How to Get Up After a Fall: A Step-by-Step Guide for Older Adults and Carers

Do Not Rush to Get Up

Almost everyone's first instinct on the floor is the wrong one. You land, you feel foolish, someone is watching, and every part of you wants to be upright again in the next two seconds so that the whole thing can be over. That instinct is the single most dangerous moment of an ordinary fall.

The reason is simple. A great many falls do no lasting damage. Some of them fracture a hip, crack a wrist, or knock a head hard enough to start a slow bleed — and in those first seconds, lying on the carpet, you cannot tell which kind you have had. Getting to your feet on a fractured femoral neck can displace it. Twisting up off a spine that took the impact can turn a stable injury into an unstable one. Standing up on a head injury that is about to make you dizzy earns you a second fall from standing height, which is worse than the first.

So the sequence in this guide begins where the clinical guidance begins: stop, stay still, and check. Everything else — the roll, the crawl, the half-kneel, the push — comes afterwards, and only if the check comes back clear.

A note on how we work: we researched published NHS, CDC and clinical guidance for this article and have cited it throughout, with every page we read listed at the end. We have not tested or demonstrated any technique ourselves, and nothing here replaces being taught in person.

The Sequence, in One Picture

Five stages, in order, and none of them start until the injury check is done.

Step 1: Stop. Stay Still and Breathe, Then Check for Injury

Do nothing for a minute. That is the instruction, and it is harder to follow than any of the physical steps that come later, because lying on the floor feels urgent and undignified and every instinct says get up, quickly, before anyone sees.

The NHS is unambiguous here: if you fall, try to stay calm, and take a couple of minutes to check for any pain or injuries and see whether you think you can get up. NHS Ayrshire and Arran's MSK physiotherapy service says the same in its own words — the first part of getting up is to remain calm and do not rush.

What to check, in order

• Hip and groin. The most consequential fracture in this whole topic. Pain in the groin or the upper thigh that spikes when you try to move the leg is the warning sign. OrthoInfo from the American Academy of Orthopaedic Surgeons describes hip fracture pain as acutely painful and usually limited to the groin and the upper part of the thigh.
• Head. Did you hit it? Do you know, for certain, that you did not black out — even for a second? A gap in the memory of the fall itself counts as a possible loss of consciousness.
• Neck and back. Central pain in the spine, or pins and needles, numbness or weakness anywhere, means stay exactly where you are.
• Wrists, elbows and shoulders. The instinctive hands-out landing puts the force through the wrist, and wrist fractures are among the commonest fall injuries. This matters for the next steps too, because the whole getting-up technique loads the arms.
• Everything else. Try small, slow movements of each limb before you attempt any large one. A gentle wiggle of a foot tells you something; heaving yourself upright tells you something far too late.

While you are doing this, breathe. Adrenaline and fright make people short of breath and unsteady, and both of those wear off in a minute or two if you let them. A person who lies still for two minutes and then gets up carefully is in a far better position than one who is upright in four seconds and swaying.

Step 2: Decide Whether to Get Up at All

This is the decision the entire article exists for. Some falls should never be followed by an attempt to stand, and the cost of getting this wrong is measured in displaced fractures and brain bleeds rather than in inconvenience.

Two further situations sit just below the emergency threshold but still need advice rather than a shrug. A fall with vomiting or dizziness afterwards, and a fall in someone on blood thinners even without an obvious head strike, both warrant a same-day call to a doctor or, in the UK, to NHS 111 — the NHS lists those among the reasons to get urgent advice after a head injury. So does a fall from a height of more than a metre or more than five stairs, which the NHS puts on its call-999 list outright.

And there is the quieter category: the fall that had a cause. If the person fell because they blacked out, because the room spun, because their chest hurt, or because a leg simply stopped working, then the fall is a symptom and the cause is the emergency. Getting them off the floor does not address it.

Step 3: If Uninjured, Roll Onto Your Side, Then Onto Hands and Knees

Only now does the getting-up sequence begin. The NHS instruction that opens it is worth quoting for its first four words: take your time — do not get up too quickly. Then roll onto your side, and use your arms to push yourself onto your hands and knees.

