Balance & Falls: How to Stay Upright and Prevent Injury

[0:00] All right, welcome back to the PTCH Podcast, where a chiropractor and a physical therapist walk into a mic and hopefully don’t trip over the cord. I’m Jason Young. Kathy: And I’m Dr. Kathy Lynch. Jason: Today — Kathy: wait a minute. Wait a minute. You wrote in there that you’re Dr. Kathy Lynch and I’m just Jason. I’m Dr. Jason Young. Kathy: That’s right. Jason: Today we’re diving into a topic that affects way more people than you think. Balance and falls. Kathy: Yes. Exactly. And let’s be honest, we’ve all had those not-so-graceful moments, like when you trip over absolutely

[0:31] nothing. Jason: Oh yeah, the classic invisible speed bump. But here’s the deal. For older athletes and adults — Kathy: and adults, yeah — Jason: falls aren’t just embarrassing. They can be life-changing. Kathy: Sure. But the good news: falls are not an inevitable part of aging. In fact, there’s a lot that you can do to stay steady on your feet and avoid becoming best friends with your living room floor. So today we’re busting myths, sharing prevention tips, and maybe telling a few stories about the ways humans managed to defy gravity

[1:01] badly. Jason: Okay, so stick with us. This is going to be equal parts educational and entertaining. And spoiler alert, throw rugs may be the villains of this story. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? Kathy: Chiropractors and physical therapists don’t like each other. Jason: Oh, think again. Kathy: I’m Dr. Kathy Lynch, physical therapist, who likes to help people move and get stronger. Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the

[1:31] PTCH Podcast. Kathy: Remember, there’s no “I” in PTCH. And we’re back. So, wow. First of all, Kathy, this is our 22nd episode. Kathy: We’re still doing this. Jason: What are we doing? This is amazing. Yes. One of these days we’re going to get our first listener. Kathy: Yeah, it’s going to be very exciting. Jason: No, it’s going to be a good time. But seriously, there’s a lot of you listening. We know — we see you. We see you out there. We’ve got more

[2:01] subscribers than we can count. I can only count to seven. But yeah, we’ve got lots of subscribers on YouTube, on Spotify, Apple Podcasts, all the things. So we’re very, very grateful for all of our listeners, people who participate, comment, and all those sorts of things. So like and subscribe. Kathy: Come on, smash that subscribe button. Jason: Yeah. So I don’t think that people want to hear about that though. I think they want to get right into the topic. This is an interesting one and it’s kind of a throwback to another

[2:32] episode that we did. What was that episode? Kathy: Sarcopenia. Jason: Sarcopenia. Right. So if you thought that was a great episode, oh, just wait. But yeah, Kathy, I think that you’re going to be kind of doing the heavy lifting on this one because this is really in your wheelhouse. Kathy: Yeah. Jason: This is a big one for physical therapists. Kathy: This is quite big. Jason: You guys love people that fall. Kathy: Well, we love all people. We prefer people don’t fall. Jason: Yes. But you see people who fall. Kathy: You do see people there. There is the

[3:02] business side to that, right? Jason: Well, and outside of people who are injured and need rehab, balance and fall prevention is one of the most common reasons that I refer people to physical therapists, because y’all do a great job with this. So I’m really excited to hear what you have to say about this, and to fill all the people listening in on what they can do to fall better. No, to fall less often. Kathy: Well, that — and we can talk about this later — that is an intervention that we do. Jason: Oh, okay. Can you fall better?

[3:34] Kathy: Oh, yeah. So yes, you can. You know, all my kids have done martial arts. You know, I don’t beat up children, but none of them could take me, right? Jason: So, can I just — here’s an aside. Yes. Far be it from me to get sidetracked, but so when my kids — okay, let me back up. I’ll just bring up the reason I’m talking about this. One of the first skills you learn is how to fall, right? You fall backwards and you slap out, right? So that you’re not hitting your head and stuff. So watching my kids go to these martial arts things — there’s

[4:04] belt testing, so you go to these belt tests — and man, I just I can’t suppress the competitive jerk in me, because they go to these things and there’s all these people and they’re doing their forms and everything, and the only thing going through my mind the whole time is, I could take that guy. There’s no way on earth that guy’s beating me. I don’t care what color that belt is. Like, I’ve been in an actual fight. This guy is not going to be — Kathy: okay. Do you have a color belt? Jason: I don’t. I have a brown belt

[4:35] for when I’m wearing brown shoes and I have a black belt for when I’m wearing black shoes. Kathy: That’s how it works. Jason: That’s how it works. It’s like — what is it — Mr. Miyagi, Karate Kid said, belt good for holding up pants, right? So Kathy: yeah, Jason: your kids have belts, but you don’t. Kathy: Yeah. Anyway, so that’s one of the first things you learn in martial arts — is how to fall well. So that is something that you’re going to talk about today. Hopefully we can learn how to fall Jason: gracefully. Kathy: Yes. Jason: Yes. Okay. All right. Well, where do you want to start?

[5:05] Why are we even talking about balance and falls? Kathy: Okay. Why are we talking about balance and falls? Well, I got a lot of stats. Are you ready for some numbers? Jason: Stat me. Kathy: Okay. So recent data from the CDC — Centers for Disease Control and Prevention, Jason: yes, Kathy: in Atlanta, Georgia, Jason: in case you didn’t know. Kathy: Mhm. Yeah. Recent data indicates that approximately 28% of Americans aged 65 years and older experience one fall a

[5:37] year, resulting in over 36 million falls annually. Jason: Holy smokes. Jeez, that’s like a local, you know, middle school dance recital. Kathy: Let’s keep doing some more math. Jason: Okay, give me some more stats. Kathy: Yeah, so these incidents lead to about 3 million emergency department visits and more than 950,000 hospitalizations. So, you know, when you can’t find a hospital bed, that’s because people keep

[6:08] Kathy: falling. Jason: Oh my gosh. Yeah, that’s a ton, a ton of people. Kathy: So, why are you talking about older people though? Like, doesn’t everybody fall? Like, why is it a big deal for older people? Jason: Everybody does fall Kathy: once in a while. Jason: Okay. Is this — this sounds like a song lyric. Kathy: Everybody falls once in a while.

[6:38] Jason: That was a good harmony. Kathy: Yeah, it was good. And we did not practice that. Jason: Well, we actually didn’t. Kathy: It’s funny you asked that. Jason: Is it funny? Kathy: It is. Oh gosh. Jason: Because fall-related injuries are the leading cause of injury-related deaths among older adults. Kathy: Get out. Jason: Mhm. Kathy: Woo. Okay. Mhm. And Jason: even more shocking. Kathy: Mhm. Jason: The fall death rate

[7:12] in this population has increased by 41% since 2012. Kathy: What on earth is happening? What’s on the floor? Jason: Actually, we don’t know. This was the article that I read. They said we need more — Kathy: like at nursing homes. Are they just like, “Let’s break some glass and put it over in that corner.” Jason: Holy smokes. Are they falling into lava or something? Kathy: Experts are trying to figure it out. Jason: Wow. Kathy: So, while we try to figure it out, we’ve got to — we’re working on prevention.

