The effect of asymmetrical body orientation during simulated forward falls on the distal upper extremity impact response of healthy people

The occurrence of distal upper extremity injuries resulting from forward falls (approximately 165,000 per year) has remained relatively constant for over 20 years. Previous work has provided valuable insight into fall arrest strategies, but only symmetric falls in body postures that do not represent actual fall scenarios closely have been evaluated. This study quantified the effect of asymmetric loading and body postures on distal upper extremity response to simulated forward falls. Twenty participants were suspended from the Propelled Upper Limb fall ARest Impact System (PULARIS) in different torso and leg postures relative to the ground and to the sagittal plane (0°, 30° and 45°). When released from PULARIS (hands 10 cm above surface, velocity 1 m/s), participants landed on two force platforms, one for each hand. Right forearm impact response was measured with distal (radial styloid) and proximal (olecranon) tri-axial accelerometers and bipolar EMG from seven muscles. Overall, the relative height of the torso and legs had little effect on the forces, or forearm response variables. Muscle activation patterns consistently increased from the start to the peak activation levels after impact for all muscles, followed by a rapid decline after peak. The impact forces and accelerations suggest that the distal upper extremity is loaded more medial-laterally during asymmetric falls than symmetric falls. Altering the direction of the impact force in this way (volar-dorsal to medial-lateral) may help reduce distal extremity injuries caused when landing occurs symmetrically in the sagittal plane as it has been shown that volar-dorsal forces increase the risk of injury.     

Martial arts fall techniques decrease the impact forces at the hip during sideways falling

Falls to the side and those with impact on the hip are risky for hip fractures in the elderly. A previous study has indicated that martial arts (MA) fall techniques can reduce hip impact force, but the underlying mechanism is unknown. Furthermore, the high impact forces at the hand used to break the fall have raised concerns because of the risk for wrist fractures. The purpose of the study was to get insight into the role of hand impact, impact velocity, and trunk orientation in the reduction of hip impact force in MA techniques. Six experienced judokas performed sideways falls from kneeling height using three fall techniques: block with arm technique (control), MA technique with use of the arm to break the fall (MA-a), and MA technique without use of the arm (MA-na). The results showed that the MA-a and MA-na technique reduced the impact force by 27.5% and 30%, respectively. Impact velocity was significantly reduced in the MA falls. Trunk orientation was significantly less vertical in the MA-a falls. No significant differences were found between the MA techniques. It was concluded that the reduction in hip impact force was associated with a lower impact velocity and less vertical trunk orientation. Rolling after impact, which is characteristic for MA falls, is likely to contribute to the reduction of impact forces, as well. Using the arm to break the fall was not essential for the MA technique to reduce hip impact force. These findings provided support for the incorporation of MA fall techniques in fall prevention programs for elderly.     

Effect of pre-impact movement strategies on the impact forces resulting from a lateral fall

Approximately 90% of hip fractures in older adults result from falls, mostly from landing on or near the hip. A three-dimensional, 11-segment, forward dynamic biomechanical model was developed to investigate whether segment movement strategies prior to impact can affect the impact forces resulting from a lateral fall. Four different pre-impact movement strategies, with and without using the ipsilateral arm to break the fall, were implemented using paired actuators representing the agonist and antagonist muscles acting about each joint. Proportional-derivative feedback controller controlled joint angles and velocities so as to minimize risk of fracture at any of the impact sites. It was hypothesized that (a) the use of active knee, hip and arm joint torques during the pre-contact phase affects neither the whole body kinetic energy at impact nor the peak impact forces on the knee, hip or shoulder and (b) muscle strength and reaction time do not substantially affect peak impact forces. The results demonstrate that, compared with falling laterally as a rigid body, an arrest strategy that combines flexion of the lower extremities, ground contact with the side of the lower leg along with an axial rotation to progressively present the posterolateral aspects of the thigh, pelvis and then torso, can reduce the peak hip impact force by up to 56%. A 30% decline in muscle strength did not markedly affect the effectiveness of that fall strategy. However, a 300-ms delay in implementing the movement strategy inevitably caused hip impact forces consistent with fracture unless the arm was used to break the fall prior to the hip impact.     

Martial arts fall techniques reduce hip impact forces in naive subjects after a brief period of training.