Two details make this stage go better:

• Pause on your side. Rolling is the first big positional change since the fall, and it is where light-headedness shows up. Stop there, breathe, and let it pass before you push up. If it does not pass, you have learned something important — stay down and call for help.
• Roll towards the stronger side where there is a choice, so that the arm doing most of the pushing is the one that can. If a wrist hurt during the injury check, that arm should not be the one taking your weight.

From your side, bring the top hand across to the floor in front of your chest and press. The arms do this work, not the abdominal muscles — there is no sit-up in this technique and there does not need to be.

Once you are on hands and knees, stop again. Check that both knees are comfortable on the surface. A hard tile or wood floor is unkind to kneecaps, and if there is a cushion, folded towel or rug within reach, sliding it under the knee that will stay down is a small kindness that makes the next two stages much easier.

Step 4: Crawl to Something Sturdy

The NHS instruction is to look for something stable to hold — such as a heavy piece of furniture, or a bath or sink — and to crawl to it if it is out of reach. Guy's and St Thomas' NHS Foundation Trust names sturdy furniture specifically: a sofa, a chair, or the stairs.

The word doing the work in both is sturdy. The chair you push up against will take a large share of your body weight through your arms at an angle, and a surprising amount of household furniture is not up to that.

What will hold, and what will not

• Good: a heavy armchair or sofa with its back against a wall; a solid dining chair; the bottom stair; a bath edge; a fixed vanity unit; a bed with a solid frame (not a bed on castors).
• Bad: anything on wheels or castors. An office chair will roll away at precisely the wrong moment. A wheeled walker or rollator is not a getting-up aid — its brakes are parking brakes and its frame can tip; NHS falls services are consistent that walking aids should not be used to pull yourself up from the floor.
• Bad: lightweight folding chairs, plastic garden chairs, nesting tables, a coffee table, a TV stand, a towel rail, a shower curtain rail, a radiator, or a door. Towel rails in particular come off walls; our bathroom safety checklist covers why a properly fixed grab bar and a towel rail are not interchangeable, which matters enormously if the fall happened in the bathroom.

Crawl on hands and knees, moving one limb at a time, and take a rest partway if the distance is long. If your knees genuinely cannot tolerate crawling — after a knee replacement, with severe arthritis, or with an amputation — this is exactly the point at which an individually taught technique matters, because some physiotherapy programmes teach an alternative in which the person shuffles backwards on their bottom to the bottom stair or a low step and lifts up onto it with the arms. That variation should be taught and practised with a therapist rather than improvised on the day.

If someone is with you, this is where they earn their keep: rather than watching you crawl across a room, they can bring a stable chair to you and hold it firmly against a wall.

Step 5: Kneel, Hands on the Seat, Stronger Leg Forward

Guy's and St Thomas' NHS Foundation Trust describes this stage as placing your hands on the furniture and bending your stronger leg forward. Broken into its parts:

1. Kneel facing the chair, close enough that you are not reaching for it. Close is stable; stretched out is not.
2. Put both hands flat on the seat — palms down on the cushion or the seat frame, not gripping the back of the chair. Pushing down on a seat is stable. Pulling on a chair back tips the chair towards you.
3. Bring the stronger leg forward and plant that foot flat on the floor beside the chair. You are now in a half-kneel: one foot flat, one knee down, both hands on the seat. That is four points of contact, which is why this position is the safe staging post of the whole sequence.

Which leg is the stronger one is not always obvious, and it is worth deciding in advance rather than on the floor. It is usually the leg that does the work on stairs, the one you naturally lead with when you stand from a chair, and the one that is not the arthritic hip or the replaced knee. If you use a walking stick, it is the leg opposite the hand the stick goes in — the pairing we explain in our guide to fitting a walking cane.

Pause in the half-kneel. Get your balance. Check that the chair has not moved and that your planted foot has real grip — which is a practical argument against smooth-soled slipper socks around the house, and for non-slip socks with genuine tread or proper shoes indoors.

