Winter Slips and Falls

By: Laura Wenger, PT, DPT

This time of year, when the sidewalks and roads tend to become ice-covered after recent snowfalls and colder temperatures, our attention turns towards falling and especially the risk of falls in older adults. A study in Sweden, the land of ice and snow for a good portion of the year, found that over 50% of traffic-related injuries in adults over 60 years old were associated with a slip and fall and that females were more likely than males to slip.1 Falls have a huge effect on our health care system, as they can often result in debilitating injuries that may lend toward secondary impairments of loss of independence or even death.2 This is why it is imperative for all people, but especially adults over 60, to think about fall prevention when you are out facing the grocery store parking lot or trying to cross the street whenever there may be ice or snow on the ground.

One type of training that can be done to reduce your risk of fall is called perturbation training.2 Merriam-Webster defines perturbation as, “a disturbance of motion, course, arrangement or state of equilibrium.”3 In physical therapy, we use perturbation for many different purposes, but it is especially important during any fall prevention training. With this type of training, the central nervous system adapts both proactively and reactively to control your stability and resist a fall.2 These adaptations can happen fairly quickly and sometimes even within a single training session.2

A recent randomized control trial sought to find out how well perturbation training in a lab translated to actually decreasing fall risk in older adults over the span of a year. Participants were hooked up to a harness system on treadmill that was designed to induce “slips” and were monitored to assess their ability to recover from these perturbations.2 One group was only subjected to one “slip”, whereas the other was subjected to 24 “slips” within a single session.2 After monitoring the amounts and types of falls that these groups sustained during their daily lives over the next year, the researchers found that the group that was trained with multiple “slips” was able to significantly reduce their falls by 50% in contrast with no significant change in the group that only experienced one “slip” in the laboratory.2 The evidence also suggested that the perturbation training had a more profound effect on participants that had a history of a falls versus those that didn’t.2

These types of high-quality studies are important because they reinforce the types of training that can take place in physical therapy in order to reduce a person’s risk of falling, and they show that this training can be done rather efficiently. Although we do not have a fancy laboratory with a treadmill designed to induce slipping, this type of training is easily performed within the clinic and can be of great benefit for people of all ages but especially if you are 60 or older. If you have experienced falls in the past or are feeling wary about your ability to stay upright on those icy days, schedule an appointment with one of our qualified physical therapists to begin perturbation training and reduce your fall risk. Remember, don’t take it personally if we give you a nudge or shove to test your balance in the clinic: we are just looking out for your well-being!

  1. Gard G, Lundborg G. Pedestrians on slippery surfaces during winter- methods to describe the problems and practical tests of anti-skid devices. Accident Analysis and Prevention. 2000;32: 455-460.
  2. Pai Y-C, Bhatt T, Yang F, Wang E. Perturbation training can reduce Community-Dwelling Older Adults’ Annual Fall Risk: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2014 December;69(12): 1586-1594.
  3. Merriam-Webster. Definition of Perturbation. 2014. Available at, Accessed December 17 2014.