Fall Prevention for Seniors – The Causes


Seniors - MSHere’s a few quick statistics from the Center for Disease Control.  One out of three older adults have a fall every year.  They are the leading cause of fatal and non-fatal injuries for seniors. 46% of these fatal falls are the result of a traumatic brain injury.  Men are 40% more likely to die from falls than women.  White seniors are 2.4 times as likely to have a fall than blacks.  For seniors over 75, they are 400-500% more likely to end up in a long term care facility for greater than 1 year than people between 65-74 years of age.

Now that we have those grim statistics, what can be done about it? Quite a lot actually.  As with so many health issues, so much depends on the cause.

What are the main causes of falls?

  • Muscle weakness – According to the National Institutes of Health, muscle weakness is one of the most important risk factors for causing falls.   Particularly weakness of the stabilizing muscles of the ankles and hips.
  • Neurological – there are 3 main categories that are commonly involved: 1) Sensory nerves to the joints; 2) motor nerves to the muscles; 3) central nerve processing
  • Vision – If people can’t see well, they are more likely to miss a step on the stairs or trip over an obstruction
  • Vestibular sense organs – the semi-circular canals in each ear that help you maintain balance.
  • Environment – Items in this category include: poor lighting, cluttered environment, slippery surfaces (rugs, tubs), rickety ladders or step stools, missing handrails or grab bars, poorly fitting or missing footwear.
  • Low blood pressure – When it gets too low, you can experience momentary confusion or loss of consciousness.
  • Low blood sugar – This can also cause short term confusion or even unconsciousness.
  • Drugs – Many prescription medications can have an impact on most of the categories above.  The more drugs you are taking, the greater the risk of you experiencing a fall.

We’ll do posts going into more details on each of these causes of falls along with ways you can look for their possible involvement.  We’ll also do a post on screening tests that don’t look for the specific causes, but rather, just measure the overall susceptibility to falling from whatever cause.

Screening Event

The Diagnosis Foundation is available to do a free screening event on Fall Prevention at your facility.  If you would like to schedule a Fall Prevention screening event for your organization, please contact us to discuss date options and which aspect of fall prevention you are interested in testing.     Info@DxFoundation.org

Fall Prevention Screening



Senior hispanic man working on a white background
Senior hispanic man working on a white background

The Diagnosis Foundation (DxF) will be doing a Fall Prevention screening at the Sayville Public Library.  There are many factors contributing to falls, including:

  • Vision impairment
  • Obstructed environment
  • Equilibrium or inner ear impairment
  • Decreased proprioception (sensory awareness of body and joint position)
  • Decreased overall muscle strength & control
  • Decreased individual muscle strength or symmetry

There are diagnostic tests to look at each of these factors separately or in groups.  This screening will involve a brief assessment of overall risk of falling assessment along with a more in depth look at individual muscle strength and control.  Each person will be screened on muscle strength symmetry and control of 12 individual muscles in each leg.

Each screen takes 15 minutes to complete and participants with abnormal findings will be referred to their own health care providers for follow up.  Participants without providers or those needing recommendations for physicians who do individual muscle strength testing, differential diagnosis or treatment will be referred to the DxF DxProvider data base.

This screening is free but scheduling an appointment is highly recommended.

Importance: “Unintentional falls are a common occurrence among older adults, affecting approximately 30% of persons aged >65 years each year.” (1)  In the US, “in 2003, a total of 13,700 persons aged >65 years died from falls, and 1.8 million were treated in emergency departments (EDs) for nonfatal injuries from falls.” (2)

When: The event runs 3:00-5:00 pm on Thursday, December 12, 2013.

Where: At Sayville Library 88 Greene Ave. Sayville, NY 11782

Clothing: Wear comfortable clothing to sit, stand and lay down.  Shorts or pants recommended.

For additional info:

1 – Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 2001;82:1050–6.

2 – Retrieved from http://www.cdc.gov/ncipc/wisqars

Runners – Off Season Tune Up


Running Machine Woman at gym - MSRunning is a fantastic way to keep fit.  If you are an outdoor runner throughout the warmer months, the

off-season can signal an end to light clothing, a move to indoor running or ‘gasp’ a halt for the season.  No matter what you do during the colder months, this is a good time to get checked for the balance of your muscle strength so you can work on correcting the issues through the winter.

