Fallen Before? Backward Chaining Can Help You Feel More Confident
A fall can affect much more than your physical health.
For many people, one of the biggest consequences is a loss of confidence. You might start worrying about falling again, avoiding certain activities, walking less, or relying more heavily on family members.
A very common worry I hear as an Occupational Therapist is:
“What would I do if I fell and couldn't get back up?”
This is where a technique called backward chaining can be really useful.
What is backward chaining?
Backward chaining is a way of breaking an activity down into smaller, manageable stages and learning it from the end backwards.
When we use backward chaining as part of falls rehabilitation, we don't necessarily start by asking someone to lie on the floor and get themselves all the way back up.
For someone who has recently fallen or is already anxious about falling, that can feel incredibly daunting.
Instead, we might start with the final and most familiar part of the movement – for example, safely standing from a chair.
Once the person feels comfortable with this, we can gradually work backwards.
This might progress to:
Supported kneeling → sitting on a chair → standing
Then:
Hands and knees → supported kneeling → sitting on a chair → standing
And eventually, where appropriate:
Floor → hands and knees → supported kneeling → chair → standing
Each stage is introduced gradually and according to the person's individual abilities.
Why can backward chaining help after a fall?
After experiencing a fall, it is completely understandable to become more cautious.
The difficulty is that fear of falling can sometimes lead people to do less.
Someone may stop going outside, avoid the stairs, reduce their walking or rely increasingly on other people.
Over time, reduced activity can affect strength, balance and confidence – potentially making everyday activities feel even more difficult.
Backward chaining gives us an opportunity to practise safely and answer some of those frightening “what if?” questions.
Instead of thinking:
“If I fall, I'll be completely helpless.”
The person can begin to think:
“I know what to do. I've practised this before.”
That change in confidence can be incredibly valuable.
It's not just about getting off the floor
As an Occupational Therapist, I'm not only interested in whether somebody can physically complete a floor transfer.
I'm also looking at the whole situation surrounding their falls.
This might include:
What caused the fall?
Is balance, strength or mobility contributing?
Is the person becoming anxious or avoiding activities?
Can they recognise whether they may be injured?
How would they summon help?
Is appropriate equipment or technology available?
Is the home environment increasing their risk?
Could small changes make everyday activities safer?
Would Physiotherapy or another service also be beneficial?
Sometimes the most important outcome isn't somebody being able to get completely off the floor independently.
It may be knowing how to move into a more comfortable position, reach a telephone or falls alarm, keep warm and call for help safely.
Should everyone practise getting up from the floor?
No.
Floor transfer practice isn't appropriate for everybody and should be considered according to the person's health, mobility, strength, cognition and individual circumstances.
If someone actually falls, they should not rush to get up.
If there is significant pain, a suspected injury, a head injury, dizziness, illness or an inability to move normally, they should seek appropriate assistance rather than attempting a floor transfer.
Backward chaining is best introduced and practised when the person is safe and well, with appropriate assessment and support.
Worried about falling?
If you or someone you care for has experienced a fall, is becoming less steady or has started avoiding activities because of a fear of falling, an Occupational Therapy assessment can help.
I can look at mobility around the home, everyday activities, confidence, equipment, the home environment and strategies to help someone remain as safe, confident and independent as possible.
Sometimes, having a plan for “what if I fall?” can make a big difference to having the confidence to keep doing the things that matter.
Helena Amos Occupational Therapy
Helping you remain safe, confident and independent at home and in the community.
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