Fear Of Falling, Or How To Navigate A City Turned Wilderness

First it was the cat vomit on the wooden kitchen floor a few days ago. I didn't see it in my bleary early-morning stumble toward the coffeemaker. So I began my day with sprawling and cursing.

Then on Sunday I went outside to explore the snowpocalyptic world, and a step onto snow turned into a step onto the ice under the snow. More sprawling, onto the same bruised knee, and even more colorful cursing.

A supremely fit friend writes: “Just going to Trader Joe's earlier was my expedition for the day. I am a horrible wimp when it comes to walking around in this stuff; I have an embarrassing fear of falling.”

Why embarrassing? Perhaps “sensible” is the better adjective. Falls take a major toll on health; true, mainly among the elderly and mainly indoors, but still, who wants to end up face down in the mushy mess of a Boston street these slippery days?

Online, I found advice on walking like a penguin, walking like a skier (behind the Globe paywall) and assorted other tips. In search of more preventive wisdom, and to bolster my friend’s courage, I spoke today to Dr. N. Stuart Harris, an emergency physician at Massachusetts General Hospital who worked until 1 a.m. last night. He’s also — and here’s the cool part — the hospital’s chief of wilderness medicine. And have the streets of Metro Boston ever felt more like the Yukon or Antarctica? Or, well, Helsinki, at least?

I asked for helpful pointers and cautionary tales from the ER. Dr. Harris, lightly edited:

One way of thinking about it — as we would in the wilderness medical division — is assessing the risk as you would in a climbing scenario. The two factors that go into that assessment are: What is the risk of the fall happening and what are the consequences if you were to fall.

The risk of the fall: The colder and icier it is, the more likely you are to fall. Also, your individual characteristics: Are you older and less agile than you used to be? Do you have an unsteady gait?

Then, the consequences of the fall: In the mountains, it’s how high you are. In an urban environment, it’s increasing age and osteoporosis and the frailty of bones.

A fall that for a 14-year-old is no big deal can, for an 80-year-old, mean a hip fracture. And blood thinners can make a simple fall potentially deadly with a head bleed.

There’s pretty limited data, but there’s some growing information on the public health risk and economic burden of falls. Not surprisingly, Sweden has studied ice and falls, and some limited data shows increased risk of hospital admission with age. Interestingly, there are two bumps: It’s young men, probably because of risk assessment, but those tend to be limited injuries. But then there’s a pretty steady increase in the risk of bad injuries from a simple fall and consequent admission; especially in the seventies and eighties, it starts getting much steeper.

Ultimately, the whole community is picking up the cost of all these falls. So it’s not just nice to have people shovel out their walks and use grit and salt to treat them, it’s the right thing to do, and it’s cost-effective.

I shared my recent slips with Dr. Harris, and asked if there was any knowledge that could have helped me.

It’s more a kind of foresight you need. Once you fall, it’s too late. So you need the foresight of being aware of where you’re stepping. Obviously when you have warmer days and cooler nights, there’s not much you can do about the risk of ice short of putting on crampons.

There are some nice, fairly inexpensive mini-crampons you can put on your shoes. Anything short of something metal pushing into the ice is not likely to help you on clear ice. But you can put those mini-crampons even on dress shoes and walk around Boston and not look like a freak.

And again, it’s more common sense: If you take the preventive measures of getting out and shoveling things and letting the sun warm them and melt them during the light of day, then they’re clean and dry and it doesn’t matter if it’s cold at night.

There’s some data on whether some protective gear like padding could be used to protect against falls, especially with known osteoporosis, but that’s ultimately still up in the air.

What’s really bugging me, I confessed, is that I’ve been doing a lot of strength training lately, but it somehow didn’t help me stop those falls.

I lived in Japan for a couple of years and studied judo, and a huge part of judo is learning to fall. It really irritated me for the first six weeks, all we would do was fall training, to the point that I said, ‘This is ridiculous.’ But I think it bears real fruit, just in that learning how to fall and making it reflexive. So you don’t think about it, you just do it. You get some portion of your anatomy down on the ground quickly, typically your hand, and you’re turning a bad force into a more rolling, gentle force, and so spreading out your fall.

You could also do flexibility exercises or any kind of balance exercises. Common sense would be that you’re more likely to be able to adequately absorb the force of a fall. And importantly, with any kind of weight-bearing exercise, you’re teaching your bones every time you bounce down or even are just walking, and they’re getting stronger. The more physical activity you do, the less likely you are to have brittle bones, and the more likely you are to be able to handle the force of a fall.

But yet again, the vast majority of my clinical practice is based on a maybe-not-universal regard for common sense: Just leaving yourself time and not unduly rushing and having some regard for your environment. Having an awareness of your environment is absolutely mandatory in the back country. It’s interesting — in storms like this, the lay public suddenly has to say, ‘Wait a second, what goes on in the universe outside my little bubble has some bearing on me.’”

Readers, any favorite anti-falling tricks to share? And anybody else thinking about judo lessons?