Falls Prevention

Support for safer movement, balance and confidence

Falls can happen for many reasons, including reduced strength, poor balance, changes in mobility, dizziness, medication, vision problems or difficulty moving safely around the home and community.

Falls prevention physiotherapy focuses on identifying the physical factors that may be increasing your risk of falling and helping you move with greater confidence.

Treatment may include strength and balance exercises, walking practice, mobility advice and practical strategies for everyday activities.

Who may benefit from falls prevention physiotherapy?

An assessment may be useful if you:

• Have fallen recently
• Have experienced several falls
• Frequently lose your balance
• Feel unsteady while walking
• Have had near falls
• Feel less confident outdoors
• Avoid certain activities because you are worried about falling
• Find stairs increasingly difficult
• Struggle to get up from a chair
• Feel weak in your legs
• Use a walking stick or frame
• Have difficulty walking on uneven surfaces
• Have reduced mobility following illness, injury or surgery
• Have a neurological condition that affects balance
• Feel less stable when turning or changing direction

Falls prevention is not only for people who have already fallen. It may also be useful when balance or mobility has started to change and you want to reduce future risk.

Understanding why falls happen

A fall is often caused by a combination of factors rather than one single problem.

Physical factors may include:

• Reduced leg strength
• Poor balance
• Slower reactions
• Joint stiffness
• Changes in walking
• Reduced coordination
• Dizziness
• Fatigue
• Difficulty seeing obstacles
• Reduced confidence with movement

Environmental factors may also contribute, such as poor lighting, loose rugs, clutter or difficult steps.

The assessment therefore looks at how you move as well as the situations in which you feel most unsteady.

What happens during your first appointment?

Your first appointment begins with a discussion about your mobility and any falls or near falls you have experienced.

The physiotherapist may ask:

• When and where falls have happened
• What you were doing at the time
• Whether you felt dizzy or light-headed
• Whether you lost consciousness
• How often you feel unsteady
• Whether you use a walking aid
• How you manage stairs
• Whether you can get up from the floor
• Your current activity level
• Other medical conditions
• Medication that may affect balance or alertness
• What activities you have stopped because of fear of falling

The physical assessment may include:

• Walking
• Standing balance
• Leg strength
• Getting up from a chair
• Turning
• Stepping
• Coordination
• Walking speed
• Stair use
• Moving around obstacles
• Balance on different surfaces

The findings help identify which areas may benefit from rehabilitation.

What treatment may include

Treatment is based on the factors identified during your assessment.

Strengthening exercises

Leg and hip strength are important for standing, walking, using stairs and recovering balance.

Exercises may include:

• Sit-to-stands
• Supported squats
• Step exercises
• Calf raises
• Hip strengthening
• General lower-limb exercises

The exercises can be progressed as strength improves.

Balance exercises

Balance rehabilitation may include:

• Standing with a narrower base
• Reaching
• Stepping in different directions
• Turning
• Weight shifting
• Walking around obstacles
• Practising uneven surfaces
• Standing with reduced hand support

The level of difficulty will depend on your current ability and safety.

Walking practice

If your walking has become slower or less stable, rehabilitation may focus on improving confidence and control.

Treatment may include:

• Step length
• Foot clearance
• Walking speed
• Turning
• Changing direction
• Outdoor walking
• Uneven surfaces
• Using a walking aid correctly

Functional exercises

Exercises can be based on movements you regularly need to perform.

This may include:

• Getting out of a chair
• Getting into bed
• Using stairs
• Stepping over obstacles
• Getting in and out of a car
• Carrying light objects
• Moving around the home

Home exercise programme

You may receive exercises to practise between appointments.

The programme can be adjusted as your balance, strength and confidence improve.

Strength and falls risk

Reduced leg strength can make everyday movements more difficult.

You may notice problems with:

• Standing from a low chair
• Climbing stairs
• Walking for longer periods
• Recovering balance after a stumble
• Getting up from the floor

Gradual strengthening can improve the physical capacity needed for these activities.