Hip fractures are among the most serious consequences of falls in the elderly. Martial arts (MA) fall techniques may reduce hip fracture risk, as they are known to reduce hip impact forces by approximately 30% in experienced fallers. The purpose of this study was to investigate whether hip impact forces and velocities in MA falls would be smaller than in a 'natural' fall arrest strategy (Block) in young adults (without any prior experience) after a 30-min training session in sideways MA fall techniques. Ten subjects fell sideways from kneeling height. In order to identify experience-related differences, additional EMG data of both fall types were collected in inexperienced (n=10) and experienced fallers (n=5). Compared to Block falls, MA falls had significantly smaller hip impact forces (-17%) and velocities (-7%). EMG results revealed experience-related differences in the execution of the MA fall, indicative of less pronounced trunk rotation in the inexperienced fallers. This may explain their smaller reduction of impact forces compared to experienced fallers. In conclusion, the finding that a substantial reduction in impact forces can be achieved after a short training in MA techniques is very promising with respect to their use in interventions to prevent fall injuries.     

The relation between hip impact velocity and hip impact force differs between sideways fall techniques.

Fall techniques that reduce fall severity may decrease the risk of hip fractures. A fundamental variable for fall severity is impact force, but impact velocity is also used. The purpose of the study was to determine whether impact velocity is valid to determine differences in fall severity between different techniques. Five young adults with martial arts (MA) experience performed sideways falls from kneeling height using three techniques: Block with arm (Block) and MA techniques with and without use of the arm to break the fall. In addition, one subject also performed MA falls from standing height. Linear regression analysis showed a moderate relation between hip impact velocity and force, which was depended on technique. In falls with comparable impact velocities, forces in MA falls were lower than forces in Block falls. Hence, differences in impact force could not be predicted by velocity. In conclusion, hip impact velocity may be useful to make an approximate prediction of impact force within fall techniques. However, to determine differences between techniques it was not always a valid predictor. When direct impact force measurements are not possible, methods combining impact velocity with energy estimates before and after impact might be more valid.     

Effect of upper and lower extremity control strategies on predicted injury risk during simulated forward falls: a study in healthy young adults

Fall-related wrist fractures are common at any age. We used a seven-link, sagittally symmetric, biomechanical model to test the hypothesis that systematically alterations in the configuration of the body during a forward fall from standing height can significantly influence the impact force on the wrists. Movement of each joint was accomplished by a pair of agonist and antagonist joint muscle torque actuators with assigned torque-angle, torque-velocity, and neuromuscular latency properties. Proportional-derivative joint controllers were used to achieve desired target body segment configurations in the pre- andor postground contact phases of the fall. Outcome measures included wrist impact forces and whole-body kinetic energy at impact in the best, and worst, case impact injury risk scenarios. The results showed that peak wrist impact force ranged from less than 1 kN to more than 2.5 kN, reflecting a fourfold difference in whole-body kinetic energy at impact (from less than 40 J to more than 160 J) over the range of precontact hip and knee joint angles used at impact. A reduction in the whole-body kinetic energy at impact was primarily associated with increasing negative work associated with hip flexion. Altering upper extremity configuration prior to impact significantly reduced the peak wrist impact force by up to 58% (from 919 N to 2212 N). Increased peak wrist impact forces associated greater shoulder flexion and less elbow flexion. Increasing postcontact arm retraction can reduce the peak wrist impact force by 28% (from 1491 N to 1078 N), but postcontact hip and knee rotations had a relatively small effect on the peak wrist impact force (8% reduction; from 1411 N to 1303 N). In summary, the choice of the joint control strategy during a forward fall can significantly affect the risk of wrist injury. The most effective strategy was to increase the negative work during hip flexion in order to dissipate kinetic energy thereby reducing the loss in potential energy prior to first impact. Extended hip or elbow configurations should be avoided in order to reduce forearm impact forces.     

Trunk and upper limb muscle activation during flat and topspin forehand drives in young tennis players

This study compared EMG activity of young tennis players' muscles during forehand drives in two groups, GD-those able to raise by more than 150% the vertical velocity of racket-face at impact from flat to topspin forehand drives, and GND, those not able to increase their vertical velocity to the same extent. Upper limb joint angles, racket-face velocities, and average EMGrms values, were studied. At similar joint angles, a fall in horizontal velocity and a rise in racket-face vertical velocity from flat to topspin forehand drives were observed. Shoulder muscle activity rose from flat to topspin forehand drives in GND, but not for drives in GD. Forearm muscle activity reduced from flat to topspin forehand drives in GD, but muscle activation was similar in GND. The results show that radial deviation increased racket-face vertical velocity more at impact from the flat to topspin forehand drives than shoulder abduction.     

