at Baylor College of Medicine. If that’s the case—and it often is—she works with them to strengthen the weaker link. Core exercises, which strengthen the muscles around your trunk, are also key to maintaining proper balance.
Physical therapy might also help after a fracture. While you might not be able to move the broken body part, it’s important to work and strengthen the surrounding muscles so that they don’t atrophy, McNeal says. “In the case of a hip fracture, we would figure out how to strengthen your leg without you putting weight on it, such as by doing leg raises on your back or side.”
Question 3: When Can I Start Exercising on My Own Again?
If you’re in physical therapy, you’re already exercising, McNeal says. But what you probably really want to know is when you can strike out on your own, return to the gym, or get back to your favorite SilverSneakers class. There’s no one-size-fits all timeline, so be sure to confer with your doctor (and physical therapist, if you’re working with one).
The answer will also depend on what your old workouts looked like. If you were primarily a walker and you hurt your wrist, you can likely start walking again right away, Dr. Weida says. But if you were a runner and you injured your hip, you’re going to need to be far more patient.
Question 4: Will I Ever Return to the Same Fitness Level?
We’d love to say that everyone eventually gets back to where they were before, but that’s not always possible. Whether that’s realistic will largely depend on how severe an injury you sustained as well as your overall health status, McNeal says. But you should never be afraid to communicate your desires to your doctor or physical therapist.
“I ask every patient, ‘What are your ultimate goals?’” McNeal says. “If their goal is to get back to an exercise class, we’ll gradually increase their activity level” to try to make that happen. That said, if everyday activities—like brushing your teeth or getting something out of a cabinet—are really challenging, you’re probably not close to being ready for something like a fitness class, but you may have other activity options. (Keep reading!)
Question 5: Is It Okay to Try This Specific Activity?
“I like to know exactly what kind of exercise a patient is thinking about so we can figure out whether it will interfere with healing,” Dr. Weida says. If your doctor can’t currently give you the green light, he or she might suggest some modifications.
If you used to love aerobics but are still recovering from a lower body injury, swimming, water exercise, or even treading water might be a good alternate activity. “I’ve often recommended ‘aqua-sizing’ because it allows you to move your leg muscles without having to bear your whole bodyweight,” Dr. Weida says. Looking to “aqua-size?” SilverSneakers Splash is safe for non-swimmers.
Or your doctor may say you can resume your favorite activity—at a lower intensity. That might mean walking instead of jogging, using only your bodyweight for strength exercises, or choosing a class with easier moves. Be sure to tell any instructors about your injury, so they can suggest additional modifications.
Question 6: What Should I Do if I Experience Pain While I’m Exercising?
This is an easy one: Stop. When returning to exercise after an injury, the notion of “no pain, no gain” doesn’t apply, Dr. Weida says. “My general advice is to go low and slow,” he says, “and work your way up from there.”
And if you have any major discomfort in an area you previously injured, back off and either take a break from exercise or focus on training other body parts in the meantime.