How to Fall Correctly to Prevent Hand Injuries

As a physical therapist and hand therapist, one of the biggest concerns I hear from my patients is that they are worried they are going to fall and hurt themselves. It is not uncommon for a therapist to be treating injuries that resulted from a fall. The upper extremity (shoulder through the fingers) is a common place for injuries to occur following a fall as many will use their hands to brace their fall in order to protect their face or head. This type of fall is called a F.O.O.S.H or a fall on an outstretched hand. This blog will briefly look into common injuries of the upper extremity with a fall and will talk about ways to prevent these injuries.

Fractures

Following a fall, there could be an increased risk of fracture. A fracture can occur anywhere that trauma occurred during the fall and can affect any bone of the upper extremity depending on how the person falls. The most common type of fracture secondary to a fall is a distal radius fracture.¹ This fracture occurs to the end of the long bone of the forearm located on the thumb side of the arm. Distal radius fractures can occur at any age, however, are more common in those 65 years or older, after a fall.¹ In the younger adult, the most commonly injured bone secondary to a fall is the scaphoid bone.² The scaphoid is a small bone in the wrist that provides stability.² Fractures from a fall can occur at the hand, elbow and shoulder, however, are less common than the distal radius fracture and scaphoid fracture. Remember fracture type and location is heavily influenced on how someone falls, and it is important to follow up with an upper extremity specialist/hand surgeon if you think you have a fracture.

Dislocations

A second class of injury that may occur second to a F.O.O.S.H is dislocation. A dislocation is a displacement of one or more bones of a joint.² The most common dislocation from a F.O.O.S.H is an elbow dislocation.² Dislocations can occur with factures or soft tissue damage depending on how the person falls.² Though it is less common than an elbow dislocation, the shoulder or digits (fingers) can also be dislocated from a fall on an outstretched hand.² It is important that if you think you have a dislocated joint, that you see a trained medical professional to which may include putting the joint back in place to prevent further damage from occurring.

Soft Tissue Damage

Soft tissue damage from a fall can span from cuts and bruises to ligament and tendon damage. As with all other injuries, soft tissue damage is heavily dependent on how a person falls and what other injury may be associated with the fall.

How to Prevent a Fall

There are many ways one can prevent a fall, including:

• Be aware of your surroundings. Limit or get rid of throw rugs and clutter on the floor of your home. These can be seen as trip hazards and are easy to stumble over.
• Slow down. Falls can occur when people are in a rush or moving too quickly. Take a few extra seconds to slow yourself down and ensure that you can achieve whatever task you are trying to achieve safely. Always place safety first over time constraints.
• Focus on lower extremity (leg) and core strength. The gluts (buttocks muscles) and core (abdominal muscles) play a large roll in balance. It could be beneficial to take a few moments to do some core activation activities and glut squeezes to keep yourself strong. If you are worried about your balance, or have fallen frequently, you should consider seeing a physical therapist for a balance and lower extremity strengthening program.

How to Fall Safely

Finally, if a fall cannot be prevented, remember these tips to help you fall as safely as possible.

• Lean forward, twist your shoulder, and swing your arms into the fall. This can help you control the direction of you fall and can decrease the risk of landing backwards on your head.³
• Try to aim your fall away from busy areas, people, or hard surfaces. Landing on grass or dirt could decrease the risk of injury compared to landing on concrete, people, or sharp objects.³
• Do not lock out your joints or throw out your hands. Locked out knees, wrist, elbows, etc. can accelerate the fall and cause one area of the body to take the entire force of the fall which increases the risk of injury.³ It is best to keep your joints and body as relaxed as you can. Try to land on the soft, meaty, or squishy areas of your body as the extra tissue can act as a layer of protection for your body.³ These areas might include your buttock or your thighs.⁴ Landing on boney areas just further increases the risk of soft tissue damage, fractures, and dislocations as discussed above.
• Finally, keep falling. Don’t try to stop the fall abruptly but rather roll through the fall so that no one area takes the brunt of fall.⁴

A Hand Therapist Can Help

If you have experienced a fall, or injury as a result of a fall, please seek medical help. If you have injured the upper extremity, it is important to seek help from a hand specialist. In the therapy world, hand therapists are specialists at treating the upper extremity and will best be able to serve in the rehabilitation of your injury.

Find a Hand Therapist Near You

References:
1. Wright, H. H. (n.d.). FOOSH Injuries – Hoverboards & Beyond: The Hand Society. FOOSH Injuries – Hoverboards & Beyond | The Hand Society. https://www.assh.org/handcare/blog/advice-from-a-certified-hand-therapist-on-FOOSH-hoverboards-beyond.
2. Davenport, T. E., Kornelia Kulig, Sebelski, C. A., Gordon, J., & Watts, H. G. (2013). Diagnosis for physical therapists: a symptom-based approach. F.A. Davis.
3. How to fall without injury. Harvard Health. (2020, June 17). https://www.health.harvard.edu/staying-healthy/how-to-fall-without-injury.
4. Zimmerman, M. (2017, November 28). Falling Safely: How To Fall To Prevent Injury. AARP. https://www.aarp.org/health/conditions-treatments/info-2017/how-to-fall-safely.html.