After the fall: The hidden costs and complications of non-fatal fall injuries in the roofing industry.

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Broken feet, a few thrown-out backs, and a nasty muscle tear in the shoulder. These were just a few of the issues familiar to the roofer that repaired our damaged roof after Hurricane Florence (North Carolina). He’d suffered a fall from a ladder and a few near-misses earlier in his career. While the bones and bruises had healed years ago, his ankles ached, his back was stiff most mornings, and he admitted his shoulder still kept him up some nights. 

Falls are complicated – what happens now can affect you later.

Some of the most severe and costly injuries in the roofing industry are due to falls. Most estimates report an average cost of $106,000 for falls from elevations and $68,000 for falls from ladders or scaffolds. Falls are expensive to treat medically because a fall rarely impacts only one part of the body. It’s common for a roofer to sustain multiple injuries to the head, back, and limbs, hence the initial high costs.

However, the story is far from over once the initial trauma has healed. Even in the best-case scenario, a seemingly healed injury can cause costly consequences down the road if collateral injuries go undetected. And they often do, because while the attention is on the primary injury (which is apparent), less-important or less-urgent problems may be missed or ignored. The longer you ignore something, the easier it is to forget!

Here are three primary injuries experienced by roofers, potential hidden or collateral injuries to watch out for, and the subsequent costs they may incur: 

Primary injury #1: foot fractures

  • Costs (direct +indirect): $31,500
  • Time Away From Work: 6 weeks to 3 months
  • Hidden Injury: High Ankle Sprain 
  • Costs: $35,500
  • Time Away From Work: 4 weeks to 2 months with early diagnosis 
  • Long Term Effects: chronic ankle pain, poor balance, loss of calf muscle strength

A fracture is a break in a bone. Falls that involve direct trauma to the feet usually cause multiple fractures, due to the level of force and intricacy of the foot itself. 

A high ankle sprain (or syndesmosis sprain) occurs as the result of a twisting or high force injury. The long bones of the lower leg are destabilized just above the ankle. These injuries are associated with high rates of disability, with many cases going undiagnosed for 6-12 months or longer despite persistent pain. Professional NFL football athletes can stay on the injured reserve list for several months following this injury, even when diagnosed early.

Primary injury #2: shoulder muscle tears

  • Costs: $51,500
  • Time Away From Work: 4 weeks (no surgery) to 4+ months (surgery)
  • Hidden Injury: Shoulder joint instability 
  • Costs: $64,500
  • Days Away From Work: 1-3 weeks per pain episode (no surgery) to 4+ months (surgery)
  • Long Term Effects: chronic neck/arm pain, shoulder arthritis, pinched nerves, loss of arm/grip strength

The rotator cuff muscles stabilize the shoulder’s ball and socket joint. They may be damaged due to a fall on the shoulder or outstretched arm. They may also suffer harm due to pulling forces in an attempt to grab and catch oneself from falling. 

The rotator cuff is the secondary restraint system supporting the shoulder joint, the first line of defense being the ligaments that hold the joint together. When injury forces are high enough to tear muscles, ligaments may also be damaged, creating instability of the joint. Surgery may not be required for small ligament tears but left unaddressed these injuries can cause other complications and accelerate wear and tear.  

Primary injury #3: lumbar muscle strains 

  • Cost: $69,000 
  • Lost Work Time: 10 Days
  • Hidden Injury: Internal Lumbar Disc Herniation
  • Cost: $85,000
  • Lost Work Time: 7-10 days per pain episode (no surgery) to 3+ months (surgery)
  • Long Term Effects: chronic back pain, spine arthritis, loss of hip mobility, leg weakness

A lumbar (back) strain describes small tears in the muscles. Directly falling onto the muscles, or the forces they generate to “brace” for impact, can cause these tears. 

The force of a fall can also cause disruptions to the shock-absorbing discs in the spine. A herniated disc, sometimes inaccurately called a slipped disc, occurs when the cushioning gel at the center of a disc has ruptured through the disc’s wall. Conventional medical tests can easily detect this injury when the gel breaches entirely through the wall. 

The disc wall is up to 20 layers thick, meaning that if the injury forces are relatively low, only the inner layers are damaged, and no gel leaks out. What follows is an incredibly painful but masked condition called an internal disc herniation. An internal herniation can be misdiagnosed as repeated back strains because the back muscles are tight and painful. The muscles are protecting the spine but not injured themselves. Unfortunately, the diagnosis of “back strain” is often over-used when no back trauma occurred, and x-rays are free of broken bones.


Fall-related injuries in roofers can be costly, and associated problems may not be readily apparent. While still expensive in terms of time and money, early identification of collateral injuries can prevent long-term complications such as chronic pain, accelerated wear and tear, and repeated work absence. If pain or disability persists beyond the expected healing time following a fall, consider that healing may be incomplete, and additional investigation is needed. 


  1. Estimated costs of occupational injuries and illnesses and estimated impact on a company’s profitability worksheet. Occupational Health and Safety Administration. U.S. Department of Labor. 2019.
  2. Injury facts; Workers’ compensation costs. National Safety Council. 2017
  3. Construction Industry; Workers’ compensation costs among construction workers. Occupational Safety and Health Administration. 2012
  4. Nonfatal Occupational Injuries and illnesses requiring days away from work. Bureau of Labor Statistics. 2015
  5. Length of Disability and Medical Costs in Low Back Pain. Journal of Occupational and Environmental Medicine. 2015

Are you dealing with persistent pain or weakness after a fall, and aren’t sure what to do about it? f you have questions, reach out to us at We answer every question.