The exercises do not need to be complicated. Simple movements performed consistently can form an important part of falls prevention.

Improving balance

Balance depends on information from the eyes, inner ear, muscles and joints working together.

When one or more of these systems becomes less effective, maintaining stability may require more concentration.

Balance exercises challenge the body in a controlled way so that you can practise responding to changes in position.

The programme may progress from basic standing exercises towards more realistic activities such as turning, stepping and walking in different environments.

Walking and confidence

After a fall, some people begin walking more cautiously.

You may take shorter steps, look down more often or avoid walking outdoors.

Although this may feel safer initially, becoming less active can gradually reduce strength and confidence.

Rehabilitation can help you return to walking in a structured way.

This may begin indoors before progressing to:

• Pavements
• Uneven ground
• Shops
• Parks
• Stairs
• Busier environments

The pace of progression depends on your balance and confidence.

Fear of falling

Fear of falling can affect people even when they have not recently fallen.

You may begin avoiding:

• Going outside alone
• Stairs
• Longer walks
• Social activities
• Public transport
• Exercise

Reducing activity can then lead to further weakness and make movement feel even more difficult.

Falls prevention rehabilitation aims to rebuild confidence gradually rather than expecting you to immediately return to activities that currently feel unsafe.

Getting up from a chair

Difficulty standing from a chair can indicate reduced leg strength or balance.

Treatment may include:

• Adjusting foot position
• Moving the body forwards
• Leg strengthening
• Repeated sit-to-stand practice
• Gradually reducing the use of the arms

This movement is useful both as an exercise and as a practical everyday skill.

Using stairs safely

Stairs require balance, strength and coordination.

If stairs have become difficult, rehabilitation may include:

• Step exercises
• Leg strengthening
• Balance work
• Controlled lowering
• Safe use of a handrail
• Practising the appropriate stair pattern

Where stairs remain unsafe, practical alternatives or additional support may also need to be considered.

Turning and changing direction

Many falls happen while turning rather than while walking in a straight line.

Turning requires the body to shift weight while changing foot position.

Physiotherapy may include practising:

• Slow controlled turns
• Wider turns
• Turning around furniture
• Changing direction while walking
• Turning in smaller spaces

These exercises can help improve both coordination and confidence.

Uneven surfaces and outdoor mobility

Walking outdoors can be more challenging than walking on a smooth indoor floor.

Common difficulties include:

• Kerbs
• Grass
• Gravel
• Slopes
• Uneven pavements
• Crowded areas

Rehabilitation may gradually introduce these challenges where appropriate.

The aim is to prepare you for real environments rather than only practising balance inside the clinic.

Mobility aids

A walking stick, frame or other mobility aid may improve safety for some people.

An assessment can help determine:

• Whether an aid is appropriate
• Which type may be suitable
• Correct height
• How to use it safely
• How to manage stairs
• Whether the aid is still required as strength improves

Using a walking aid is not a sign of failure.

In some cases, the right aid can increase independence by allowing someone to walk further and more confidently.

Footwear

Footwear can affect stability, particularly when shoes are loose, worn or difficult to walk in.

Where relevant, practical advice may be provided about choosing footwear that:

• Fits securely
• Provides adequate support
• Does not easily slip
• Is suitable for the surfaces you regularly walk on

Footwear is only one part of falls prevention and should be considered alongside strength, balance and mobility.

Falls around the home

Many falls happen during normal household activities.

Possible risks may include:

• Loose rugs
• Cluttered walkways
• Poor lighting
• Slippery floors
• Difficult steps
• Frequently used items stored too high or too low
• Lack of support in areas where balance is difficult

Falls prevention may therefore include discussion about how your home environment affects mobility.

Where more detailed home assessment or equipment is required, occupational therapy may also be helpful.

Dizziness and falls

Dizziness or vertigo can increase falls risk.