Disturbance type and gait speed affect fall direction and impact location

Since falling to the side and impacting on or near the hip increase hip fracture risk, we examined the fall direction and pelvis impact location resulting from four disturbances (faint, slip, step down, trip) at three gait speeds (fast, normal, slow) in 14 young adults instructed not to attempt recovery. We hypothesized that certain disturbances such as faints and slips and slow walking speed were more likely to result in an impact on the hip. For each trial, the fall direction, impact location and pelvis impact velocity were measured. The results showed that both disturbance type and gait speed significantly affected fall direction and impact location (analysis of covariance with repeated measures, p< or =0.0001) with a significant interaction (p<0.05). Trips and steps down usually resulted in forward falls, with frontal impacts regardless of gait speed. At fast gait speed, slips and faints also usually resulted in forward falls, with frontal impacts. As gait speed decreased, however, slips usually resulted in sideways or backward falls, with impact on the hip or buttocks, and faints resulted in a greater number of sideways falls, with impact near the hip. Therefore, compared to other disturbances and gait speeds, slipping or fainting while walking slowly was more likely to result in an impact on the hip, suggesting a greater risk for hip fracture. Furthermore, 56% of the impact velocities generated were within one standard deviation of the estimate of the mean impact velocity needed to fracture an elderly femur.     

Wrist impact velocities are smaller in forward falls than backward falls from standing

The wrist is a common fracture site for both young and older adults. The purpose of this study was to compare wrist kinematics in backward and forward falls with different fall protective responses. We carried out within-subject comparison of impact velocities and maximum velocities during descent of the distal radius among three different fall configurations: (a) backward falls with knees flexed, (b) backward falls with knees extended and (c) forward falls with knees flexed. We also examined the effect of fall configuration on fall durations, elbow flexion, trunk flexion and forearm angles at impact. Forward falls resulted in smaller impact velocities of the distal radius, longer fall duration, longer braking duration, greater elbow flexion and more horizontal landing position of the forearm compared to backward falls. The distal radius impact velocity during forward falls (1.33 m/s) was significantly lower than in backward falls, and among the backward falls the impact velocity of the flexed knee strategy (2.01 m/s) was significantly lower than the extended knee strategy (2.27 m/s). These impact velocities were significantly reduced from the maximum velocities observed during descent (forward falls=3.57 m/s, backward falls with knee flexed=3.16 m/s, backward falls with knees extended=3.52 m/s). We conclude that (1) smaller impact velocities of the wrists in forward falls could imply a lower fracture risk compared to backward falls, and (2) fall protective responses reduced wrist impact velocities in all fall directions.     

The interplay between speed,kinetics, and hand postures during primate terrestrial locomotion

Nonprimate terrestrial mammals may use digitigrade postures to help moderate distal limb joint moments and metapodial stresses that may arise during high‐speed locomotion with high‐ground reaction forces (GRF). This study evaluates the relationships between speed, GRFs, and distal forelimb kinematics in order to evaluate if primates also adopt digitigrade hand postures during terrestrial locomotion for these same reasons. Three cercopithecine monkey species (Papio anubis, Macaca mulatta, Erythrocebus patas) were videotaped moving unrestrained along a horizontal runway instrumented with a force platform. Three‐dimensional forelimb kinematics and GRFs were measured when the vertical force component reached its peak. Hand posture was measured as the angle between the metacarpal segment and the ground (MGA). As predicted, digitigrade hand postures (larger MGA) are associated with shorter GRF moment arms and lower wrist joint moments. Contrary to expectations, individuals used more palmigrade‐like (i.e. less digitigrade) hand postures (smaller MGA) when the forelimb was subjected to higher forces (at faster speeds) resulting in potentially larger wrist joint moments. Accordingly, these primates may not use their ability to alter their hand postures to reduce rising joint moments at faster speeds. Digitigrady at slow speeds may improve the mechanical advantage of antigravity muscles crossing the wrist joint. At faster speeds, greater palmigrady is likely caused by joint collapse, but this posture may be suited to distribute higher GRFs over a larger surface area to lower stresses throughout the hand. Thus, a digitigrade hand posture is not a cursorial (i.e. high speed) adaptation in primates and differs from that of other mammals. Am J Phys Anthropol 2010. © 2009 Wiley‐Liss, Inc.     