Step 6: Push Up With Legs and Arms Together, Then Turn to Sit

Guy's and St Thomas' gives the order plainly: push through your arms and legs, then turn yourself around slowly and sit down.

Together is the operative word. The common error is to treat this as an arm exercise — to haul the body upward on the arms alone while the legs trail. Older arms usually cannot do it, the attempt fails halfway, and the failure happens in the least controlled position available. Drive the planted foot into the floor at the same moment the hands press down on the seat, and let the big muscles of the leg do what they are built for while the arms steady and share.

As you rise, the trailing knee comes up off the floor and that foot joins the other one. Do not try to come up and turn in a single motion. Come up first, get both feet under you and your balance settled with hands still on the chair, then turn slowly and lower yourself to sit.

Lower yourself deliberately, with a hand on the seat or arm of the chair. Dropping the last few inches into a chair is how compression fractures happen in an older spine, and it is an odd way to end a sequence you performed carefully up to that point.

Step 7: Sit and Rest Before You Stand

The NHS ends its sequence with the instruction to sit down and rest while you recover, and it is not a courtesy line. Getting up off a floor is a genuine physical effort — for many older adults it is the hardest single thing they will do that week — and it is followed by exactly the conditions that produce a second fall: a racing heart, shallow breathing, shaky legs and a blood pressure that has not caught up with the change in position.

So sit. Several minutes, not several seconds. Then stand slowly, with a hand on something solid, and pause once you are upright before you take a step. If standing makes you light-headed, sit straight back down — that light-headedness on standing is itself one of the treatable causes of falls, and the CDC's STEADI fall-prevention materials include postural hypotension as a specific thing to raise with a doctor.

Once you are up and steady, a few practical things are worth doing in the next hour rather than the next week:

• Tell someone. Guy's and St Thomas' ends its getting-up sequence with precisely this — tell someone you have fallen. A person who has fallen once today should not be alone and unmonitored tonight.
• Look at what caused it. The rug, the flex, the wet patch, the unlit hallway, the step you have misjudged before. Fix the one you can fix today.
• Watch for delayed symptoms. Worsening headache, confusion, drowsiness, vomiting, or pain that grows over hours rather than settling — all reasons to seek help even though you got up successfully.

If the fall happened getting in or out of bed, that is a specific and common pattern with specific answers — a bed rail or bed assist handle, a higher bed, and a lamp within reach. If it happened in the bathroom, our bathroom safety checklist goes room by room.

Step 8: Tell a Doctor, Even If It Feels Fine

This is the step people skip, and skipping it is the reason many second falls happen.

The CDC's falls data makes the case in one line: falling once doubles your chances of falling again. A fall is not a random event that has now passed; it is a signal about balance, strength, medication, blood pressure or vision, and the signal is actionable. The CDC also reports that more than one out of four older people falls each year but less than half tell their doctor, which is precisely how a treatable cause stays untreated until the second fall does the damage the first one missed.

The stakes are not abstract. The CDC reports around 4.5 million emergency department visits a year in the United States from older adult falls, nearly 319,000 older people hospitalised annually for hip fractures, and falls as the most common cause of traumatic brain injury in older adults. About 37% of people who fall report an injury that needed medical treatment or restricted their activity for at least a day.

What the appointment should cover

• A medication review. Sedatives, sleeping tablets, some antidepressants, and blood-pressure medicines all raise fall risk, and the review is free. CDC STEADI materials specifically flag medicines as a fall risk to discuss.
• Blood pressure lying and standing. A drop on standing is common, easily measured and often fixable.
• Eyes. An out-of-date prescription, cataracts, or new varifocals — which change how the ground looks at the bottom of the lens — are all ordinary culprits. "Check your eyes" is one of CDC STEADI's headline prevention steps.
• Strength and balance. The single most effective intervention in the entire falls literature is progressive strength and balance exercise, and that means a referral, not a leaflet.
• Feet and footwear. Pain, deformity and unsafe shoes are all on CDC STEADI's list, and all are fixable.
• Whether a walking aid is now appropriate, and if one is already in use, whether it is the right one and correctly fitted. Our guides to fitting a cane and to choosing between a rollator and a walker are written to prepare you for that conversation rather than replace it.