[7:42] Jason: Okay. Kathy: Yeah. Jason: Man. Now I’m so curious. What is making — what is making the falls more dangerous than ever before? Kathy: What’s happened? What happened in 2012 that is making people just fall all over themselves? Jason: Yeah. Well, I think that 2012 was a big disaster movie year if I remember correctly. I don’t think that has anything to do with it, but Notre Dame got blown out in the national championship game. Kathy: That sounds accurate. Jason: I think that was it. People are still devastated by it.

[8:13] Kathy: Yeah, there’s just old people falling everywhere. Jason: All the old Irish Catholics. That was our best chance. Kathy: Ma, that was our best chance. The Irish — they lost again. Jason: They lost again. Kathy: Oh my goodness. Jason: Yeah. Yeah. So, Kathy: well — so, but just first, like — so, it’s not the ground. The ground’s not more dangerous than it was. Jason: Not that I know of. Kathy: So, it’s got to be the people. Jason: Earthquakes. Yeah. Kathy: Got to be the people. I wonder if it’s — is there — are there more falls

[8:44] or just the quality of the old people declining over the years? They’re just not made from the same stuff as they used to be. Jason: You know, in my practice, I’m thinking that part might be true. Kathy: Yeah, Jason: we’re not as strong. Kathy: Well, but I imagine obesity’s gone up. So, it’s like fluffier people falling, so there’s more padding. Maybe — Jason: actually, you know, Kathy: yeah, Jason: heavier people have stronger bones. So,

[9:15] that’s not a bad theory, but Kathy: okay. Well, I don’t know. Think about that. Jason: Yeah. I feel like we have a pretty frail older population. Kathy: Yeah. Maybe it’s something nutritional Jason: in my perspective. Yeah. Kathy: Like the bone density Jason: and is worse Kathy: and being sedentary. Yeah. Jason: And not being told to lift weights, which we’ll — Kathy: we’re going to talk about that Jason: shockingly. I’m going to talk about lifting. Kathy: That’s interesting. I feel like every

[9:45] episode you talk about lifting weights like it’s important or something. Jason: Yeah. I think people should start doing it. So — Kathy: so why do we care other than more people are dying from falls? Jason: Other than that — Kathy: I mean, this is America, so it’s tied back to money. Jason: It is. Oh yeah. It’s got to be so expensive. What’d you say? 38 million falls. Kathy: And so, yeah, I imagine each one of those comes with a price. Jason: Yeah. Kathy: Yeah. And so the data I found — most

[10:15] recent research — is actually numbers from 2015, and I’m sure it’s way higher now, but total medical costs attributable to Jason: to falls — Kathy: fatal and non-fatal falls exceeded $50 billion in one year. Jason: What, in one year? Kathy: Yeah, with Medicare and Medicaid shouldering 75% of these costs.

[10:46] Jason: Oh my gosh. So, if we could get rid of falls, like if we put old people in one of those big inflatable hamster balls, Kathy: we would save bazillions of dollars. Jason: Bazillions. Bazillions. Kathy: We’d be at Mars by now with all that money Jason: basically. Yeah. We could stand on the pile of money and just touch Mars, Kathy: right? Jason: Wow. That’s so much. Kathy: Mhm. Mhm. Jason: Golly. Okay. You know, and we’ll get into this later, but falling is complex.

[11:16] Kathy: The cause of falls is very complex. Jason: Oh, I thought that you were talking about the difference between falling in love and falling downstairs. Kathy: Okay. You were talking — it’s fine. You were talking about something different than I was, but yeah, Jason: falling in love is complex. Kathy: That is too, Jason: but it’s outside the scope of our discussion for today. Kathy: Yeah. Jason: Yes. We did an episode on matters of the heart. Kathy: We did. Jason: Yes. Mhm. Kathy: Yeah. The follow-up. That’s a callback, too. Jason: That is a callback. Yes. Hey, in case you didn’t know, folks, we have other episodes. I know you’re loving this

[11:47] episode and don’t go anywhere, but check out the other episodes. Kathy: Yeah. Jason: Yes. Kathy: Okay. So, if you had to — don’t look at the agenda — but if you had to pick Jason: the biggest reason people fall — one of the reasons people — Kathy: Jason, the moment you sent me the agenda, I did not look at it. If nobody can tell, I’m just — Jason: You never — I’ve studied this deeply. All right. Kathy: Okay. Jason: And one reason. Kathy: What? Number one reason? Jason: Not number one. Just one reason.

[12:18] Kathy: One reason that people fall. Okay. Well, I do know that one of the reasons that people fall is they’re tripping. Jason: Them people be tripping. Kathy: People tripping, right? Jason: Tripping. Kathy: Yeah. Well, okay. But more seriously, yeah, if you do trip and fall, I know that one of the most serious reasons that older people have dangerous falls is like — there’s, oh, grandma fell and broke her hip, but a lot of times

[12:48] Grandma breaks her hip and then falls. And the reason she does that is because of osteoporosis, right? That bone gets so thin that she has what’s called a pathological fracture where, you know, she puts some stress on it, that thing snaps and down she goes. And I think the 5-year mortality rate on that is shockingly high. So, it’s a serious thing that happens. Kathy: Mhm. Yeah. Grandma’s turning to reach for that glass of brandy. Jason: Yeah. Ever since she got run over by the

[13:18] reindeer. Kathy: Twists on that hip and that torsional force just might be too much. Jason: If that lush would just quit drinking. Kathy: There’s a reason she made it to 87. Sorry, grandma. Jason: One brandy a night is good. Kathy: Mhm. So, Jason: that’s the health advice on the PTCH Podcast. Kathy: Yeah. Do you want to live longer? Drink more brandy. Jason: Yes. But osteoporosis,

[13:48] yes, is definitely one of the reasons why. Kathy: Mhm. I’m sure a lot of the listeners are thinking, “Oh, weakness.” Jason: Yes. Kathy: Is very true. Jason: Mhm. In the abs, in the legs, the calf muscles. Absolutely, man. And sometimes I feel that — like I’m not old yet, unless you ask any of my children. But yeah, it’s like sometimes if you do a lot of sitting, for example, it is harder to lift your

