By Dr. Jerry Yoo, DPT, CSCS | NL Physio
One of our clients came in last week and looked beat up.
She misjudged a curb in low light, caught her toe, and went down hard, and I mean, hard.
Big cuts on both knees and elbows, abrasions to the face, swollen hand…and no, not from a fist fight..they were the result of her bracing a fall.
She's in her 50s. Trains regularly and not the type of gal you picture when you hear “fall risk.”
We're hearing this story more and more from our active clients over 40. Same pattern almost every time: a misstep in distance, a crack in the sidewalk they didn't see coming, a curb that showed up faster than expected.
Especially with our early AM runners, when visibility is at its worst. Then it's a sprained ankle, a jammed wrist, a twisted knee. Sometimes worse.
Balance runs on three inputs working together: your eyes, your inner ear (the vestibular system), and the feedback your joints and muscles send your brain about where your body is in space (proprioception). All three degrade with age, and it often starts around your 30s and 40s.
- Vision: depth perception and contrast sensitivity drop first. This is exactly why early morning runs (low light, long shadows) are a common setup for a fall. You're not seeing the ground the way you did at 25. When I work with someone who has fallen, I always ask when their last eye exam was.
- Vestibular: the inner ear sensors that track head movement and orientation lose precision over time. If you’ve had vertigo before, you know firsthand what a room that’s spinning looks like.
- Proprioception: nerve signals from your ankles and feet slow down, so your brain gets a delayed report on what your foot is actually doing.
To add insult to injury, reaction time slows and fast-twitch muscle power drops faster than raw strength does. A strong 45-year-old can have noticeably slower reflexes than they did at 30. That gap, between being strong and being fast enough to catch yourself, is where falls happen (Colón-Emeric et al., 2024).
Falls are one of the leading causes of unintentional injury in adults over 40, and the risk climbs hard after 65.
One fall roughly doubles your odds of another fall within the following year. Hospitals are now trialing intervention programs after a single fall specifically because a second fall tends to come faster, and hit harder, than the first (Charmant et al., 2026).
For this reason, if you find yourself saying, “I just tripped” more and more often, it deserves more attention than most people give it. A twisted ankle now can be the early warning system for something worse later: a fracture, a head injury, or a fall that’s hard to bounce back from.
Watch for these patterns:
- You've several stumbles, near-falls, or actual falls in the last 12 months unrelated to new footwear or a current lower leg or foot injury (the single strongest predictor of a future fall)
- You avoid certain terrain (grass, curbs, trails) because you're not confident about uneven surfaces.
- You feel unsteady turning quickly or looking over your shoulder or going down a staircase.
- Your training is almost entirely straight-line and forward (running, biking, lifting), with zero lateral, rotational, or reactive movement
- You train in low light and haven't changed your route, pace, or attention when visibility drops
Two or more of these sound familiar? Your balance system may be more compromised than your fitness level would suggest, but the good thing is that most balance issues can be mitigated with training.
Two quick tests. No equipment.
1. Single-leg stance: stand on one leg, eyes open, no hands. Time how long you hold it before wobbling or touching down. Under 10 seconds is a signal worth paying attention to. Try it eyes closed for a harder version, you're removing the vision input and forcing your vestibular and proprioceptive systems to do the job alone.
2. Tandem stance: stand heel to toe, one foot directly in front of the other, arms crossed. Hold for 10 seconds. This one often exposes a problem before single-leg stance does.
This is training the system that actually saves you when you misstep.
1. Single-leg stance progressions: start on stable ground, eyes open. Progress to eyes closed, then to an unstable surface (pillow, foam pad). 3 sets of 30 seconds per side.
2. Perturbation drills: anchor one end of a pull up band to a doot and place the other end around your waist, get some tension on it, and practice stepping in different angles and pausing. Your job is to catch yourself, not brace beforehand. This trains the “oh no” reflex directly, which static balance work never touches.
3. Lateral and multidirectional movement: lateral lunges, skater hops, cone drills that force you side to side and on an angle. Most runners and lifters live in one plane of motion. Falls happen in every plane.
4. Step-downs and step-ups on an uneven or slightly unstable surface: controlled, slow, full range of motion. This trains your ankle and hip stabilizers to react to variable ground, exactly what a curb or trail root demands.
5. Dual-task balance work: stand on one leg while doing something else, counting backward, catching a ball, checking your phone. Real falls rarely happen when you're only thinking about your feet. They happen when your attention is split, which is most of the time.
Here's how we think about it clinically. Every fall has two diagnoses.
The first diagnosis is what actually got hurt: the sprained ankle, the twisted knee, the jammed wrist.
The second diagnosis is what caused it in the first place. Now, there are many reasons why this could have happened, and in my practice, we want to rule out a faulty balance system.
Most people only get the first diagnosis treated. Ice it, rest it, move on. Then they're back on the same trail, in the same low light, with the same untrained balance system. And the next fall could be worse than the first.
PS-> Falling or stumbling a lot these days? Get your balance system assessed. We’re here for you.
