Ukemi training for the elderly?

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[CitoMaramba]

Researchers have measured the decrease in impact force on the hip achieved by ukemi training. They are recommending ukemi training for the elderly to prevent hip injuries from falling.

"J Biomech. 2006 Feb 8;

Martial arts fall techniques decrease the impact forces at the hip during sideways falling.

Groen BE, Weerdesteyn V, Duysens J.

Sint Maartenskliniek Research, Development & Education, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands; Institute for Fundamental and Clinical Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.

ABSTRACT:

Falls to the side and those with impact on the hip are risky for hip fractures in the elderly. A previous study has indicated that martial arts (MA) fall techniques can reduce hip impact force, but the underlying mechanism is unknown. Furthermore, the high impact forces at the hand used to break the fall have raised concerns because of the risk for wrist fractures. The purpose of the study was to get insight into the role of hand impact, impact velocity, and trunk orientation in the reduction of hip impact force in MA techniques. Six experienced judokas performed sideways falls from kneeling height using three fall techniques: block with arm technique (control), MA technique with use of the arm to break the fall (MA-a), and MA technique without use of the arm (MA-na). The results showed that the MA-a and MA-na technique reduced the impact force by 27.5% and 30%, respectively. Impact velocity was significantly reduced in the MA falls. Trunk orientation was significantly less vertical in the MA-a falls. No significant differences were found between the MA techniques. It was concluded that the reduction in hip impact force was associated with a lower impact velocity and less vertical trunk orientation. Rolling after impact, which is characteristic for MA falls, is likely to contribute to the reduction of impact forces, as well. Using the arm to break the fall was not essential for the MA technique to reduce hip impact force. These findings provided support for the incorporation of MA fall techniques in fall prevention programs for elderly."

[miratim]

I thought people generally fell because they broke their hip, not the other way around. Maybe that's just an urban legend..

[Basia Halliop]

Never heard that one before...

Slipping from poor footing or ice are very common kinds of falls for elderly people, who are at a higher risk of being less agile and able to deal with uneven footing, and our bones generally get more fragile and easy to break as we age, so a fall that would leave a younger person with just a few bruises or scrapes can easily mean broken bones for many elderly people.

Maybe this is a more widely known problem in icy climates?

[CitoMaramba]

This is from the Introduction of the article I posted above:
"Hip fracture is a serious consequence of falls in elderly people. About 90% of hip fractures are caused by falls (Cumming and Klineberg, 1994). In particular falls to the side and those with impact on the hip have an increased risk for hip fractures. Interventions that reduce the fall severity of these more dangerous falls are expected to decrease the risk of fractures (Greenspan et al., 1994; Nevitt and Cummings, 1993)."

The full article is available from the Elsevier ScienceDirect website, in the Journal of Biomechanics.

Also since the hip bone is heavily vascularized, there is a danger of serious, possibly fatal, hematoma and blood loss, when the hip bone (pelvis) is fractured.

[DaveS]

Ninety percent of falls end on the ground...

[DaveS]

And on a serious note, how advisable actually are ukemi off the mat? I've experienced a real world situation that reinforced for me why we do breakfalls the way we do on the mat - coming down a mountain in icy conditions, slipped, stuck my arms out to break the fall, sprained my wrist - but in that situation, I'm not sure that I'd have been happy to do a proper backwards breakfall and fallen in a relaxed way without using my arms. I might not have sprained my wrist, but an inconveniently protruding rock could have caught me in the back of the head while I was still falling at speed, causing a sudden and premature end to my day's walking...

[Don_Modesto]

Ninety percent of falls end on the ground...
LOL!

[Jeanne Shepard]

It seems to me, as an occupational therapist who works with the elderly, that there are two problems here:
Firstly, the elderly fall because their balance is poor
and secondly, when they do fall, they tend to break bones due to ostoporosis.

It might be too late to help someone with ukemi training if they are at risk for breaking bones due to osteoporosis. I'm not sure I'd want to take that on as an instructor.