[14:18] leg. It’s like, man, if you do a lot of sitting, it’s even more important, I think, to do something that’s active, because it’s like you’re just turning off all your walking parts. Kathy: Yep. Yeah. So, sitting’s easier than walking. Jason: Yes. And then there go your muscles. Kathy: Yeah. Jason: Yeah. Okay. Kathy: Are you saying you can’t walk good without muscles? Jason: I would definitely go down that road. Kathy: I don’t want to be definitive in it. You know, I’m not a black and white kind of person. Jason: Sure. Kathy: I’m more like gray area. So,

[14:50] yes. One of the things I see a lot — and as we age, we lose sensation in our feet, Jason: Mhm, Kathy: which is called neuropathy. Jason: Yes. Kathy: Peripheral neuropathy for some people. And so there’s three things. There’s three systems involved in balance. One is your sensory system — so your nerves and what you can feel. The other is your vision. Jason: Okay. And the third is your vestibular

[15:21] system. Kathy: Yes. Jason: Have we even talked about that? Kathy: I don’t think that we have. No, I think we’ve talked about the other stuff, but yeah. Jason: What is it? Kathy: The vestibular system? Jason: Yeah. Kathy: Well, that is your sense of balance, really. A lot of that has to do with your inner ear, how it communicates with your brain. You’ve got a few kind of areas that — well, everybody wants the horizon to be level, right? Nobody’s walking around like, “Oh, the earth is too flat. I’m going to tilt my head.” Jason: Right. And so that vestibular sense is

[15:53] what helps our body to make all the little fine corrections that get the horizon to be level. Jason: Yeah. Kathy: And if that’s messed up, oh, that’s when the fun begins. Jason: That’s when the fun begins. You don’t need brandy after that. Kathy: You’ll just start bouncing off of walls all by yourself. Jason: Yeah. So the vestibular system — and you kind of mentioned the inner ear. So it’s behind your eardrum. You can’t actually touch it and there’s no wax getting into the vestibular system. Kathy: No. Jason: So there’s three canals in there and

[16:24] they’re filled with fluid and they also have hair cells in there. And as you turn your head — Kathy: Yeah. Jason: like they dangle down in there. Kathy: They do dangle. Jason: When you turn your head that fluid moves and it moves those hair cells, which then gives your brain information about where your head is in space. And so if your vestibular system is not strong, just like you have weak muscles, you can have a rusty vestibular system. Kathy: Yes. Jason: You’re more prone to falling. Kathy: Definitely. Jason: Mhm.

[16:54] I knew about the vestibular system younger than the average person. The reason is because my brother Tyler has palsy, and so he doesn’t walk, but we used to do this kind of physical therapy — kind of home physical therapy — system every day where he had volunteers that were coming and helping him move his body and stuff. And so one of the phases of it was what was called vestibular stimulation. Kathy: Oh wow. Jason: Yeah. So it was fun too. We had one of those swivel chairs and part of it was we put him in the chair and we spin

[17:25] them — no, spin them the other way, spin them this way, that way — and it’s to stimulate that vestibular stuff. We also did a thing where we would have him, like, on a blanket, you know, kind of roll around on the blanket. And it was kind of cool because in the beginning he had difficulty like keeping balance, holding his head up and things like that, but doing that vestibular stimulation helped to kind of wake those parts of the brain up. And I think that there’s also like some studies that show that kids who rough house with siblings or with

[17:55] parents and things like that — that vestibular stimulation helps them to be better athletes. Kathy: It does. Jason: Yeah. So if you want your kid’s college paid for, you got to start wrestling with them right now. Kathy: Right. Yeah. I mean, my head was on a swivel from the day I was born, because I have an older brother. Jason: That’s right. Kathy: When’s the next attack coming? Jason: Shout out. Yeah. But no, it’s good. Like all those things — I think that’s one of the benefits of play and activity when

[18:26] you’re younger that people take for granted — is you end up having better balance later. Jason: Yep. Kathy: Yep. But it’s definitely something that diminishes the older that you get. Jason: Yep. Exactly. So those hair cells — we start to lose some of those as we age, like with everything else. And the other part is the vestibular system and your vision are connected in some ways. And you kind of mentioned it with gaze stabilization. Kathy: Mhm. Jason: So turning of the head and the reflex of the eyes — there’s a reflex

[18:58] called the VOR. And so those two systems are connected to each other, right? And if that connection is not kept strong, your gaze stabilization is not great. Kathy: Down you go. Jason: Yeah. You turn your head quickly and you lose your balance. Kathy: Grandma. Jason: Yeah. Yeah. So the other thing — as we’re older, again, we’re going to frame this as an

[19:28] older person problem. The falling, right. Jason: Only old people listen to this anyway. And you know, I’m about to get a comment cuz I’ve — I’ve made that kind of comment before. I get a comment from somebody. You know who you are. What’s up, Megan? Kathy: You just called her out. Jason: Yeah, I know. She’s going to be all surprised. “Oh my gosh, you said my name.” Yeah. And then this is the last episode she’ll listen to, but she’s like, “I’m not old.” That’s what she says in the comments. Kathy: And I listen. And Megan, I don’t think that you’re old, but I hope that one day

[19:58] you get old because, you know, that’s the best thing that you could wish anybody — is that they reach a very, very old age. So, we love you, Megan. Jason: Yeah. Kathy: So, balance suffers as we get older, too, because our vision gets worse. Jason: Yes. Kathy: So, our vision is getting worse. Our vestibular system, unless we’ve trained it, is getting worse. And then our sensory system — our nerves in the bottom of our feet — is getting worse. So that just pushes us up higher on the notch to

[20:28] be more prone to falls. Jason: Yes. Kathy: So those are the biggest root causes of falls. Jason: Mm-hmm. Kathy: There’s also external reasons for falls. Medications. Jason: Mm-hmm. Kathy: So it’s Brandy. Jason: Brandy. Kathy: Yeah. I’m talking about the musician, not the alcohol, right? Jason: Uh-huh. Kathy: Brandy with an I. Oh, and then here we talk about the environment. Jason: Mm-hmm. Kathy: Yeah. Little little dogs like Monster —

[20:59] Jason: Monster. Yeah. My monster dog. Kathy: Ankle biters. Jason: Ankle biters. Yes. Throw rugs. Kathy: Throw rugs. Yes. Jason: Yeah. Bad lighting. Kathy: Bad lighting, definitely. And yeah, I get in the habit of — when I’m walking with somebody who, you know, does have not-as-good vision and maybe a lot of years on them — of like, as we’re walking, being like, “Hey, there’s a bump coming up here. Here’s a curb, or here’s a step.” Just because, you know, you take those things for granted, and like

[21:31] Jason: Yeah, the environment’s huge. Kathy: It is. Jason: Yeah. Because a lot of times when people be tripping, they actually tripping over things. Kathy: Yes. Jason: All right. So, we’ve covered a good part of what are the reasons people are falling. I still don’t know why this has increased since 2012. Kathy: That’s weird. I think the lighting’s just gotten worse everywhere, right? Jason: Are people wearing sunglasses outside?

