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• W2013422246 abstract "To the Editor: Dr. Bruno J. Vellas and coworkers deserve credit for having called attention to the fact that a compromised one-leg balance is a common cause of falls in older persons.1 At the start of their study, which extended over 3 years, 316 healthy subjects with an average age of 73 years were tested for their ability to stand on one leg for 5 seconds without losing their balance. Thereafter, the participants were requested to report any fall and its circumstances to the investigators. The data were analyzed at the termination of the study 3 years later. A total of 225 of the 316 subjects had fallen at least once during the 3-year period, but 155 individuals had sustained no significant injuries during the fall. The statistical analysis showed that for this group, the one-leg balance test had not been a significant predictor of subsequent falls. However, 70 subjects had suffered significant injuries, and for this subgroup the inability to stand on one leg for 5 seconds constituted a significant risk for an injurious fall during the subsequent 3 years. In the Discussion section, the authors concede that the one-leg balance test should have been repeated at pre-set intervals during the 3-year period of the study. I agree with this concession. In this age group, many things can occur that will make subjects susceptible to falls, and the most careful statistics can be made invalid by confounding factors. However, my main concern is that the biomechanics and muscular dysfunction of the one-leg balance have been disregarded in this study. In the past, many investigators have explored the role of the hip abductor muscles, the gluteus medius, the gluteus minimus, and the tensor fasciae latae in maintaining single leg balance, and they have found that the weakness of these muscles is a risk factor for falling.2–5 The principal aspects of these investigations can be summarized as follows: In standing position, the center of gravity of the upper part of the body, excluding the supporting legs, is located anterior to the 11 thoracic vertebra. From there the gravity line descends vertically to a horizontal line connecting the hip joints. From this point, the force of the upper body weight — head, arms and trunk (HAT) — is symmetrically distributed to both legs. When one leg, for example the left leg, is lifted and does not bear weight, the mass of the HAT plus the left leg is now borne by the right leg. The body balance is preserved by the right hip abductor muscles. The mechanics are those of a 1st class lever system, with the axis (or fulcrum) at the right hip joint. When the hip abductors on the right pull the bony pelvis down, the left half of the pelvis with the HAT and the left leg will move up, similar to a see-saw. The distance from the fulcrum at the right hip to the weight line is almost twice as long as the distance from the fulcrum to the insertion of the hip abductors at the greater trochanter of the right femur. The shorter distance is a mechanical disadvantage to the right hip abductors, and they will need to produce a force greater than 85% of body weight to maintain equilibrium. If they are weak, the center of gravity and weight line move to the right to be closer to the supporting leg. The patient will then walk leaning to the right, and this so-called abductor gait, with the patient leaning sideways, is awkward and tiring. It is insecure and may become a cause for falling. Patients with hip abductor paralysis or great weakness will need to rely on a cane in the opposite hand. If an older patient's risk of falling needs to be assessed, the hip abductor muscles should be evaluated. Their strength can be estimated with a fair degree of accuracy by a manual muscle examination. A dynamometer will give reliable quantitative data if this is desired: We have measured hip abductor strength in 25 women older than age 65 and in good health and compared the results with young women between the ages of 20 and 30. There was a considerable difference between the two groups. Peak torque, work, and power were markedly lower in the older women, significant at a level of P < .001. We have not collected data on falls." @default.
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• W2013422246 date "1998-09-01" @default.
• W2013422246 modified "2023-10-16" @default.
• W2013422246 title "IMPAIRED ONE-LEG BALANCE AS A CAUSE OF FALLS" @default.
• W2013422246 cites W1980962788 @default.
• W2013422246 cites W4214496813 @default.
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• W2013422246 doi "https://doi.org/10.1111/j.1532-5415.1998.tb06666.x" @default.
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