A kinetic and kinematic analysis of the Harai-goshi judo technique

The purpose of this study was to analyze and compare the kinetic and kinematic characteristics of the throwing technique, Harai-goshi of novice and advanced judo competitors. A heterogeneous group of 28 male and female judo competitors participated in this study. Each subject was required to perform three successful trials. Kinetic and kinematic data were collected by utilizing the Kistler Instrument Corporation Multicomponent Force Measuring Platform System and the Peak Technologies Motion Video Analysis System. Data were collected in order to quantitatively and qualitatively analyze the horizontal and vertical forces of the support leg, and the horizontal and vertical velocities of the sweeping leg during execution of the throwing technique, Harai-goshi (hip sweep). The study revealed a significant difference in horizontal force application, between novice and advanced judo competitors. In addition, we found numerous significant relationships among mean horizontal ground reaction force application and horizontal leg sweep velocity in 19 of the 28 participants when analyzed individually. The results suggest (1) leg sweep velocity is a function of ground reaction force application; and (2) horizontal leg sweep velocity plays a primary role in good technical execution of the Harai-goshi throw.     

A single-spring model predicts the majority of variance in impact force during a fall onto the outstretched hand

The objective of this study was to validate a single-spring model in predicting measured impact forces during an outstretched arm falling scenario. Using an integrated force plate, impact forces were assessed from 10 young adults (5 males; 5 females), falling from planted knees onto outstretched arms, from a random order of drop heights: 3, 5, 7, 10, 15, 20, and 25 cm. A single-spring model incorporating body mass, drop height plus the estimated linear stiffness of the upper extremity (hand, wrist and arm) was used to predict impact force on the hand. We used an analysis of variance linearity test to test the validity of using a linear stiffness coefficient in the model. We used linear regression to assess variance (R²) in experimental impact force predicted by the single-spring model. We derived optimum linear stiffness coefficients for male, female and sex-combined. Our results indicated that the association between experimental and predicted impact forces was linear (P < 0.05). Explain variance in experimental impact force was R² = 0.82 for sex-combined, R² = 0.88 for males and R² = 0.84 for females. Optimum stiffness coefficients were 7436 N/m for sex-combined, 8989 N/m for males and 4527 N/m for females. In conclusion, a linear spring coefficient used in the single-spring model proved valid for predicting impact forces from fall heights up to 25 cm. Results also suggest the use of sex-specific spring coefficients when estimating impact force using the single-spring model. This model may improve impact force to bone strength ratios (factor-of-risk) and prediction of forearm and wrist fracture.     

Lower and upper extremity loading in nordic walking in comparison with walking and running

Nordic walking (NW) was compared with walking (W) and running (R) with respect to upper and lower limb injury risks. 24 NW-instructors performed W, NW, and R trials on a runway covered with artificial turf at controlled speeds. Foot pronation and ground reaction forces were measured as well as shock wave transmission to the right wrist. Comparison of NW and W shows similar results for all of the four chosen velocities (5 km/h, 7 km/h, 8 km/h, 8.5 km/h). Except for the 2nd peak of the vertical ground reaction force, NW results in higher loading rates and horizontal forces as well as higher pronation and pronation velocity values as compared with W. Wrist acceleration values up to 7.6 times gravitational acceleration were recorded in NW. Compared with R at the same speeds (8 km/h and 8.5 km/h), NW can be recommended as low impact sport with 36% lower loading rates and 59% lower pronation velocities. However, the high wrist accelerations in NW reveal that the upper extremities are exposed to considerable repetitive shocks, which may cause overuse injuries of the upper extremities. Thus, additional preventive exercises for the upper limb muscles are recommended as well as using shock absorbing walking poles.     

Limb work and joint work minimization reveal an energetic benefit to the elbows-back,knees-forward limb design in parasagittal quadrupeds

Quadrupedal animal locomotion is energetically costly. We explore two forms of mechanical work that may be relevant in imposing these physiological demands. Limb work, due to the forces and velocities between the stance foot and the centre of mass, could theoretically be zero given vertical limb forces and horizontal centre of mass path. To prevent pitching, skewed vertical force profiles would then be required, with forelimb forces high in late stance and hindlimb forces high in early stance. By contrast, joint work—the positive mechanical work performed by the limb joints—would be reduced with forces directed through the hip or shoulder joints. Measured quadruped kinetics show features consistent with compromised reduction of both forms of work, suggesting some degree of, but not perfect, inter-joint energy transfer. The elbows-back, knees-forward design reduces the joint work demand of a low limb-work, skewed, vertical force profile. This geometry allows periods of high force to be supported when the distal segment is near vertical, imposing low moments about the elbow or knee, while the shoulder or hip avoids high joint power despite high moments because the proximal segment barely rotates—translation over this period is due to rotation of the distal segment.     