Jeanne :(

But, on the other hand, I'd like to see studies on people who've been doing Aikido to see if their bones are stronger from the years of physical impact. :)

[Kevin Wilbanks]

And on a serious note, how advisable actually are ukemi off the mat? I've experienced a real world situation that reinforced for me why we do breakfalls the way we do on the mat - coming down a mountain in icy conditions, slipped, stuck my arms out to break the fall, sprained my wrist - but in that situation, I'm not sure that I'd have been happy to do a proper backwards breakfall and fallen in a relaxed way without using my arms. I might not have sprained my wrist, but an inconveniently protruding rock could have caught me in the back of the head while I was still falling at speed, causing a sudden and premature end to my day's walking...

You've actually given a good argument in favor of the Waite-style back falls instead of the traditional backward fall. In the standard side-backward fall, you can control where you are going, your head tends to stay further from the ground, and most of the landing involves lowering yourself onto the side of your butt and hand, after which the rest of the fall is soft enough that hitting an object isn't going to be that big of a deal. If both legs slip out, and you do the side-backward breakfall, you can hold your head and torso up to some extent with your arms and also look where you are headed almost immediately. The more I get into these falls the less I like traditional backward rolls or backward slap falls.

[DonMagee]

A lot of people forget front break falls too. I perfer a front break fall to a back break fall. I've been lucky enough to never need to breakfall on 'the street'. One time though I tripped on my cat and fell down the stairs and did a perfect roll out. I've always looked at breakfalls as not a way to fall when you trip or slip, but a way to land so that when another man lands on your chest you can still continue to defend yourself.

[Janet Rosen]

Last yr I was walking down the street and my foot slipped on a wet metal plate and shot up in front of me. w/o thinking I did the soft, nonslapping fall that is "in my body"--sort of a hybrid back breakfall/soft sidefall--onto the sidewalk, got up and kept walking. No pain.
The SINGLE most important thing physical thing for prevention of frailty and maintenance of selfcare skills in the elderly, based on research I recall reading in the 80s and 90s, is strength training for quads--it was remarkable in its effects. I would consider maintaining leg and core function number 1 key, the thing I'd least surrender!
In terms of the ukemi: we are taught NOT to thud down flat on our sacrums or on our hips. This in-between position, using large muscles of the bodies to land on AND moving as we fall instead of going down like a sack o taters, has to be an improvement at least over numbers of people if not in any one case.
We are also taught not to reach down w/ our hands to catch ourselves--the resulting colles fracture of the wrist is one of the most commoninjuries caused by a fall. And also, in the pre-bone density testing era, the way many older women found out they had osteoporosis--on xray when the fracture was diagnosed.

[ChrisMoses]

Ninety percent of falls end on the ground...


80% of statistics are made up. :D

[CitoMaramba]

"There are three kinds of lies, sir.. Lies, damn lies, and statistics"

[Don_Modesto]

It seems to me, as an occupational therapist who works with the elderly, that there are two problems here:
Firstly, the elderly fall because their balance is poor
and secondly, when they do fall, they tend to break bones due to ostoporosis.Thanks for this post. I'd wondered about this, actually.

I always appreciate a point of view from OUTSIDE aikido per se when dealing with issues extending beyond aikido, per se.

[John Brockington]

I have been thinking about this recently, particularly in the context of what is "useful" about Aikido, or really any martial art. It is unlikely that the majority of martial artists will ever use their training in a "real world" fight, unless it is something they actively seek, for whatever reason. But every single one of us is going to fall at some time in our life. And if we have the good luck and genes and habits to live beyond age 70, a fall at that point in our lives could be catastrophic. This happens all the time, with an older person falling and breaking a hip or suffering a spinal compression fracture, leading to prolonged hospitalization, physical and mental deterioration, and death. If you talk to older people, they are terribly afraid of falling, and for good reason. So it is reasonable to surmise that one of the only aspects of martial arts training we will ever likely use for true self-preservation is the ability to fall well. Of course, most of us don't like to think about what our lives will be like when we are in our 70's or 80's or even 90's, but most of us will be there one day. Too many of us are preoccupied with the improbabilities of today, rather than the inevitable of tomorrow.

John

[Kevin Wilbanks]

So it is reasonable to surmise that one of the only aspects of martial arts training we will ever likely use for true self-preservation is the ability to fall well.

