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Fall On Outstretched Hand (FOOSH) is an acronym commonly used by healthcare professionals to describe a mechanism of injuries in which a person instinctively uses their hand to break their fall. It typically results in fractures or sprains to the wrist, elbow, or shoulder. FOOSH injuries are common in sporting activities like gymnastics, cycling, running, contact sports, but it can occur to anyone who experiences a fall.^[1][2]

FOOSH injuries typically occur when one falls forward or sideways and instinctively extends a hand or arm out to break their fall. Odds of injury are generally higher when there is sufficient kinetic energy in the fall and also when the impact force is concentrated on a single part of the body rather than being distributed more evenly across a wider body area. Activities like football, skateboarding and cycling, where an athlete may instinctively throw out their hands to protect themselves in a tumble, are common examples of how FOOSH injuries can occur.^[3][1][4]

When a person extends their arm to absorb the impact of the fall, the force can typically travel from the hand through the wrist, forearm, elbow, and shoulder, resulting in possible injuries throughout those areas.^[4] Typically, when the hand lands hard on the ground, and the wrist is hyperextended, it can result in forces stretching or tearing the ligaments in the wrist, causing a wrist sprain.^[5][4] Wrist fractures can also be commonly caused from falls with the wrist extended and pronated. In this position, a dorsal bending moment is applied across the distal radius where the thin dorsal bone can collapse under intense compressive force, resulting in impaction and a distal radius fracture, such as a colles' fracture.^[6]

Other injuries associated with FOOSH include carpal fractures, particularly fractured scaphoid; shoulder fractures, smith fractures, cellulitis, boxer's fractures, factures in the forearm, and elbow fractures and dislocation.^[2][3][7][8]

Diagnosis of FOOSH injuries typically involves clinical assessment and medical imaging.

The risk or severity of FOOSH injuries may be reduced through the use of protective equipment, safer falling techniques, and measures that reduce the likelihood or the impact of falls.

Safe falling techniques aim to distribute impact across larger body areas so no one particular part of the body receives the brunt of the fall, and to avoid directly falling on vulnerable bones and joints.^[9] A 2017 meta-analysis that reviewed 13 human studies and examined 7 landing strategies, found that specific falling techniques can significantly reduce impacts forces during a fall and may reduce severity of fall-related injuries. It outlined that when it came to falling sideways, both forward rotation and martial arts rolling (side falls) had a very high protective effect. The review also found squatting strategies were effective in reducing backward fall impact, and "elbow flexion with outstretched arms" technique had a significant effect in reducing forward fallling impact. The review however concluded that, unlike all other assessed strategies, the martial arts slapping technique was the only one deemed ineffective in significantly reducing overall impact severity.^[10]

• Sports injury
• List of medical abbreviations: F
• Ukemi

A common injury that occurs when falling on outstretched hand. Usually impacts the wrists.

.

Most injuries to the arm are FOOSH injuries, due to people having a reactive tendency to use their hand to break their falls.

Proper learned safe falling techniques can help reduce odds of injury.

Systematic review in the Archives of Physical Medicine and Rehabilitation; found safe falling techniques can lower the energy of falls by 40% to 60%.^[11]

• Try landing on your big muscles and not on your bony bits. Avoid landing on bones such as your elbows, knees, tailbone, hips, or wrists.
• Keep knees and arms bent.

• Protect impact to head, if falling backwards - tuck your chin to your chest.
• Keep falling. To educe the energy of the fall further - you should allow yourself to roll with the energy, only trying to stop when the energy is more dissipated. Ideally follow the roll of a martial artist being thrown.
• Do not lock out your joints or throw out your hands. Doing so may lead to the full force be concentrated focused on one area (typically palms) - and accelerate the fall. Ideally one should keep body relaxed as you can, land on the soft, meaty, or squishy areas of the body, and try to extend entire falling process to spread out the energy. Do not try to stop the fall abruptly but rather roll through the fall so no one particular area takes the brunt of fall.^[12]
• If on bike - Falling safely on bicycle means involves resisting the urge to lock your arms and instead opting for a "tuck and roll" technique, aiming to land on one's shoulder and roll with the impact to absorb momentum. Ideally; separate from the bike, keep limbs tucked in, and aim for the soft surface if possible.
• Falls on bikes are typically falling forward given forward momentum and tripping or losing balance - anc a tuck and roll method can help prevent significant injuries. Tuck in so elbows are besides ribs and hands near chest to avoid injuries to wrists. And continue to roll to absorb the last bit of forward momentum, and "slap out" to spread out the force as widely as possible. There is no safe way to fall. But can reduce the worst kind of falls; Ideally relax and roll and do not lock joints and don't put arms out, is generally the best one can do.
• The potentially life saving manoeuver doesn't come naturally but learning to relax and roll is very easy to practice, even at home. Japanese ukemi techniques are good forn practising and enforcing muscle memory to help fall safely. Can help with “don't panic + protect head + distribute impact” reflex tho not foolproof.^[13]