If you’re over the age of 75, you might worry about the possibility of falling on a regular basis. This concern is completely understandable, as falls are the leading cause of injury for older adults, and the likelihood of falling increases with each additional year of age. About 40% of older adults living at home experience a fall once per year, and this figure is even higher for adults living in nursing homes and assisted living facilities.

One commonly recommended strategy to mitigate the risk of falling is for older adults to use a walking aid like a cane or front–wheeled walker. These devices assist with upright balance and mobility, which are essential for avoiding a fall; however, some research has suggested that surprisingly, using a walking aid may be an independent risk factor for falling. This is likely due to lack of guidance on how to use these devices, as one study found that over 80% of wheeled frame users reported not receiving any instructions on how to use it and another found that 66% of patients with hip problems were not educated on which hand to hold their assistive device in.

In response, a 2020 study was conducted to investigate older adults’ use of walking aids, how their usage patterns affect stability, and what the general perception is of walking aids from the perspective of users and healthcare professionals.

17 older adults are closely monitored while using a walking aid

For the study, researchers identified 17 older adults with an average age of 70 that regularly used a walking aid. These participants then completed the Falls Efficacy Scale—which measures concerns about falling—and were evaluated in different environments several outcome measures. They were also recorded on video while using a front–wheeled walker to assess their techniques. Finally, two focus groups were formed, with one comprised of 5 walking aid users and the other comprised of 10 healthcare professionals. These focus groups were intended to stimulate meaningful discourse about the use of walking aids and identify any areas that could be improved.

Results showed that the percentage of time in which the walking aid was used incorrectly varied between participants, but all participants displayed incorrect usage at some point in the study. On average, the group had incorrect usage of walking aids during 16% of their single support periods and 30% of dual support periods. Video analysis also showed that many participants did not use front–wheeled walkers properly. The most common error was lifting the frame when turning, which is risky and can lead to a fall.

The walking aid user focus group identified several key themes, one of which was that participants considered the lack of guidance in the safe use of walking aids to be a problem. Members of the healthcare provider focus group agreed that a gold–standard, universally accepted approach was lacking for the prescription of walking aids and training of users, which highlights a gap that needs to be addressed. Healthcare providers reported that they instead rely on their clinical judgement regarding the user’s safety and gait performance, and that they train patients on how to use a walking aid based on practice and repetition rather than established guidelines.

Overall, results suggested that adherence to current guidance on how to safely use a walking aid in the home is poor amongst users, and that both environmental and design–related factors serve as barriers to adherence. Participants also displayed low stability during incorrect use of walking aids, which indicates that they are putting themselves at risk of falling when improperly using these devices in various environments.

Key tips to ensure safe use of walking aids

These findings highlight the importance of proper use of walking aids and the need for better training of walking aid users. To accomplish this, experts must work together to establish clearer guidelines for healthcare providers who train patients to use walking aids, but in the meantime, here are a few key tips to help ensure you’re using a front–wheeled walker (a popular type of walking aid) properly:

• The height of the walker should be adjusted so that your arms are slightly bent (about 20–30 degrees) when using it
• When using a front–wheel walker, be sure to keep the front of your body in line with the back two posts of the walker
• Advance the walker a few inches in front of you first, and make sure all tips and wheels are touching the ground before taking a step
  • When you’re ready to take a step, step forward with your bad leg first, followed by your good leg, placing it in front of your lead foot
• When turning the walker, keep the walker in front of you and take small steps; DO NOT pick the walker up at any time
• Don’t place all your weight on the walker; allow it to assist your gait by bearing only part of your weight upon it
• Add tennis balls to the bottom of the walker to make it glide more smoothly

If you or someone you care for uses a walking aid, we can provide additional guidance on how to properly use these devices to reduce the risk for falling. Contact us for more information.

In the realm of sports–related injuries, the hamstring is one that most people are at least somewhat familiar with. This makes sense, as a pulled hamstring—or hamstring strain—is one of the more common injuries in sports. The pain and movement restrictions that result from this type of injury usually prevents an athlete from participating in their respective sport for some time, but following a course of physical therapy can lead to a fast recovery and safe return to sports for patients dealing with a hamstring strain.

Although it might be assumed to be a single muscle by some, the hamstring is a muscle group consisting of three separate muscles—the semitendinosus, semimembranosus, and biceps femoris—that run down the back of the thigh from the lower part of the pelvis to the back of the shinbone. These three muscles serve a crucial role, as they help the knee joint to bend (flex) and the hip joint to straighten (extend). The hamstring is balanced by the quadriceps muscles in the front of the thigh, which are responsible for the opposite function: extending the leg at the knee joint and flexing the thigh at the hip joint. Together, they control the power and stability of the knee joint and allow for running and other activities.

A hamstring strain can involve any of the three hamstring muscles, and the most common cause for an injury is overloading one or more of these muscles. This can occur when a muscle is stretched beyond its capacity or challenged with a sudden load, which is why hamstring strains are so common in sports, especially those that involve lots of sprinting or sudden changes in direction. Therefore, athletes who participate in basketball, football, tennis, soccer, and the sprinting events of track—as well as dancers and gymnasts—have the highest risk for sustaining a hamstring strain. Other risk factors include prior hamstring injury, muscle tightness, poor conditioning, and older age.

When a hamstring strain occurs, the most common symptom is a sharp pain in the back of the thigh that may be felt immediately. Patients may also feel a “popping” or tearing sensation in this region, which may be followed by tenderness or swelling that may develop within a few hours. Some patients may experience bruising or discoloration on the back of the thigh or persistent weakness in this area as well.

Physical therapists always ensure patients are ready to return to sports

A hamstring strain may sound like a daunting injury, but for most patients, conservative (non–surgical) treatment and some time away from sports is all that’s needed. Physical therapists are uniquely positioned to manage patients with hamstring strains and can help them recover quickly and safely through individualized and evidence–based treatment. A standard treatment program for a patient with a hamstring strain will consist of the following:

• Range of motion exercises: once initial pain and swelling have subsided, the patient will start with some gentle stretching exercises like a hamstring stretch to improve flexibility
• Strengthening exercises: includes various strengthening exercises to build back strength in any areas that are weak
• Manual therapy: involves the therapist applying hands–on techniques to the patient’s muscles and joints to alleviate pain and improve range of motion and strength
• Functional training: this type of training includes exercises that are specifically catered to the sport or activity that the patient is returning to

Another significant benefit of having physical therapy for a hamstring strain is that therapists always take every measure to ensure that athletes don’t return to sports until they have completed their rehabilitation and can do so with a minimal risk for injury. This is accomplished by structuring the timeline of programs based on the average time needed to recover from a hamstring strain, closely evaluating the athlete’s progress along the way, and then assessing the athlete when they are nearing a return to ensure they fulfill all appropriate criteria. Only then will the therapist provide the go–ahead that the athlete can safely return to his or her sport.

According to a proposed algorithm for hamstring strains, an athlete will be ready to return to their sport once they meet the following criteria:

• No tenderness when pressure is applied to the hamstring
• Adequate muscle strength based on strength testing
• No insecurity on the active hamstring test, which is done by performing a straight leg raise as fast as possible to the highest point without fear of injury
• Ability to complete 30 or more repetitions of the single leg bridge test
• No pain or hesitation with sport–specific movement testing (eg, accelerations, decelerations, rotations, sprinting, cutting, pivoting, jumping, or hopping)

So if you’ve recently injured yourself and your symptoms sound similar to a hamstring strain, we strongly recommend seeing a physical therapist to help you get started on your path to recovery.