Running is notorious for exercising some leg muscles and not significantly working others.  Over time, this leads to strength imbalances for all the muscles surrounding your ankle, knee and hip joints.  Your leg flexors and extensors get an excellent workout with running, and gradually get stronger. Your leg abductors, adductors and rotators get hardly any exercise with running and their strength remains static.  Eventually, the stronger you get at running, the more imbalanced the muscles crossing each of your leg joints becomes.

This results in your joints tugging abnormally in one direction or another as you move. This leads to ligaments, tendons and connective tissues getting stretched. You might experience this as swelling in a joint after a run.

If more advanced, this might be experienced as soreness or pain. As the joint starts becoming loose or sloppy from the imbalanced muscle strength stretching tissues over and over, the bones will start to ride into places where they shouldn’t.  This can sometimes show up as a clicking sensation or sound as a bone slips into and out of position while sliding over cartilage or other soft tissue that it normally doesn’t.  Classical muscle imbalance injuries include: ilio-tibial band syndrome, plantar fasciitis, groin pull, hamstring strain, etc.

Put too much pressure on your leg when the bones are out of position like this, and you have a chance of cutting the cartilage or other tissue.  At this stage, you are doing significant damage to a joint.  Once the cartilage gets cut, the odds of repairing it fully decrease very significantly.  If left to continue, this type of damage is one of the causes of osteoarthritis.

What can be done to prevent this type of muscle strength imbalance injury? Get a check up on a regular basis to measure the strength of all the muscles crossing each of your leg joints.  Ask your doctor if they do testing for individual muscle strength (as opposed to testing groups of muscles).  Testing hip flexors or quadriceps are a group of muscle tests.  Testing psoas major or vastus lateralis are individual muscles.

Find out if your exercise program is not working out all your muscles evenly.  Then, over the winter, put some extra exercise attention to the muscles that are lagging behind.  This will not only prevent the classic runner’s injuries, it will also improve you speed and endurance for when the weather warms up again.

The Diagnosis Foundation (DxF) is a non-profit organization dedicated to promoting diagnostic testing to find underlying causes of disease and ways to improve athletic performance.  We are offering screening events in the mid Atlantic through New England regions to search for imbalanced muscle strength. The DxF also provides a free data base of health care providers who test and treat these types of conditions. The DxF also offers educational programs to help train doctors, therapists, trainers and the public in doing muscle strength testing.  For those who can get to Long Island, we have a 2 day, weekend seminar intensive to learn muscle strength testing this October 18 & 19.

Education is empowerment.  Run smarter…get healthier.

Target stores sets itself apart with GMO free products. How do you set yourself apart?


target-msTarget sets itself apart by announcing its store brand is non GMO. Whole Foods started the trend when it noticed a 15-30% increase in a products sales when it is labeled GMO free. Chipolte restaurants have signed on with development of a new GMO free menu and Ben & Jerry’s ice cream has announced a new non GMO product. 1

They respond to a public need and they will be successful. At the Diagnosis Foundation (DxF), we have been responding to the public’s need for answers about important health questions. We developed a course in Balanced Muscle Strength to target workouts for individuals. When individual muscles are tested for strengths and weaknesses, a purposeful workout is designed to improve safety, health, and performance.

Read more facts about setting yourself apart.

Certification courses

Education courses


Clinic / Screening – Balanced Muscle Strength for Runners – August 29


NYIT Bears LogoWhat: The Diagnosis Foundation will be holding a clinic and a screening regarding Balanced Muscle Strength for Runners .

Who: New York Institute of Technology (NYIT) Cross Country Team.  This event is not open to the public.

Where: NYIT Central Islip campus, 300 Carleton Ave. Central Islip, NY 11722-9029

When: The events will take place on Thursday, August 29, from 2-3:30 pm.

Activities include:

  • Clinic: Topics will include: Introduction to the DxF, Stages of Muscle Imbalance, Classical Muscle Imbalances for Runners & Screening Demonstration with Clinical Implications.
  • Screening: Balanced Muscle Strength testing of 12 leg muscles for team members.  Balancing muscle strength in the legs results in improved runner’s athletic performance, decrease injuries and prevents certain forms of osteoarthritis.