Say the word "fall" out loud at the appointment. Clinicians act on it; "I had a bit of a tumble, nothing really" tends not to make it into the notes.

Step 9: For a Carer — How to Help Without Lifting

If you are the one who finds someone on the floor, your instinct will be to get them up. Resist it.

NHS Ayrshire and Arran's MSK physiotherapy service gives helpers a sequence of its own: stop, stay calm, assess the situation, check for any injuries, make the person comfortable — and it warns, plainly, not to try to lift someone else unless you know what you are doing, because you could make things worse.

There are two distinct harms in a well-meant lift. The first is to them: an undisplaced fracture that would have healed with a pin can become a displaced one under traction from a pair of arms, and a spinal injury moved without support is the injury nobody recovers from. The second is to you. Lifting a limp adult weight from floor level, bent forward, usually from an awkward angle in a confined space, is a recipe for a prolapsed disc — and a carer with a damaged back is the beginning of a much larger problem for everybody involved.

What a helper actually does

1. Stop and reassure. Get down to their level so they are not looking up at you and craning their neck. Calm voice. No pulling.
2. Ask before you touch. Where does it hurt? Did you hit your head? Do you remember falling? Can you move both legs and both arms? Their answers are the assessment.
3. If anything on the emergency list applies, call 911 or 999 and do not move them. Put a blanket or coat over them, something soft under the head, and stay.
4. If they are uninjured, coach — do not lift. Talk them through each stage in their own time: roll to the side, pause, hands and knees, crawl. Stand close enough to steady, not to take their weight.
5. Bring the furniture to them. Place a sturdy chair where they are, back braced against a wall, and hold it there. This is the most useful physical thing a helper can do and it is not a lift.
6. Stay for the standing. Once they are sitting, stay for a few minutes. The moment they stand is a real second-fall risk.
7. Know when to call anyway. If they cannot get themselves up, if the effort is going badly, or if you simply cannot help safely, that is a call — not a failure. Many ambulance services and local falls teams operate a non-injury "lifting" or falls response service for exactly this.

Where a transfer belt does and does not fit. A gait or transfer belt is a handling aid for someone who can already bear weight and is being steadied or guided during a transfer — from bed to chair, or chair to frame. It is not a hoist and it is not a floor-recovery device. Using one to drag a person up off the floor is exactly the lift NHS guidance warns against. Where it earns its place is afterwards: a capable person rising from a chair with a carer steadying them, trained in how to use it. Our guide to gait and transfer belts covers what they are for, what they are not for, and the training that should come with one. If floor recovery is a recurring problem in a household, the equipment to ask about is an inflatable lifting cushion supplied through a falls service, not a belt and a strong back.

If a carer is regularly helping someone off the floor, that fact alone belongs in front of a clinician. It usually means the person needs strength and balance rehabilitation, a home assessment, or a review of what they are attempting to do unaided — and a physiotherapist can teach both people a technique that actually suits that body and that home.

The Long Lie: Why Time on the Floor Matters Medically

The phrase clinicians use for a prolonged period on the floor after a fall is a long lie, usually defined as an hour or more. It is treated as a serious clinical event in its own right, separately from whatever injury the fall caused, and understanding why changes how urgently people treat the "I'll just wait until someone comes" plan.

The best-known evidence comes from a prospective cohort study of people aged over 90 in Cambridge, published in the BMJ by Fleming and Brayne. Over a year of follow-up, 60% of participants fell at least once; 80% of those who fell were unable to get up without help on at least one occasion; and 30% of fallers lay on the floor for an hour or more. The authors reported that long lies were strongly associated with serious injuries, admission to hospital, and subsequent moves into long-term care.