If you regularly feel dizzy, light-headed or as though the room is spinning, this should be discussed during your assessment.

Depending on the cause, you may benefit from vestibular physiotherapy or further medical assessment.

Falls prevention treatment may still include balance and strengthening work alongside management of the underlying dizziness.

Falls after illness or hospital admission

Strength and mobility can decline quickly after illness, surgery or a hospital stay.

You may notice that activities you previously managed easily now require more effort.

Rehabilitation may focus on:

• Rebuilding leg strength
• Walking
• Standing balance
• Increasing activity gradually
• Using stairs
• Returning to normal routines

Improving general physical conditioning can help reduce the effect of this period of inactivity.

Falls and neurological conditions

Conditions such as Parkinson’s disease, multiple sclerosis, stroke and other neurological disorders can affect balance and walking.

Falls prevention in these situations may need to consider:

• Muscle weakness
• Coordination
• Freezing
• Changes in sensation
• Muscle stiffness
• Reduced foot clearance
• Fatigue

The rehabilitation programme can be adapted according to the neurological condition and the specific movement difficulties involved.

Getting up from the floor

Knowing what to do after a fall can be useful.

For people who can practise safely, physiotherapy may include learning how to get up from the floor.

This may involve:

• Rolling
• Moving onto hands and knees where appropriate
• Moving towards stable furniture
• Moving into a kneeling position
• Using support to stand

Not everyone should practise floor transfers independently.

If this is not safe, the focus may instead be on how to call for assistance and remain comfortable until help arrives.

Maintaining activity

Fear of falling can lead to long periods of sitting or reduced movement.

Although rest may feel safer, reduced activity can gradually affect:

• Strength
• Balance
• Fitness
• Confidence
• Walking ability

Falls prevention therefore encourages an appropriate level of regular activity.

Depending on your ability, this may include:

• Walking
• Strength exercises
• Balance exercises
• Exercise classes
• Cycling
• Other suitable physical activities

The programme should remain challenging enough to support physical ability while still being safe.

Family and carer support

Family members and carers may become involved when falls risk increases.

Where appropriate, they may receive guidance on:

• Safe walking assistance
• Transfers
• Use of mobility aids
• Supporting exercises
• What to do after a fall
• Encouraging safe independence

Providing too much assistance can sometimes reduce the amount of movement a person completes independently.

The aim is to provide enough support for safety while still encouraging active participation.

Working with other healthcare professionals

Falls can have several causes, so physiotherapy may form one part of a wider assessment.

Depending on individual needs, other professionals may include:

• GPs
• Occupational therapists
• Pharmacists
• Falls services
• Neurologists
• Vestibular specialists
• Vision services
• Other relevant healthcare professionals

Medication, vision, blood pressure, home environment and medical conditions may all need consideration where appropriate.

After a fall

Not every fall causes an injury, but some require medical assessment.

Seek appropriate help if a fall results in:

• Severe pain
• An inability to stand or walk
• A possible fracture
• Significant head injury
• Loss of consciousness
• New confusion
• Significant bleeding
• New weakness or numbness

If falls are becoming more frequent, even without injury, it is worth discussing this with an appropriate healthcare professional.

Treatment based on your goals

Falls prevention should reflect the situations that matter to you.

Your goals may include:

• Walking around the home confidently
• Going outside independently
• Using stairs
• Getting out of a chair more easily
• Returning to shopping
• Walking the dog
• Using public transport
• Returning to exercise
• Reducing reliance on a walking aid
• Feeling less worried about falling

Your programme can be developed around these practical goals.

How long does falls prevention rehabilitation take?

The length of rehabilitation depends on:

• Current strength
• Balance
• Walking ability
• Medical conditions
• Falls history
• Confidence
• The activities you want to return to

Some people may need a short period of exercise and advice.

Others may benefit from a longer programme, particularly after repeated falls, illness or a significant loss of mobility.

Progress can be reviewed according to changes in strength, balance, walking and confidence.