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Is a fear of falling a symptom of osteoarthritis?

Q) I'm 86 and have had osteoarthritis for many years. This has worsened during the past five years with me requiring a walking stick and now a tri wheel walker. The worst side-effect is that I can't go down slopes and am nervous even with the help of the walker, feeling that I will fall over. Initially I believed that this was a psychological reaction but I was assured that it was a symptom of the disease. Is this correct, please, and is there anything I can do about it?
Robert, via email (Summer 2013)

A) People with osteoarthritis of joints in the legs commonly complain of nervousness and fear of falling. I think the cause of this is not straightforward but a result of many factors all of which can contribute. In some people, especially those who have already fallen, psychology does play a part and it takes some time and effort to get the confidence back. Other factors are more directly related to the arthritis. As joints become more arthritic, the muscles controlling them weaken, thus increasing the chance that the joint will give way. At the same time the mechanisms that the joint uses to judge balance and position also fail, increasing the chance of a fall. And pain in the joint causes people to trip and fall, especially if it is sudden and severe. The good news is that all these factors can be controlled with treatment – with drugs to control the pain and exercises to increase strength and mobility. Most physiotherapy departments will also have balance and walking classes which you can attend. And finally, doesn't that walker of yours have brakes? It certainly should do!

This answer was provided by Dr Philip Helliwell for the Summer 2013 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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