For additional info:

  • DxF screening program
  • DxF Clinics – 1-2 hour programs to introduce the concept of Balanced Muscle Strength and the implication on athletic performance and health.
  • Volunteer at screening event – To volunteer at the DxF screening booth, please contact: Info@DxFoundation.org
  • Certification Course – To become certified to be an muscle strength examiner at DxF sanctioned screening events.
  • Online Education Course – Learn how to perform 12 muscle strength tests in the legs. (Certification not included)
  • Seminar Review – Learn muscle strength testing for 12 muscles during 1 weekend.  Course intended for fitness & health professionals with some knowledge of anatomy.

Weak Tibialis Posterior muscle leads to…



Tibialis posterior - 1.4 - BP3DIf your Tibialis Posterior (TP) is weak, what kinds of performance and health issues can you get?  It’s a major factor for foot pronation, plantar fascitis, achilles tendonitis, shin splints, knee pains and lots more.  Let’s look at TP anatomy, actions, measurement methods along with the implications weak TP strength can have on your athletic performance and health.

Anatomy – The TP muscle is located in the back of your calf region.  The top of the muscle attaches to the top and back of the tibia and fibula bones as well as the tough membrane that lies between them.  The muscle runs down the back of the calf, connects to its’ long tendon which runs behind the medial ankle.  From there, the tendon continues around the mid foot at about the peak of the long foot arch.  There it breaks up into many smaller tendons which attach to the bottom of most of the bones in the mid foot.

Action – The main action of this muscle will be to flex your foot to the bottom (plantar flexion) and twist the forefoot medially (inversion).  The quick way to refer to this motion is that it twists your foot down & in.  This is one of the key ‘stabilizing’ muscles of the foot.  In addition to twisting your foot down and in, the TP is also one of the primary muscles holding up the long arch of the foot.

Diagnosis – Weakness in the TP can be determined with manual muscle strength testing, careful observation of ankle movement during walking, running and at rest, long arch height measurements and other tests. Supporting information can be gained through a careful history as well as physical examination for neurological, vascular and orthopedic signs.  Detailed measurement of TP ranges of motion and muscle strength are available with specialized equipment when required for insurance purposes, research or in advanced cases.

Functional Implications – When the TP muscle is weak, you will not have the strength you should when a) moving the forefoot down & in, b) your ankle will be unstable and c) there will be some degree of difficulty holding up your long arch (excessive foot pronation) when the foot is put under more stress than the muscle can handle.  In more advanced weaknesses, the foot will be unable to hold the long arch up during even mild stress such as weight bearing.  With extreme or prolonged weakness, the long arch may become permanently deformed to the flat position (flat footed) even without weight bearing.

Performance Issues (Arch) – Difficulty in holding up the long arch will have implications in a very large number of sports.  Any athlete involved in sports which include running will suffer to some degree.  If the long foot arch is fully collapsed, shock absorption will be reduced (depending on what type of foot strike you use).  Speed will be lost as the forefoot cannot contribute as effectively in the toe off phase.

Performance Issues (Knee) – When the ankle pronates, the long arch collapses medially.  If you stand and look at your knee while you pronate your foot, you will see that this motion also results in the knee deviating medially (towards ‘knock kneed’). This stretches the medial collateral ligament and strains one of the thigh adductor muscles (the gracilis).

Athletes in sports that require high power outputs in the legs (such as weight lifting and high jumping), with weak TPs, may notice that their knees ‘give out’ or ‘buckle’ medially when under high stress.  When joints buckle outside of their normal ranges of movement, reflexes are initiated which severely restrict continued muscle contraction.  A weak TP can effectively become the weak link which limits your athletic performance.

Athletic Performance Issues (Down & In) – Sports that use the motion of twisting the foot down and in will suffer when this muscle is weak.  Kicking a soccer ball in a forward / diagonal direction is a clear example.  While the main power behind the kicking is due to the larger thigh muscles, additional power is also derived from the TP to give you the extra power needed to advance you to the next level of athletic performance.  Perhaps more important than the extra power, will be the degree of ball control that is lost in kicking because the forefoot cannot maintain a reliably stable kicking surface.

Sports with jumping that include a lateral motion like basketball or volleyball will also suffer.  Athletes who need agility with strong lateral movement will be aided by the TP to evade their competitors as in football.