The mechanism is not mysterious. Lying still on a hard floor for hours produces, in order of how quickly they arrive: cooling and then hypothermia, especially on tile or in an unheated room; dehydration, because there is nothing to drink; pressure damage to skin over the hip, heel, shoulder and ear; muscle breakdown from sustained compression, which can injure the kidneys; and chest complications in someone lying immobile and cold. None of that is caused by the fall. All of it is caused by the waiting.

The NIHR's evidence summary on floor-rise training puts the scale of the problem in one sentence: only about half of people who fall without injury can get themselves back up, and many stay on the floor for at least an hour, risking complications such as pressure sores or pneumonia.

The practical conclusion: a way to call for help, within reach

The most striking finding in the Fleming and Brayne data is not about injury at all. It is that call alarms were available but almost never used — the overwhelming majority of long lies happened to people who had an alarm system and did not activate it. An alarm in a drawer, a pendant left on the bedside table, or a phone charging in the kitchen is not a way to call for help. It is an object.

So the useful version of this advice is narrow and specific:

• It has to be worn, not placed. A pendant or wrist button that lives on the body all day, including in the bathroom and the garden, is the only configuration that works — because falls do not wait until you are near the handset.
• It has to be usable after a fall. A phone is only a lifeline if it is in a pocket. Carrying it from room to room in a pocket or a cross-body bag is a free upgrade that costs nothing but a habit.
• Agree a check-in. A daily call at a fixed time, from a person who will act if there is no answer, is a low-technology version of the same protection and is often more reliable than a device nobody wears.
• Leave a key safe or key with a neighbour. Help that arrives and cannot get through the front door has not arrived.

If you want to see what wearable help buttons look like, current listings are here; monitored services differ enormously in how they work, what happens when the button is pressed, and whether they function outside the home, so read that detail rather than the headline claim. We have not tested any monitored service, and this is one purchase where the local falls service or occupational therapist is likely to have better advice than any website.

If you cannot get up: what to do while you wait

Guy's and St Thomas' NHS Foundation Trust gives clear instructions for this situation, and they are worth knowing in advance because they are hard to think of on the spot:

• Get help. Shout if someone else is in the house. Use a personal alarm or a phone if either is within reach. It is fine to phone 999.
• If you cannot reach a phone or an alarm, the NHS advises trying to attract attention — shouting for help, or banging on a wall or the floor.
• Get warm. Pull down anything reachable that will cover you: a blanket, a rug, a coat, a tablecloth, cushions. Heat loss into a hard floor is the risk that arrives first.
• Keep moving. Roll from side to side and move your arms and legs — this helps keep you warm and reduces pressure damage. The NHS advises changing position roughly every half hour where you can.
• Make yourself comfortable. Something soft under the head, cushions for support, and a change of position when one spot starts to ache.
• Sip a drink if one is within reach.

Situation, Action, and the Thing Not to Do

The right-hand column is the one that matters. Most fall harm that happens after the fall comes from an action taken with good intentions.

Practise It Before You Need It

Everything above is far easier to do if the body has done it before. A technique read once on a screen and attempted for the first time on a cold bathroom floor, shaken and alone, is not the same skill as one that has been practised on a rug with a physiotherapist watching.

Physiotherapy services teach floor-rise using a method called backward chaining: the movement is broken into small steps and taught in reverse order, starting from the last step — standing at the chair — and working backwards towards lying on the floor. Because the learner never has to begin from flat on the floor, the anxiety that stops many people from even trying is largely removed. The NIHR's evidence summary notes that although physiotherapy guidelines recommend teaching older people how to cope with a fall, it rarely happens in practice, partly because older people and therapists alike lack confidence in it — and that care workers, exercise professionals and family members could reasonably be taught to deliver it too.

So the request to make is specific. Not "can you help with my balance", but: "Can you teach me how to get up off the floor, and can we practise it?" A physiotherapist can adapt the sequence to an individual's knees, hips, shoulders and home layout — including the alternatives for people who cannot kneel — and can tell you honestly whether floor recovery is realistic for that person at all. If it is not, that answer is just as valuable, because it shifts the plan towards a worn alarm, a daily check-in and a falls response service.

