| ||Medical Myths || |
'I'm Such a Klutz!'
March 9, 2012
By Robert H. Shmerling, M.D.
Beth Israel Deaconess Medical Center
When my daughter was 8 years old, she'd regularly bound into a room, knocking things (and people) over. She'd rumble into things much like our golden retriever. Our excuse for the dog was that he did not realize how big he was. So, what was our daughter's excuse?
We suggested she be more careful, move more slowly, and that she watch where she was going. It didn't really work.
Have you known people with similar tendencies? Are you bad at sports because you're "uncoordinated?" Could a medical reason explain it?
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Can You Really Be "Accident Prone"?
It does seem as though some people, like my daughter, experience more than their fair share of accidental injuries to themselves, others and nearby property. I'm convinced that most people who call themselves "accident prone" or "klutzy" are just in a hurry, impulsive, not paying attention or some combination of these.
However, there are conditions in which coordination is impaired. And it's likely that at least some small percentage of the "bulls in china shops" have one of these conditions. More on that in a moment.
To understand how a disease might impair coordination, it's worth understanding a bit about how our bodies handle normal coordination when everything is working well.
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Coordination Is Complicated
Most of us take our coordination for granted. When everything is working as it should, it's fairly effortless to walk across a room without bumping into anything or falling. More complex tasks like catching a fly ball, dancing or driving a car may seem effortless to those who have practiced these activities. Yet, each of these requires a huge number of nerve signals traveling to and from the brain.
- The eyes send signals to the brain about the three-dimensional arrangements of objects in our nearby environment.
- We have nerves that sense the position of our bodies in space.
- Our inner ears tell us which way is up and whether the horizon is level.
- The cerebellum integrates huge amounts of information about spatial relations and movement. And, after integrating this information, it communicates with other parts of the brain to provide updates regarding balance, body position and how the body should move next.
When certain muscles contract, others relax. When you salute, for example, you smoothly swing your arm and hand alongside your head rather than making a jerky movement that ends with you smacking yourself. And during movement, constant feedback tells us whether we're heading in the right direction or whether an adjustment is needed.
While simple activities (such as walking) require almost no active attention, they clearly require some focus. Otherwise you'd never have heard the expression, "Watch where you're going!" The environment can change your dog scurries underfoot, someone opens the refrigerator door as you walk by, a wasp lands on your nose. Each of these requires visual input, interpretation by the brain ("I'm really not happy about this wasp situation") and nerve signals to the muscles to take action, such as changing your stride (so you don't step on the dog), veering to the left (to avoid the refrigerator door) or swatting the wasp off your nose.
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How Things Can Go Wrong
As with so many things, we're most likely to appreciate how well our coordination systems work when they fail us. For example, a deficiency in vitamin B12 may occur among people whose diet is deficient or who cannot absorb the vitamin. This can lead to a number of problems, including nerve damage that affects your sense of position.
For example, it may become hard to know precisely where your foot is as you're walking. Loss of balance and poor coordination are common with vitamin B12 deficiency. Fortunately, this condition is reversible if found early and treated with supplemental B12.
Other causes of poor coordination include:
- Disease of the brain (as may occur with stroke) or nerves (as commonly occurs with diabetes)
- Movement disorders such as Parkinson's disease
- Dehydration Inadequate fluid intake may make you feel faint or dizzy.
- Electrolyte abnormalities Low salt, potassium or calcium can affect muscle, nerve and brain function.
- Arthritis Pain or stiffness may make it impossible to move precisely as intended.
- Impaired vision Loss of visual cues can make it difficult to navigate through your environment.
- Medications or drugs The list is long, but blood pressure medicines and alcohol are particularly common culprits.
In fact, just about any illness, especially if it lasts a long time, may lead to immobility, muscle weakness and reduced coordination. This tends to get better as you recover. But getting your strength and coordination back after a hospital stay is an important goal of physical therapy or a stay in a rehabilitation facility.
And, of course, healthy people can have poor coordination as well. Just ask anyone who has been sleep deprived, distracted, in a rush or just trying to do too many things at once. I suspect this is one reason people sometimes say, "The hurrier I go the behinder I get."
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Clumsiness Can Be Dangerous
We've all been embarrassed by a clumsy misstep. Maybe your hand knocked over a cup of coffee during a spirited conversation. Or maybe you backed into a stack of soup cans with your shopping cart. I once walked into a display case at a museum and had to get several stitches in my forehead.
Yes, these mishaps are embarrassing. But they can also cause significant injury. A hip fracture, for example, causes more than just pain. An elderly person who falls and breaks her hip has a good chance of losing his or her independence. About 25% of hip fractures in the elderly lead to admission to a nursing home or other long-term care facility. And about 5% of those who break a hip will die of complications in the following months.
So, while "clumsiness" is embarrassing and potentially painful, it can also be dangerous. If you find you are often knocking into things or injuring yourself, it makes sense to get checked out. There may be steps you can take to improve the situation.
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What Can You Do?
Not all "klutziness" is inevitable. That is, maybe you're actually not a klutz. Maybe your vision is bad. Or your medications are affecting your balance. Keep an open mind and don't assume your coordination (or lack of it) is something you have to live with.
Try to be more mindful of your movements. Plan how you're going to move rather than rushing forward. Then see if how you move through space improves. Of course, it can be a trick to slow down a bit and pay more attention to your movements without becoming "hypervigilant" and paralyzed with carefulness.
Keep in mind that most "klutzes," after medical evaluation, turn out to be normal and healthy. For these people, the focus should be less on medical testing (which, let's face it, can be endless) and more on finding ways to help. For example:
- See a physical therapist to improve your balance and coordination. Physical therapists can help. They may use techniques that help stroke patients recover.
- Choose exercise that improves strength and balance: dancing, tai chi and yoga. Cross train so you won't become bored and quit.
- Enroll in a relaxation program. You may become clumsy when you're nervous. Learning to control anxiety may improve how you move.
- Improve your visual tracking. Certain exercises may be able to stimulate the nerve connections that allow the eyes to track an object and send signals back to the brain. This is an essential talent for having good hand-eye coordination. People with balance problems or dizzy spells may get better by tracking an object near the horizon while keeping the head still, or while moving the head and keeping the eyes focused. These types of exercises are not yet proven to help with "garden variety clumsiness," but it's possible that they could.
- Reduce the clutter in your home. For many people, knocking things over is less about being a klutz than it is about disorganization and clutter in the house. Rearrange your furniture and get rid of the clutter so it's easier to navigate rooms with fewer turns. Use textured, no-slip surfaces or remove rugs altogether.
- Improve the lighting in your home. Get your eyes checked. New glasses, treatment for cataracts or brighter light bulbs, for example, might cure your klutziness.
- Add handrails and grab bars near your stairs or tubs. You'll have something to grab on to if you start to fall.
- Check your drugs. Some can make you clumsy, especially if they make you dizzy, sleepy or weak. If you aren't sure whether one of your medicines might be causing trouble, ask your doctor or pharmacist.
- Get your bone density checked. Even if you can't reverse your klutziness, at least you can limit the damage from falls. Improving your bone density can reduce the risk you'll fracture your hip, spine or other bone if you fall.
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The Bottom Line
See your doctor if you've become more clumsy than usual, especially if your clumsiness seems to be increasing or is causing injuries. Chances are good that it's nothing serious. Work on your strength, balance and coordination through exercise.
As for my daughter, she pretty much "grew out of it," excelling in softball in middle school and making her varsity field hockey team in high school. My guess is that she just needed to pay more attention to her environment.
Improving one's "situational awareness" paying attention to your position in space and to what is nearby could be the cure for the common klutz.
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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.