[22:02] Sun’s not as bright. Kathy: What are we doing? Jason: The ozone layer. I don’t know. Kathy: Yeah, it is a weird thing though. Jason: I’m going to guess that it has to be deconditioning. Kathy: That would be my first guess if I had to put money on it. Jason: Yeah, just because when you look at trends, there’s a lot more excuses to be sedentary. Kathy: So, yeah, Jason: let’s go with that. Kathy: That’s a fact. Put it on Wikipedia. Can you log into Wikipedia real quick, Scott? Just put that on there for us.

[22:33] Yeah, people be tripping because of deconditioning. Jason: All right. Kathy: On the things. Jason: Yes. Okay. Well, how do we train it? Kathy: Oh, that’s a great question. And you know, one thing I see — that this is in the agenda because now I’m reading the — Oh, you’re reading it. Because I think you might — I think you might have said something like that doctor thing at the beginning. If I would have read the agenda, I would have known. And yeah,

[23:03] but anyway, so one of the things that you have in there is the single leg stance. Can I talk about that? Jason: Yeah, let’s do it. Kathy: So, I think that that’s a really good way to actually find out — because I think maybe some people are like, “Oh, I don’t have a vestibular system like they’re talking about and my vision is perfect.” Well, if you want to find out just how closely those things are connected, stand on one leg. And like, when you’re doing a one-leg stand, you can’t like hook your leg around your other leg. You just have to have a free leg that’s off the ground, one leg that’s on the

[23:33] ground. See if you can stand that way. Like, take off your shoes, too. Right? That’s a better way to do it. See if you can stand that way for 60 seconds. Okay? Then once you can do that successfully, if you can, see if you can do it on the other leg. And then once you can do that successfully, close your dang eyes and see what happens. You’ll find out just how connected your vision is to your vestibular system. Jason: And so, you know, if we’re talking about how to train it,

[24:04] that’s a cool way to find out how much they’re connected, but it’s also a cool way to train it. Kathy: It is. Yeah. Exactly. Jason: So I can close my eyes and stand on one leg for hours. Kathy: I’m sure you have a record in that, too. Jason: Hours. No, not like the sit. Kathy: Oh, okay. Jason: Not like the sit. That’s a sacred, sacred record. Yeah. They’re not even in the same record book. Kathy,

[24:34] let’s get to the low-hanging fruit, though. Kathy: Yes. Jason: Strength training. Kathy: Yes. Jason: That is number one. If somebody comes in my clinic and the doc has sent them and said, “Yeah, you know, Joe over here keeps falling. Can you coach him up here?” Kathy: Yeah. Jason: And so, first things first is we’re going to train. Kathy: Well, that’s one of the tests I’ll do — the balance that’s in it. It’s rare that I actually get to the single leg stance. Oh, yeah. On people over 40, even. Jason: My — it’s a low bar for me. So, the first thing I’ll — we’ll do two-leg. We’ll stand on two legs.

[25:04] Kathy: Mm-hmm. Jason: With your feet together. Can you do that? Kathy: That’s a challenge for a lot of people. Jason: It is. Yeah. Kathy: And then you do the tandem stance, you know, heel-toe. Can you do that? Jason: If they can do that tandem, then I have them turn their head. So that gets your vestibular system involved. Eyes are still open at this point. If they can do tandem Kathy: with eyes open and turning their head, then we close their eyes. Jason: Yeah. Kathy: Then we go to — Jason: the whole time you’re like, Kathy: “Let’s put some — let’s put some pillows

[25:34] down just in case you’re going down, buddy.” Kathy: Yeah. Well, I just let them fall because then I say, “See, you need balance training.” Jason: Yeah. They’ll never forget it. They’ll never forget. Kathy: A little tough love at Encore Physical Therapy. Yeah. So you’d be surprised at how many people can’t actually — were you in that meeting? We were in a networking group together and for one of my talks I actually had people stand on one leg and it was shocking how many people in that group.

[26:06] Jason: I think I missed that. Kathy: Okay. Yeah. But well, you know, I have to admit, like I have noticed sometimes, you know, and I’m moving pretty quickly through my clinic, right? Like, get to this room, get to this room. And one of the things that I’ve started noticing is I think that my balance is getting worse, because there’s even sometimes that I’m in there and I’m just moving a little bit and it’s like, whoa, how did I end up over here? And so, like, I hate to admit that, but I probably need to start being

[26:37] a little more intentional about taking care of some of these like dynamic balance drills, the strength components of it, Jason: because it just sneaks up on you. Kathy: It does. Jason: Right. And sometimes people’s first sign that they have a problem is that they’re on the ground, Kathy: right? Jason: Yeah. And then their second sign is that they’re on a stretcher. Right. And it’s a hard lesson to learn. Kathy: So I don’t think that I’m in danger of having like a serious fall like that. And if I did

[27:07] fall, you know, I’m at an age and stage with my health where it’s like it’s not going to be too big of a deal. But sometimes like there’s things that you just don’t account for on the way down, like the corner of that table — Jason: it’s coming hard and fast. Kathy: Yeah. So you can end up with some pretty serious injuries. But so it’s worth doing even if all your hair isn’t gray yet. And even especially if you’re an athlete, Jason: right? Even if you’re a younger athlete, you want to work on your balance.

[27:38] Jason: Because it’s a lot easier to play football when you’re not on your back. Kathy: That’s — yeah. Jason: I’ve never played football, but that sounds right to me. Kathy: Yeah. Yeah. It’s pretty accurate, right? You’re a Notre Dame fan. Jason: Yes. Kathy: So yeah, we try to — we try. We like those guys on their feet. Jason: Yes. So, what does strength training do to help you with balance, right? One of the things we see with older adults too — and wait, let me get back

[28:09] to the balance thing for a second. It’s easy to train. In most cases, you can get better. Jason: Yeah, that’s the good news out of this whole podcast — is that you can train it Kathy: if you’re intentional about it, and your balance can get better. There are some people — when people have, you know, severe neuropathy — that can be a challenge, but we can also teach some compensatory skills. Jason: Yeah. Kathy: Things like that. And train. Jason: Is that when you start working on like

[28:39] how to fall better? Kathy: Exactly. Jason: Yeah. Kathy: Yep. Jason: Slap out. Kathy: Slap out. Oh, wait. Jason: No, no, no, no. Kathy: Yeah. You’re not wax on, wax off. No. Wrong. Jason: More like the melt method, you know, where you just kind of melt. Kathy: Oh, melt. I’m not familiar with it. Teach me. Jason: You melt to the ground. Kathy: Oh, okay. That was great. You’re such a good teacher. Jason: Dang, Kathy, you tore that up. Kathy: Right. Wasn’t that easy. Jason: That’s how you make the big bucks, right? Kathy: Are you doing a melt class later?

[29:09] Jason: Yes. All right. Hey, everybody. I’m glad you’re on time. Now, melt to the ground. Kathy: All of you together. Everybody up. Let’s do it again. We’re going to get it right. That’s it. So, okay. So, why is that better than, you know, locking my knees and ankles? If that wasn’t obvious, I had to answer that question. Jason: If you’re going to fall, let’s not fall on your wrist. Let’s not fall on your head,

[29:39] right? And so melting is more of like a controlled Kathy: controlled fall. Jason: So sometimes we’ll teach that. We’ll also teach, you know, we have one of those — it’s kind of a bigger treatment table, Kathy: so it’s like a double — it’s like a double-sized bed. Jason: Oh yeah, it’s a little bit — Kathy: I think they call it a plinth. Jason: Plinth. Sure. Kathy: Is that right? Jason: Yeah, I’ve heard that word. Kathy: I think they’re — are they a little lower? Jason: They’re lower. Kathy: Okay. Yeah. Maybe — Jason: I learned that in chiropractic.

[30:09] Kathy: Yes. Maybe like 3 feet off the ground. Jason: Yes. Yes. Gosh, what was the name of that guy? Man, we had an instructor in chiropractic school. It wasn’t his name, but man, he shared that and he was so proud, ‘cause he’s like, “This is something only physical therapists — Kathy: this, right, this is not a table. This is a plinth.” Jason: Okay. Like, “Oh, wow. Kathy: Plinth.” Jason: And now I’m talking with a physical therapist about it, and you’re just like, “Sure. Kathy: Sure.”

[30:39] Jason: Yeah. It might be a plinth. Who knows? Kathy: It’s supposed to be. Jason: Was his name Plinth? Yeah. Kathy: It was a secret. I’m not supposed to let anyone else know that that’s what it’s called. Jason: Okay. So you’re using a Kathy: plinth Jason: and — using a plinth. And we practice — we have practiced, you know, the tuck and roll. Kathy: Okay. Mhm. You want to tuck your chin in. Tuck your hands in. We don’t want — let’s not break our wrists. Jason: Yeah. Right. Okay. Yeah. The FOOSH. Kathy: We do not want any FOOSHes. Jason: Yes. What’s a FOOSH?

[31:09] Kathy: Falling on an outstretched hand. Jason: That is — that is the FOOSH. Yeah. Kathy: So fun to say, it is Jason: terrible to do. Kathy: Very terrible. Very painful thing to do. Jason: So then what’s a good way to brace yourself? Like if you feel yourself going, you’re like, “Okay, I’m not.” So you’re just — Kathy: tuck everything in. Jason: Tuck and protect your head. Kathy: Tuck — you’re tucking your chin to your chest. Jason: Okay. Kathy: Yeah. And that — Jason: tuck it in. Kathy: And that’s going to protect it. Jason: Mhm. Okay. Kathy: Mhm. Cool. Jason: Yeah. Easier to fall on your backside. Kathy: Mhm. Jason: Don’t want to go forward. Kathy: Yeah. Jason: Yeah. Yeah. Well, and the thing is I think realistically

[31:40] like if you’re falling, you’re going to risk getting hurt. Kathy: Yeah. Jason: So it’s about getting less hurt. Kathy: Yes. Exactly. How? Yeah. How do I become less hurt when this is happening? Jason: Right. Okay. Kathy: Okay. What was I talking about? Jason: You were talking about anytime you see somebody falling, you should take out your camera so that it can go on the gram. Kathy: Yeah. Jason: Oh, we were talking about how to train. Kathy: Yes. Jason: How to train. So we talked about strength training. Oh, yeah. And this is — this is what I want to talk about. Um, just like balance is use it or lose

[32:12] it. Kathy: Mm-hmm. Jason: I think the reason older people fall is we lose our fast-twitch fibers. Kathy: Yes. Jason: If you don’t use your fast-twitch fibers, you’re going to lose them. Kathy: Yeah. Jason: And related to that is power. Right. We don’t — as older adults, as adults, we don’t always train for power. Right. Kathy: Right. And what is power and how do you define that? Jason: It’s the strength that you can’t get on the treadmill. Kathy: No, you cannot — Jason: you can’t get it on the treadmill. You can’t get it on the Peloton.

[32:43] Now I think — so power is just how much explosiveness, how much force you have. Kathy: Yeah. The ability to generate force quickly — or more precisely, the rate at which work is done. If you’ve ever taken physics — Jason: pop, you got to have some pop. Kathy: Yeah. Think about that as your reaction time. Jason: Mm-hmm. Right. Kathy: Yeah. So, the more power you have, the quicker that you can catch yourself. That’s the other thing we’ll kind of teach — is you kind of let people stumble. I mean, Jason: Mm-hmm. Kathy: safely, because you want them to learn

[33:15] how to catch themselves. Jason: Yes. Kathy: Right. Jason: Yeah. So that’s definitely something that we try to — teach, or actually we try to treat — the how we do that is a big word called perturbations. Kathy: Mm-hmm. It’s so fun to learn, isn’t it? The perturbation. Jason: Oh yes. I remember whenever we’re learning rehab stuff and they’re like, “Yes, we’re going to do some of these perturbations.” And so like, “Oh, what’s

[33:46] that? It’s a big word, right?” And then it’s like you’re just going to push that person. Kathy: Yes. Jason: What? Yeah. But you’re going to just try and knock them off balance. Just a little push, right? So, yeah. Describe — describe what a perturbation is. Kathy: Yeah, exactly how you just described it. So what we’ll do in the clinic sometimes — we’ll start with our patient, you know, near a wall or near something Jason: stable. Kathy: And we will — blindly, we

[34:19] don’t want them — we don’t want them with their eyes closed. We also don’t want them to expect where we’re going to push them from. So we will randomly push them from the side, from the front. I mean, this is kind of — Jason: this is when I like the grin that you’re getting right now. Kathy: This is when PTs have their most fun. If you’re not watching this — if you’re not watching this — like when you get a chance, if you’re just listening in your car, when you get a chance, come back, watch this on YouTube or Spotify, and you just got to look at Kathy’s face as she’s like, “We push them. We push them.” Kathy: Least expecting.

[34:49] Jason: Yeah. You’re like poking them. You’re trying to get them a little bit off balance. Kathy: Hey, hey, hey. Yeah. Jason: Head fake. Right. Kathy: Exactly. Jason: If their vision’s really bad, they can’t see the head fake. Kathy: Anyway, Jason: that’s why you got to say head fake. Yeah, we want — we want to train their stepping, you know, we want them to be able to step to the front, to the side, to the back and catch themselves, because that’s, you know, a big part of falling is that reaction time is gone, right? Kathy: Those fast-twitch fibers are gone or not

[35:20] trained. Jason: Mm-hmm. Kathy: And so people can’t catch — when they when they drag their foot — Jason: once they realize it’s going, they can’t correct — Kathy: that train has left the station. Jason: Gotcha. Kathy: Yeah. Yeah. So, how do I specifically train them? Well, you know, I own a strength training gym. Jason: Do you really? Kathy: I’ve mentioned it once. Jason: What do you call that place? Kathy: Helix Training. Jason: Is that an official sponsor of this podcast? Kathy: Yeah, it is now. Jason: It is an official sponsor of this

[35:50] podcast. That’s good. Kathy: It is now. Jason: Like it. Kathy: Mm-hmm. So, my favorite ways to train it — in fact, I taught class today and we did some snatches Jason: where people in class are grabbing a dumbbell from the floor, hopefully bringing it up over their head. Kathy: Oh, okay. Jason: And that is training power and that is training explosiveness and fast-twitch fibers. The other thing that I’ll do — medicine balls, the medicine ball slam. Kathy: Mm-hmm. That’s a good one.

[36:20] Jason: That’s a good one for power and — not just like physical power but I think emotional power — Kathy: 100%. Jason: It is like you can work out some issues Kathy: with the medicine ball. Jason: Yeah. Against the ground, against the wall, anything. Kathy: Mm-hmm. Jason: Sit-to-stands or squats, you know, where — I have a patient or a client who — they may be sitting but I want them to stand up quickly. Kathy: Mm-hmm.

[36:51] Jason: So it kind of again trains that power. Kathy: Yeah. Jason: So not only are we getting the muscles stronger and practicing how to stand up from sitting — we are kind of training that explosiveness. So Kathy: nice. Jason: Yeah. With a squat you kind of go down slow, explode up. Kathy: Mm-hmm. Jason: And then jumps. Kathy: Yeah. Jason: Yeah. I have people jump even if it’s on a 4-inch box or a 6-inch box. Kathy: How did you know about my vertical? Jason: Yeah, I’ll tell you. Oh, you see me?

[37:23] Kathy: Okay. Sad but true. Jason: Yeah. So, yeah, it’s — that and what — how do you help people who are afraid of that? You know, because I know especially with like a box jump or anything like that, there’s some people that psychologically can’t do it. You know, they just are glued to the ground, which is kind of

[37:53] crazy because they’ll do it in real life, like they got to go up the stairs or something like that, they have no trouble, right, getting up the stairs. But when it’s like it’s time to like jump, like, how do you get people to do that? Especially if they have bad balance. Kathy: Yeah. Peer pressure. Jason: Peer pressure. Yeah. You get somebody older and more frail than them, just say, “Look at this guy.” Exactly. Mhm. No, but you make a good point. So, I’ll have them jump, but just not onto the box. And they’re jumping the 4 inches and they don’t realize they’re jumping the 4 inches. It’s — I think they mostly get

[38:23] nervous, you know, they’re going to catch their toe on the box, something like that. And jumping, they don’t have to land on a box. The jumping, the act of jumping, is training those fast twitch fibers and explosiveness. So, what about — do you ever do any sort of training where you’re jumping onto maybe a less stable surface than a box? So like jumping onto a mat or a pad or something like that. Kathy: Yeah, that’s high level. Jason: That’s high level. If it’s — if it’s — I’m not comfortable with that. Don’t

[38:53] jump onto — no. No. No. No. Yeah. You know, I’m not jumping onto a foam pad necessarily. I mean, the boxes we have at the gym are not wooden boxes. They have some little bit of cushion. There’s a little give. So, yeah, it’s not totally stable. So, they’re learning that. Jason: Yeah. So, what happens when people master like a good box jump and then they’re just going for distance? Like, is there a way other than a pad that maybe you ramp it up to kind of help? Cuz we got some people

[39:24] listening that maybe they’re like, “Oh yeah, I do a box jump all the time.” Like 20 inches. How would that person maybe get to the next level in terms of boosting their balance? Mhm. As it relates to the box jump or just any of these things. Kathy: Yeah, just any of these things. Jason: So, next level is — we talked about a little bit with the vestibular system. And it’s hard to train the vestibular system

[39:54] ultimately with your eyes open. Kathy: Okay. Jason: So, next level vestibular training is eyes closed. Okay. So we’ll start — people are sitting with their eyes closed, turning their head and doing things. Then when their balance is good enough where they can stand and safely turn their head or safely close their eyes and not lose their balance, that’s the next step. So by taking away the visual system, the vestibular system and the somatosensory system have to come together

[40:24] and take over. Like, you rarely see blind people falling. Kathy: Oh, right. I guess. Yeah, that’s true. Unless they trip over something. Yeah, I think that’s right. Jason: Right. Yeah, their balance is great because they have to really — yeah, they have to use the two other sensory systems, right? So, yeah, unless they’re, you know, something’s in front of them, and that’s just — which, you know, obviously then it’s a particular circumstance. Exactly. But yeah, their

[40:56] balance is usually really good because their vestibular system is on point. Kathy: Yeah. Yeah. Jason: For the rest of us sighted people, we really use our visual system for balance. Like, that’s why — we lean on it heavily. Kathy: Yeah. And you know, that’s why you kind of see people stooping over as we get older, too, cuz we’re staring down at the ground because we don’t know where our feet are. Jason: Gotcha. Yeah. I just went off on a tangent there. Okay. I think that it’s a very relevant tangent.

[41:28] Kathy: Yeah, that’s a great point. Jason: Yeah. Yeah. So, well, those are the kind of strategies I’ll use when we’re training balance. Kathy: Mhm. Okay. So, do you have any like practical tips outside of the gym for what people can do in terms of helping to make sure their balance is good, avoiding falls, staying safe? Like, what are some things people can be doing outside the gym? Jason: Yeah, you know, train your balance. Sometimes I’ll tell people,

[41:59] okay, stand on one foot when you’re brushing your teeth, which actually makes it really hard cuz you’re moving. That’s perturbation — cuz you’re moving your hand. But you do it for 30 seconds, you know, a day, or while you’re waiting for the coffee or the microwave to be done, you know, stand on one foot. Kathy: Yes. Jason: If that’s too easy, close your eyes, you know, and don’t hold on to the Kathy: Yes. — the table while you’re brushing your teeth. Jason: Yeah, while you’re brushing your teeth. Kathy: Nod your head. Jason: Make sure somebody’s videoing you. Kathy: Again, the importance of that camera.

[42:32] We didn’t really — we just briefly touched on medications. There are some medications out there that can impair your balance. And so it’s important that if you feel like your balance is getting worse, just talk to your doctor like, “Hey, is this a side effect of this? Is this —” Jason: Did you say talk to your chiropractor? Kathy: Yes. Talk to your chiropractor. Jason: Talk to your physical therapist. Kathy: That’s right. Talk to the doctor who prescribed it, ideally. Right.

[43:02] There are medicines out there that suppress your vestibular system, and people are given those medicines to suppress your vestibular system actually to help with nausea — a lot of things too. Nausea and vertigo. So, some of those medicines are not great for balance. Jason: Yeah. Kathy: Yeah. They’re helping one thing and they’re hurting the other thing. Jason: Yeah. And then at home, those throw rugs — just be aware. I mean, they’re beautiful. They’re great, but just be aware. I have one at home

[43:32] where the corner just sticks up. Kathy: Well, there’s ways to secure those, right? They have like rug tape and things like that. Jason: Yeah. Yeah. And I think sometimes people will walk past the same wrinkle in the rug a thousand times and it’s like, just hurry up and fix that. It will get you. Kathy: I feel like you’re talking to me because I do have that one rug. Jason: Yeah. Fix that. Kathy: Yeah. Or like — I know at our house we have a throw rug that’s like halfway under the bed and so it’s like, oh, to fix

[44:04] Jason: This — I’m gonna have to lift up the bed and it’s just like, just do that because otherwise —

Kathy: But the good news is that you’ll probably trip and fall onto the bed, which is safe.

Jason: Then you’re good.

Kathy: Right, until you bounce off of the mattress and then you’re on the floor.

Jason: That’s right. And then you’re good. I think one of the best inventions we’ve had in the last 150 years are those motion sensor lights that you plug in.

Kathy: Yeah.

Jason: Like in your bathroom when you go to the bathroom at night.

Kathy: Yes.

Jason: You know, you walk in the bathroom and the light turns on.

[44:34] Kathy: Yes. Don’t want to stub that toe. That’s a great idea. Yeah.

Jason: Yeah. It’s really easy. Especially if you’re not living alone because sometimes the landscape changes unexpectedly. So, I mean, if you’ve ever stepped on a Lego, holy smokes. Or you’ve ever walked past my son’s room and it’s like, wow. It’s like, I don’t know what your opinion is on this, Kathy, but like, if you had to store football pads somewhere —

Kathy: I mean, why would you put them anywhere

[45:05] except for in the hallway?

Jason: The hallway seems perfectly —

Kathy: The hallway is a great place.

Jason: You wouldn’t want to put them against a wall. You want to put them in the middle.

Kathy: Right in the middle.

Jason: Yes. And you want to put the helmets far enough away that when you trip over the shoulder pads, you’re going to get a concussion.

Kathy: Right.

Jason: I think he’s trying to train your balance.

Kathy: Sounds like —

Jason: Just one of them.

Kathy: Both of them. Yes. Both of them. Right. It’s like, goodness. But sure. Or if you can’t do it in the

[45:35] hallway, do it right in front of the front door.

Jason: So when you’re walking with a handful of — This is getting oddly personal, isn’t it? Yeah. Okay. Wow.

Kathy: I’m going to stop there. Love you.

Jason: This is the bicker of the week.

Kathy: Yeah.

Jason: Okay. Let me ask you about this. I send — like in our community, we have a class that people can take called Better Bones and Balance.

Kathy: Mm.

Jason: I know that some people —

Kathy: Like especially around COVID, they were doing that online.

[46:06] Jason: Yeah. And some people did very little of it because — like, there’s classes and courses out there, but can you talk about the value of doing something like that with other people?

Kathy: You know, the value — to be honest, and sort of joking but not really — peer pressure. Yeah. It’s honestly, in a good way, it’s good peer pressure, like, hey, that person’s doing that. I bet I could do it.

Jason: Yeah. And so they think, okay, they might not do it the first rep, but they might like — second time around, like, I’m

[46:37] gonna try that thing that Janet just did.

Kathy: Yeah. Right.

Jason: Janet —

Kathy: Janet is a baller.

Jason: Yeah. She’s so spry, right?

Kathy: Yeah. So that is a big part of it — is social, is peer pressure, but also if you’re in the right environment, in a supportive environment, you get encouragement from the other people in the gym.

Jason: Totally. Right.

Kathy: And some people have little competitive streaks, like, I’m going to hold the longest one-leg stand.

Jason: Yeah. Exactly.

Kathy: And I think that for some people it’s really embarrassing when you start to

[47:07] notice that you’re having some balance issues. And so it could be nice to know that you’re not alone.

Jason: Right. Right. Right.

Kathy: So if you’re listening to this and you feel like you’re alone —

Jason: 38 million — that’s a number — that’s 10% of the population of the US. 38 million people. Falls.

Kathy: Falls.

Jason: Yeah. Some people are probably responsible for about two to nine of those falls, right?

Kathy: I know some people.

Jason: But still, like, it’s — I don’t think it’s

[47:37] anything to be ashamed of. It’s just one of those things that happens.

Kathy: Yeah.

Jason: Yeah. Okay.

Kathy: Well, can we bust a few myths? Maybe we should play a quick game.

Jason: Let’s do it.

Kathy: Quick game. Okay. What about — and I’ve heard this before — people are like, you know, legs are a little shaky, but if I use a cane or walker, it’s just going to make me weaker.

Jason: Like, what do you say to somebody like that?

Kathy: I’d say strongly disagree.

Jason: Yeah, you’re wrong. You’re wrong, old guy.

Kathy: Nicely say, nah.

[48:08] Jason: Yeah. Or what about people who are like, now that ship has sailed, I’m just too old to

Kathy: get any better, improve my balance. I just — I need to sit in a wheelchair or stay home in the easy chair. Like —

Jason: You’re also wrong. No.

Kathy: Yeah. You’re wrong too, because till the day you die you can build muscle.

Jason: Mm-hmm.

Kathy: Mm-hmm.

Jason: Okay.

Kathy: And you can also train your balance.

Jason: That is absolutely true. Like, that’s going back to the sarcopenia episode,

[48:38] right? You learn that 90-year-olds, if they’re, you know, pumping some iron —

Kathy: They can put on muscle.

Jason: Yeah.

Kathy: And what I tell people about the cane — or what I try to sell them about the cane, because also it’s a perception thing. They don’t want to look like they’re old with a cane — so a lot of times we’ll try to sell the walking stick.