Injury Susceptibility – In addition to performance degradation, athletes with weak TPs will be susceptible to increased rates of injury due to ankle and knee instability.  Medial to lateral movement of the foot may be increased with each step.  This will result in a few complications, including:

  • Stretching the ankle ligaments that help maintain joint integrity against ankle sprains
  • The achilles tendon will experience excessive movement at the ankle joint leading to potential achilles tendonitis
  • The knee deviates medially each time the foot pronates.  This leads to stretching of the medial collateral ligament of the knee, knee instability and a wide range of secondary issues.

Chronic Weakness – People who experience weak TP issues for many years are putting their feet and knees through excessive wear and tear that can eventually lead to cartilage damage, osteoarthritis and potential for surgery.

By Dr. John Wallman, DC


Muscle Strength Screening at Strong Is Beautiful CrossFit competition – 10/13/13

Strong Is BeautifulThe Diagnosis Foundation will be offering balanced muscle strength screenings at the Strong Is Beautiful CrossFit competition.  This CrossFit competition is for women only but the screening event is open to the public and the DxF Screening is free.

When: The event starts at 9:00 on Sunday, October 13, 2013.

Where: At MettleWorks CrossFit at 96 E Industry Court, Deer Park, Long Island, NY

Activities include:

  • DxF Free Health & Fitness Screening: Balanced Muscle Strength testing of 12 muscles in the legs. Designed to improve athletic performance, decrease injuries and prevent certain forms of osteoarthritis.
  • Rx/Scaled Division
  • 3 workouts + Final
  • Standards:
    • Rx
      • Squat Clean and Jerk 95+
      • Deadlift 155+
      • KBS 53#
      • Chin over the bar pull ups
      • Double Unders
    • Scaled
      • Squat Clean and Jerk 65+
      • Deadlift 125+
      • KBS 35#
      • Singles
      • Jumping Pull Ups

For additional info:

Upcoming Screening Events


Review results - 4The Diagnosis Foundation (DxF) will be holding screening events at the following locations:

Balanced Muscle Strength Screenings

DxF sign Screening EventNBC NY Giants Health & Wellness Expo – June 22 & 23


Screening Event Table set up

Screening Events Near You


Marathon Starting Line……and how to make that happen!

The Diagnosis Foundation (DxF) is holding as many screening events in the Long Island / Metro NY area as their certified screeners, volunteers and funds can handle.  We could screen a much greater number of people near you if we had more:

  • Certified screeners
  • Volunteers
  • Sponsors

Certified Screeners – If you or other members of your organization would like to become certified to do the Balanced Muscle Strength Testing, we could schedule a lot more screening events near your business on a schedule that works for you.  The DxF has courses teaching the anatomy, physiology, procedures and legal environment to do the 12 key muscle tests.  The course to become a Balanced Muscle Strength screener is:

  • Short: 20 – 30 hours
  • Inexpensive: $125 – $450 depending on which options you choose
  • Convenient:  Available online, by CD, printed, webinar, seminar or at your location
  • Accessible: The course is open to physicians, physical therapists, personal trainers and others

Volunteers – In addition to the certified examiners, each new screen initiated by the DxF needs people and specialists to help develop and run events.  We need people to:

  • Prepare: participants to be screened at events
  • Record: results as participants are being tested
  • Advise: the Advisory Committee on Testing (ACT) reviews new and current screening procedures for improvements in reliability, accuracy and usefulness.

Sponsors – Everybody involved in the screening events is donating their time to help improve people’s lives.  There are still expenses which need to be covered. Travel, printing, equipment, event fees, etc.  The DxF can schedule screening events near your organization with your financial support.

Screening At Moving Towards a Cure 10K Run – July 27


moving-towards-cure-brain-tumors-22The Diagnosis Foundation will be exhibiting and performing balanced muscle strength screenings at the Moving Towards A Cure 10K Run.  This event is open to the public and the DxF Screening is free.

When: The race starts at 7:30 on Saturday, September 27, 2013.

Where: At the Fushing Meadows Corona Park, Long Island, NY

Activities include:

  • DxF Free Health & Fitness Screening: Balanced Muscle Strength testing of 12 muscles in the legs. Designed to improve runner’s athletic performance, decrease injuries and prevent certain forms of osteoarthritis.
  • There are many categories of distances, ages & teams to compete in.  Please see the Moving Towards A Cure web site for additional details.

For additional info: