Fear not!
10 Jun, 2018 - 04:48 pm 0 comments

‘It’s easy dad, just let go of the brakes and go for it!’

The immortal words of encouragement from an 18-year-old during a recent mountain biking ride. I was at the top of a steep rocky descent; it looked very slippery and unforgiving; what was the worst that could happen?

Falling, injury, pain, embarrassment, the list could go on…

I lacked confidence and was increasingly anxious about the consequences, which I noticed had an impact on my posture. I was gripping like crazy on the handlebars, in a flexed posture, going very slowly and repeatedly putting my foot down; adaptive changes in my postural control strategies, which have been well documented (Adkin 2002; Horak 2006; Yiou 2011)

I could not help but draw parallels on how this is what it must feel like for patients walking across the gym for the first time in a therapy session. The fear of falling and the wide-open space leads to increased compensatory strategies into flexion, wider base of support, and altered postural control strategies, which then, in turn, impact on their Anticipatory Postural Adaptations (APAs). This also impacts on the ability to access selective movement activity and quality of gait pattern.  I felt all of this on my mountain bike.

What do I say in therapy sessions?

“stand tall, reduce your grip, don’t look at your feet”

….all of which I was not doing.

In a treatment session, I would of course work on improving postural control, reducing compensatory strategies, maximising the sensory input to improve APAs and access to more automatic selective movement and then provide the environment for repetition.

So, I focussed, I reduced the tension in my arms, looked ahead and allowed the bike to roll a bit faster and did it work? Well, I got down a bit faster, didn’t use my feet and felt very pleased in what I had accomplished. I immediately wanted to repeat the descent to reinforce my new skills, all of which again I can identify with my patients.  All in all, it was a very rewarding bike ride on many levels.

The fear of falling and the impact it has on your balance strategies and function is very real but through applying the strategies I use within treatment sessions my performance improved.

Practice what you preach, it works!


       Adkin AL1Frank JSCarpenter MGPeysar GW.(2002)Fear of falling modifies anticipatory postural control. Exp Brain Res. Vol 143(2) p.160-170


       Horak F (2006) Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age and Ageing 35-S2:ii7-ii1 1


       Yiou, Caderby & Hussein (2012) Adaptability of anticipatory postural adjustments associated with voluntary movement. World Journal of Orthopedics Vol 3, Issue 2 p. 75-86