Jason: Yeah.

Kathy: Especially around here, Pacific Northwest.

Jason: Here’s your walking stick. You look like you’re going to go for a hike.

Kathy: Yeah. You go out there on the trail and you got people and they got both sticks.

Jason: That’s street cred right there.

Kathy: Hello. Yeah. Mm-hmm.

[49:08] Jason: It’s totally street.

Kathy: Yeah. But also the cane or the walking stick, you know, encourages independence. Nobody wants to be dependent on somebody else to do stuff for them.

Jason: And to bring this full circle — great for self-defense.

Kathy: It really is. That’s a really good point.

Jason: It really is. Start twirling that cane against brown belt Bob —

Kathy: You know —

Jason: Because he might have — he might have done the punching and kicking, but he hasn’t done

[49:38] the weapons training. He doesn’t have the nunchucks. Kathy: Absolutely not. Jason: Right. He’s not good with the bow staff. Kathy: Right. Jason: I don’t even know what that is. Kathy: He doesn’t have bow staff skills, right? I don’t know. Jason: Can you name that movie? Kathy: No. Jason: Napoleon Dynamite. Kathy: Yes. Okay. Jason: I’ve only seen that once or twice. Kathy: You know, that makes me think maybe we should play a quick game. Jason: Let’s do it. Kathy: All right. So I wanted to have like a balance spelling bee. Does that sound really weird? Jason: It sounds amazing. Kathy: It sounds really good. Okay, so here’s what we’re going to do. We’re going to get three tries and let’s use

[50:08] these microphones. Okay, here, because, you know, it’s a podcast. Jason: I’ve got a pen holder. Kathy: Yes. And I’ve got three words. Jason: Okay. Kathy: And I believe you’ve maybe selected three words — select them quickly. And I’m going to give you a word to spell, and all you have to do is balance this microphone on your head and spell it. If you can spell it correctly without the microphone falling, then you get a point. Jason: Okay. Kathy: If it falls off, you don’t get a point.

[50:38] Or if you spell it incorrectly, you don’t get a point. Okay. Jason: Okay. Kathy: And we’ll go back and forth like that. All right. Jason: Yeah. Kathy: All right. You want to go first or you want me to go first? Jason: I’ll go first. Kathy: Okay. The word is “perturbation.” Wait — here, microphone. Jason: I don’t know that word. Yeah, here we go. Yeah, there we go. Kathy: All right, we’re both using — Jason: Okay, here we go. Kathy: Perturbation.

[51:08] Jason: Wait, wait, my head’s not as flat as yours. Kathy: Can you use it in a sentence? Jason: Perturbation. P E R T E R B A T I T O N. Kathy: What are all those letters you just said? Jason: Perturbation. E T E B A T I O N. Kathy: Yeah, I think you got it right. P E R T

[51:38] U R Jason: B A. No, I didn’t do the — Kathy: Oh, okay. Missed — Jason: the spell check is for — Kathy: Goodness gracious. You just said a whole bunch of letters. I was like, what? That was pretty good. Okay. All right. I am ready. Jason: Vestibular. Kathy: V E S T I B U L A R. Jason: Good job. Kathy: Woo, that was close. I almost lost it. All right, here we go. Ready? Jason: Okay. Kathy: The word is

[52:08] “coccyx.” Jason: C O C C Y X. Kathy: Oh, very good. Very good. All right. Okay. All right. Wow. Ready? Jason: Oh, not yet. Kathy: Okay. All right. Ready. Jason: Pectineus. Kathy: P E C T I N E U S.

[52:38] Jason: Yes. Kathy: All right. Okay. Here we go. I’m going to throw you a bit of a curveball here. Let me make sure I’ve got this correct. Jason: Oh, Kathy: we’re madly typing. Okay, ready? Jason: Okay, ready. Kathy: Hippopotamus. Jason: I got the first — H I P P O

[53:11] T A M U S. Kathy: Very good. Excellent. Expertly done. Jason: All right. Kathy: Okay. Jason: Is that all of them? Kathy: Did I have one more? Fibromyalgia. Jason: Oh, jeez. Okay. Microphone, please. All right. Oh, I can’t balance it. Here we go. Why isn’t it balancing anymore? Okay. Here we go. F I B R. Dang it.

[53:44] Kathy: F I B R O M Y A L G I A. Jason: Good job. Kathy: All right, so I think that was a tie. Jason: That was a definite — Kathy: honestly. Okay, great job, Kathy. Good work. Jason: So, let’s do our takeaways. Kathy: Okay. My takeaway is going to be — after listening to all that you said, I think that I need to work on myself. I think I need to work on myself. This is stuff that’s very easy to talk about with other people focused on them, but

[54:14] I think I could get a lot of value out of this, too. So I’m going to start taking your advice for once in my life to see if it makes me happier. Kathy: Balance test right after this. Jason: Yes, ma’am. Kathy: Stay tuned. Jason: When I was doing research for this episode, I was just stunned at the numbers. Kathy: Really? Jason: I mean, it’s stunning. Imagine if we can prevent some more falls. We don’t do prevention in this country, though. No, that’s the problem. Let’s just pay for all of this. Kathy: It’s just not as lucrative. Jason: No, there’s not like there’s an industry

[54:44] full of people that can help prevent falls. Kathy: Yes. Jason: What? Kathy: What? So, but speaking of numbers, one number that we would like to see increase is the number of people subscribing to this podcast. Jason: Yes. And so, if you’re listening and you’ve enjoyed this, please subscribe. If you found that you actually hated this and this was like nails on a chalkboard, please subscribe and like. Kathy: Yes. Jason: Yes. Kathy: That’s one way we’ll go away. Jason: Totally. Yes. You just subscribe and like,

[55:14] we’ll shut our mouths. All right. Kathy: But yeah, thank you, Kathy. I think you were so well prepared for this and I think that you shared so much good information. So, really appreciate you. And yeah, so Spotify, podcast, YouTube, all those things. And we have to say a special thank you to our podcasting studio. Scott, I promise I’m gonna get this right so you don’t have to turn off my audio. Can I say the new name of the business? Is that okay yet?

[55:46] Okay. It was Cinematic Solutions, which I nailed the name, but he’s rebranding as Titan Podcast. Isn’t that an awesome name? Jason: Yes. It’s really great. Kathy: Yes. Yeah. Don’t look at the end screen — it still says the old one, but just so that you know, Titan Podcast Studio, which is every bit as good with a better name, I think. Jason: I agree. Kathy: I think the old one was bad. I like you, Scott. So,

[56:16] all right. Oh, and one more important item to get to. There’s no I in PTCH.