Balance and falls outdoors

Uneven ground is part of what makes outdoor places appealing, and also what makes balance matter more there than on a hallway floor. This page reports what the National Institute on Aging (NIA), the UK's National Health Service (NHS) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) say about falls, balance, footwear and walking aids. Much of the source material is written with older adults in mind, but the NHS says anyone can fall, and that it is more likely with mobility problems. Nothing here replaces advice from your own clinician.

What raises the risk of a fall

The NIA lists many contributors. They include changes in eyesight, hearing and reflexes; conditions such as diabetes, heart disease, or problems with the thyroid, nerves, feet or blood vessels; muscle loss; problems with balance and gait; blood pressure that drops when standing up; painful foot problems; and unsafe footwear such as backless shoes or high heels. It adds that some medications cause dizziness or confusion, and that the more medications a person takes, the more likely a fall. The NHS list is similar and also names arthritis, stroke and Parkinson's disease as conditions that affect mobility or balance.

Balance problems tied to nerve damage have their own page, nerve-related balance problems and getting active outdoors, which covers when a neurologist may be involved. NIAMS also notes that ankle sprains can happen when walking on an uneven surface, one reason surface matters on trails. What "accessible trail" means explains how surface and grade are described.

Balance and strength training

The NIA says to stay physically active and to try balance and strength training, naming yoga, Pilates and tai chi as able to improve balance and muscle strength, along with weights or resistance bands for strength. The NHS says physical activity guidelines for older adults recommend being active every day and doing activities that improve strength and balance at least twice a week. The NIA also says staying active helps prevent falls, and that fear of falling can lead people to avoid activity.

The NHS says that if a GP thinks someone is at risk of falls, they will check balance and may refer them to a falls service. Such a service may check for muscle weakness, weak bones or eyesight problems, offer strength and balance training, review medicines and look at home safety.

Footwear and walking aids

For footwear, the NIA advises nonskid, rubber-soled, low-heeled shoes that fully support the feet. The NHS advises shoes that fit well, do not slip off and have a good grip. Both pages are written about everyday settings, so neither names hiking boots or trail shoes, and this page does not recommend any product.

On walking aids, the NIA says canes and walkers used correctly can help prevent falls, that the device must be the right size, and that walker wheels should roll smoothly. It calls this exceptionally important when walking in unfamiliar areas or where walkways are uneven. It says a physical or occupational therapist can help decide which devices might be helpful and teach safe use, and recommends checking borrowed equipment with a health care provider. The NHS likewise says to consider a walking aid. Neither opened page discusses trekking poles, so for those, ask your therapist. For equipment categories in general, see adaptive equipment in outline.

The NIA also suggests using a shoulder bag, fanny pack or backpack to leave hands free, and taking extra caution on wet or icy surfaces. The NHS suggests carrying a mobile phone or wearing a personal alarm.

When to see a clinician

The NIA says to tell your doctor if you have fallen since your last check-up, even if you did not feel pain, because a fall can point to a new medical problem or to medication or eyesight issues that can be corrected. The NHS says to see a GP if you are worried about your balance or mobility or have had a fall. It says to seek urgent help if someone has fallen and may have injured the head, back, neck or hip, or cannot get up. The NHS also advises speaking to a GP or pharmacist if you think your medicines could be affecting your balance.

The short version

Agencies name balance and strength training, suitable footwear, correctly fitted walking aids and care on uneven or slippery ground as the main levers. A fall, or worry about balance, is a reason to talk to a clinician.