I have said something similar many times. My falling skills have already saved me from injury several times in the past 10 years, and timing and tenkan has saved from being hit by a bicycle as a pedestrian, but I haven't even come close to getting in a fist fight.

The part I take issue with is "only"; unless you are talking about self-preservation in terms of dealing with something that would be fatal in a short time. I have found getting back to Aikido has helped me with depression in fairly immediate terms. I also think I have gained a lot in terms of attitude, ideas, social and mental health over the long term - the lack of this influence would certainly have made my quality of life worse and thus depression problems worse as well. It may not exactly be death, but I consider the preservation of my "self" from depression vital.

[John Brockington]

Kevin-
I totally agree with you, and really was talking about the most base form of self-preservation. As I re-read my original statement, however, it struck me that the term "the ability to fall well" could be applied to many things beyond just body impact on a hard surface.

John

[Jeanne Shepard]

:p Agreed. The ability to fall well can translate into an emotional resilence that can help us cope with emotional ups and downs too.

Jeanne

[CitoMaramba]

If anyone is interested the full text of the scientific article is available on this web page (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T82-4J7B14M-1&_user=10&_handle=V-WA-A-W-WWY-MsSAYZA-UUW-U-AAZBAYCVVA-AAZUDZZWVA-AEWDDZYVC-WWY-U&_fmt=full&_coverDate=02%2F09%2F2006&_rdoc=157&_orig=browse&_srch=%23toc%235074%239999%23999999999%2399999!&_cdi=5074&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=7957fbcf2a385034efab1137006b70a8)
If your institution is a subscriber, you can access the article right away. Otherwise, it is available for purchase.

[markwalsh]

I've just started teaching an elderly man aikido - any advice on how to teach him ukemi? Ive started with half back rolls as seems most natural.

[Mark Uttech]

Mark, (Walsh) I can suggest that you begin with tenkan ho and irimi ho exercises. You can also graduate into irimi ho and tenkan ho exercises against bokken, jo, and tanto. Each student is someone to study and each student can show you (through your own observation) what techniques will help them gain a strong center. I hope this bit of information helps. In gassho, Mark

[CitoMaramba]

IMHO, start slowly with koho tento undo (sitting on the mat, rounding the back and rocking gently back and forth). After a few repetitions ask if he feels any discomfort. This can give a clue whether he has any conditions to watch out against (vestibular problems, joint problems, osteoporosis, etc). Then gradually increase the difficulty of the exercises.
Please congratulate your student (and accept my congratulations to you for teaching) for taking up this exciting adventure. Gambatte kudasai!

[markwalsh]

Thanks guys

[Aviv]

Since January 2006, we have been teaching an Aikido for Seniors class. Students are from 55 to 82 in age. It is "no fall". The seniors have increased their flexibility, stability, coordination, strength, and awareness. This should serve them well in warding off falls.

[markwalsh]

Cool Aviv - I wonder why there are not more off these classes?
Seems like a good opportunity for all.

[deepsoup]

If you talk to older people, they are terribly afraid of falling, and for good reason.
Aha. An excuse to post a link to my favourite photo at the moment (one for the rock climbers on the forum).

Here's a picture of a gentleman in his 70's who isn't at all afraid of falling:
http://www.ukclimbing.com/images/dbpage.html?id=50247

[Mark Uttech]

Very interesting that you teach a 'no fall' class, Aviv, and I am not opposing it, but-- suppose there is a fall? It happens to all of us, and if we do not train to fall, we won't have the 'built -in' reflex from training to help us. I am always surprised when I am given a sudden ukemi lesson from a slip on ice that I did not know was there. That surprise lesson is the very thing that shows me where the reliability of my practice is at.
In gassho,
Mark

[Aran Bright]

Since January 2006, we have been teaching an Aikido for Seniors class. Students are from 55 to 82 in age. It is "no fall". The seniors have increased their flexibility, stability, coordination, strength, and awareness. This should serve them well in warding off falls.

That's a great idea and one I've thought about for a while. Or the idea of no falling for those over say sixty or with hip/lumbar problems. My consern is the wear and tear particularly on the lower lumbar/ saccrum area may outway any benefits from ukemi practice.

I would still include ukemi practice but only as small part of the class and probably not full rolls.