Distal Forelimb Kinematics in <Emphasis Type="Italic">Erythrocebus patas</Emphasis> and <Emphasis Type="Italic">Papio anubis</Emphasis> During Walking and Galloping

When using symmetrical gaits, terrestrial digitigrade monkeys adopt less digitigrade, i.e., more palmigrade-like, hand postures as they move with faster speeds. Accordingly, it appears that, in contrast to other mammals, digitigrady is unrelated to cursoriality in primates. However, researchers have not documented the effects of speed on distal forelimb kinematics in faster asymmetrical gaits, i.e., galloping, when ground reaction forces are typically increased owing to the decreased number of contact points during a stride, combined with higher speed. Thus, it remains possible that primates use digitigrade hand postures during these higher-speed asymmetrical gaits. We investigated 3D angles in the wrist joint and metacarpophalangeal joint of 2 habitually digitigrade terrestrial monkeys, Erythrocebus patas and Papio anubis, across a large range of walking and galloping speeds on a motorized treadmill. Nonparametric analyses reveal that angles, and therefore hand postures, are not different at the subject’s walk-gallop transition. Regression analyses show that when walking, digitigrade postures are adopted at slow speeds and more palmigrade-like postures are adopted at fast speeds. Contrary to expectations, there is little change in hand postures across galloping speeds; both subjects maintained palmigrade-like hand postures with substantial joint yield and reextension during support. These results indicate that the hands are always less digitigrade at faster speeds because the joints of the distal forelimb cannot resist the higher ground reaction forces that accompany these higher speed gaits.     

Determining fall direction and impact location for various disturbances and gait speeds using the articulated total body model

Because fall experiments with volunteers can be both challenging and risky, especially with older volunteers, we wished to develop computer simulations of falls to provide a theoretical framework for understanding and extending experimental results. To perform a preliminary validation of the articulated total body (ATB) model for passive falls, we compared the model predictions of fall direction, impact location, and impact velocity as a function of disturbance type (faint, slip, step down, trip) and gait speed (fast, normal, slow) to experimental results with young adult volunteers. The three-dimensional ATB model had 17 segments and 16 joints. Its physical characteristics, environment definitions, contact functions, and initial conditions were representative of our experiment. For each combination of disturbance and gait speed, the ATB model was left to fall passively under gravity once disturbed, i.e., no joint torques were applied, until impact with the floor occurred. Finally, we also determined the sensitivity of the model predictions to changes in the model's parameters. Our model predictions of fall angles and impact angles were qualitatively in agreement with those observed experimentally for ten and seven of the 12 original simulations, respectively. Quantitatively, the model predictions of fall angles, impact angles, and impact velocities were within one experimental standard deviation for seven, three, and nine of the 12 original simulations, respectively, and within two experimental standard deviations for ten, nine, and 11 of the 12 original simulations, respectively. Finally, the fall angle and impact angle region did not change for 92% and 95% of the 74 input variation simulations, respectively, and the impact velocities were within the experimental standard deviations for 78% of the 74 input variation simulations. Based on our simulations and a sensitivity analysis, we conclude that our preliminary validation of the ATB model for passive falls was successful. In fact, these ATB model simulations represent a significant step forward in fall simulations. We believe that with additional work, the ATB model could be used to accurately simulate a variety of human falls and may be useful in further understanding the etiology and mechanisms of fall injuries such as hip fractures.     

Electromyography of lumbar erector spinae muscles--influence of posture, interelectrode distance, strength, and fatigue

The aims of the study were to obtain information (1) on surface electromyograms (SEMG) from the lumbar erector spinae muscles at different interelectrode distances and postures during short isometric contractions with constant force, (2) on the relationships between SEMG and extension force at different postures, and (3) on changes in SEMG during fatiguing isometric contractions at different postures and strengths. Six male subjects developed target forces in prone postures without gravity confounding the measurement of the extension torque. The angles between the constantly horizontal upper trunk and thighs were 90 degrees (P1), 135 degrees (P2), 170 degrees (P3), and 190 degrees (P4). Standard deviations of the distribution of SEMG amplitudes (RMS values), autoregressive (AR) time series models of the 15th order and spectral densities, including mean power frequency (MPF), were computed. Smaller interelectrode distances accompanied smaller RMS values and higher MPF. At a constant extension torque of about 110 Nm, RMS values and MPF increased from P1 to P4. Changes of interelectrode distance were of relatively minor importance, compared with the variation in the posture. With increasing torque, the increase in RMS values was steeper at P3 than at P2. The AR structure and MPF did not exhibit distinct effects of force. During sustained contractions at P2 and P3, only the highest force (mean = 140 Nm) at P3 caused a significant decrease of the MPF at the very beginning of the contraction. Endurance at P2 was greater than at P3. Higher forces and/or shorter muscles (P3) induced more pronounced and earlier relative decreases of the MPF and residual variance of AR models. Up to the "failure point", RMS values increased slightly, but without significant differences.     

Estimating severity of sideways fall using a generic multi linear regression model based on kinematic input variables

Many research groups have studied fall impact mechanics to understand how fall severity can be reduced to prevent hip fractures. Yet, direct impact force measurements with force plates are restricted to a very limited repertoire of experimental falls. The purpose of this study was to develop a generic model for estimating hip impact forces (i.e. fall severity) in in vivo sideways falls without the use of force plates.Twelve experienced judokas performed sideways Martial Arts (MA) and Block (‘natural’) falls on a force plate, both with and without a mat on top. Data were analyzed to determine the hip impact force and to derive 11 selected (subject-specific and kinematic) variables. Falls from kneeling height were used to perform a stepwise regression procedure to assess the effects of these input variables and build the model.The final model includes four input variables, involving one subject-specific measure and three kinematic variables: maximum upper body deceleration, body mass, shoulder angle at the instant of ‘maximum impact’ and maximum hip deceleration. The results showed that estimated and measured hip impact forces were linearly related (explained variances ranging from 46 to 63%). Hip impact forces of MA falls onto the mat from a standing position (3650 ± 916 N) estimated by the final model were comparable with measured values (3698 ± 689 N), even though these data were not used for training the model. In conclusion, a generic linear regression model was developed that enables the assessment of fall severity through kinematic measures of sideways falls, without using force plates.     

Wrist loading patterns during pommel horse exercises

Gymnastics is a sport which involves substantial periods of upper extremity support as well as frequent impacts to the wrist. Not surprisingly, wrist pain is a common finding in gymnasts. Of all events, the pommel horse is the most painful. In order to study the forces of wrist impact, a standard pommel horse was instrumented with a specially designed load cell to record the resultant force of the hand on the pommel during a series of basic skills performed by a group of seventeen elite male gymnasts. The highest mean peak forces were recorded during the front scissors and flair exercises (1.5 BW) with peaks of up to 2.0 BW for some gymnasts. The mean peak force for hip circles at the center or end of the horse was 1.1 BW. The mean overall loading rate (initial contact to first loading peak) ranged from 5.2 BWs-1 (hip circles) to 10.6 BW s-1 (flairs). However, many recordings displayed localized initial loading spikes which occurred during 'hard' landings on the pommel. When front scissors were performed in an aggressive manner, the initial loading spikes averaged 1.0 BW in magnitude (maximum 1.8 BW) with an average rise time of 8.2 ms; calculated localized loading rates averaged 129 BW s-1 (maximum 219 BW s-1). These loading parameters are comparable to those encountered at heel strike during running. These impact forces and loading rates are remarkably high for an upper extremity joint not normally exposed to weight-bearing loads, and may contribute to the pathogenesis of wrist injuries in gymnastics.     

Active responses decrease impact forces at the hip and shoulder in falls to the side.

Active responses, such as using the arm to break the fall, may be an effective means of decreasing likelihood of injury in a fall and may help explain why only a small percentage of falls result in a fracture. We quantified the impact force at the hip and shoulder in falls to the side from a kneeling position under three conditions: (1) attempting to break the fall by using an arm; (2) falling with the body relaxed; and (3) falling with the body tensed. Subjects fell from a kneeling position onto a force platform array covered with foam padding and impact force data were recorded. The ground reaction force-time curve was generally bimodal due to sequential impacts of the hip and shoulder. Impact forces at the hip and shoulder were 12 and 16% less for the slap condition (p < 0.05) than for the tensed condition. The impact forces for the relaxed and tensed conditions were not significantly different, although impact forces tended to be less in the relaxed condition. We concluded that active responses reduce the impact forces experienced at the hip and shoulder in falls to the side. Decreased effectiveness of protective responses, due to increases in reaction time and decreases in strength with age, may help explain why so many hip fractures occur in the elderly but so few occur in younger people.