Practise on a carpeted floor, with something sturdy in position, and with another person present the first few times. And practise the other half too: the position to get comfortable in, and how to reach a phone from the floor.

Frequently Asked Questions

Sources

• NHS — Falls (stay calm and take a couple of minutes to check for pain or injuries; take your time and do not get up too quickly; roll onto your side, push onto hands and knees, find something stable to hold, put one foot flat on the floor, stand slowly, sit and rest; use a phone or personal alarm, or shout or bang on a wall or floor; keep warm and change position; call 999 if the head, back, neck or hip may be injured or the person cannot get up; see a GP after a fall).
• Guy's and St Thomas' NHS Foundation Trust — Falls: what to do if you fall (the eight-stage getting-up sequence: roll onto your side, push onto hands and knees, crawl to sturdy furniture such as a sofa, chair or stairs, place hands on the furniture and bend the stronger leg forward, push through arms and legs, turn slowly and sit down, rest, tell someone; if you cannot get up — shout, use an alarm or phone, it is OK to phone 999, keep warm with a blanket, roll side to side and move arms and legs, sip a drink).
• NHS Ayrshire & Arran MSK Physiotherapy — Falls (the first part of getting up is to remain calm and do not rush; call 999 for head, back, neck or hip injuries; guidance for helpers — stop, stay calm, assess the situation, check for any injuries, make the person comfortable; do not try to lift someone else unless you know what you are doing because you could make things worse).
• NHS — Head injury and concussion (call 999 for a head injury with failure to wake, inability to stay awake, a fit, a fall from more than one metre or five stairs, vision or hearing problems, fluid or blood from the ears, new numbness or weakness, or problems with walking, balance, speech or understanding; get urgent advice if you have a condition that thins your blood or take medicine that thins your blood).
• CDC — Facts About Falls (more than one out of four older people falls each year but less than half tell their doctor; falling once doubles your chances of falling again; about 4.5 million emergency department visits a year; nearly 319,000 older people hospitalised for hip fractures each year; falls are the most common cause of traumatic brain injury in older adults; about 37% of those who fall report an injury requiring medical treatment or restricting activity for at least a day).
• CDC STEADI — Patient & Caregiver Resources (falls are preventable; talk to your doctor about fall risks and prevention; medicines as a fall risk; check your eyes; keep moving; make your home safer; materials covering postural hypotension and feet and footwear).
• OrthoInfo, American Academy of Orthopaedic Surgeons — Hip Fractures (a hip fracture is acutely painful, with pain usually limited to the groin and upper thigh; with most hip fractures you will not be able to stand, bear weight or move the upper leg; the injured leg will often appear shorter than the opposite leg and will be twisted or rotated; patients are usually taken to hospital by ambulance).
• Fleming J, Brayne C — Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90 (BMJ, 2008) (60% of participants reported at least one fall over a year; 80% of those who fell were unable to get up without help on at least one occasion; 30% of fallers lay on the floor for an hour or more; long lies were strongly associated with serious injuries, hospital admission and subsequent moves into long-term care; call alarms were available but very rarely activated during long lies).
• NIHR Evidence — Getting up after a fall: training could encourage older people to get themselves back up (backward chaining breaks getting up into small steps taught in reverse order, reducing anxiety because the learner does not have to start lying flat on the floor; only about half of people who fall without injury can get themselves up; many remain on the floor for at least an hour, risking pressure sores or pneumonia; physiotherapy guidelines recommend the training but it rarely happens).
• The Chartered Society of Physiotherapy — Fall Proof: a guide to getting up from falls (physiotherapy guidance on fall prevention and on getting up if you are unhurt and think you can).

Clinical guidance above is summarised from the published sources listed and is general information, not medical advice. Emergency numbers differ by country: 911 in the United States, 999 in the United Kingdom. If you are injured or unsure after a fall, call emergency services rather than attempting to get up.