Balance Disorders: The Unseen Effects of Jobsite Fall Injuries

Depending on the injury, neurological impairments could occur after musculoskeletal injuries have healed.
By Michael Morgan
September 13, 2022

Nonfatal workplace injuries resulting from falls continue to occur at a higher rate in the construction industry compared to the private industry at large. To heighten awareness and reinforce construction worksite safety measures around this ongoing problem, OSHA developed the National Safety Stand-Down campaign, which encourages contractors to emphasize the importance of fall prevention by training employees on the worksite hazards that lead to falls.

After an employee suffers a fall or direct blow to the head, healing from injuries incurred is of paramount importance. But depending on the type of injury, there could be underlying neurological impairments even after the musculoskeletal injuries have healed. These impairments can include dizziness or a persistent imbalance that occurs while walking, bending or performing other normal physical activities. These sudden, recurring bouts of unsteadiness can place a construction employee at higher risk of falling again on the job.

Understanding vestibular dysfunction

Athletic trainers and physical therapists may be exposed to patients who exhibit symptoms such as unsteadiness and instability, which are often associated with vestibular system dysfunctions. The vestibular system includes parts of the inner ear and brain that help to control balance and eye movements. This sensory system provides the brain with information about our head position, motion and body posture in relation to our surrounding environment. Some common causes of vestibular dysfunction include:

  • Traumatic head/brain injury;
  • Aging;
  • Genetic conditions;
  • Viral infections; and
  • Medicines.

Environmental factors can impact vestibular function

When the vestibular system is damaged, loss of equilibrium, blurry vision, hearing loss, dizziness and imbalance or unsteadiness may occur. And environmental factors such as weather (e.g., extreme heat) can exacerbate or trigger symptoms of a vestibular disorder. The sudden onset of these symptoms in a hazardous work environment such as a construction site can escalate injury risks to dangerous, life-threatening levels.

Balance function is important in construction due to the amount of time employees spend on uneven and unstable surfaces (e.g., dirt/rocky surfaces, elevated/moving platforms, unstable/unfinished flooring and foundations, etc.). Whether working on a high-rise build or a highway expansion, vestibular function is essential to this workforce due to the need to focus on tasks while moving and contending with external motion in their work environment. If the vestibular system is disrupted, an employee may experience illusions of motion in their peripheral vision and subsequent imbalance.

Extended exposure to high-noise environments such as construction sites can damage hearing and affect balance. And because there is a natural connection between hearing and balance, noise exposure is yet another environmental condition that can place a construction employee suffering from balance issues at greater risk of suffering a fall.

Diagnosing vestibular disorders

Clinicians with extensive training in vestibular rehabilitation—such as ear, nose, and throat specialists and some physical therapists—are most qualified to examine patients who exhibit signs of a vestibular disorder. These clinicians can also diagnose the condition and develop a treatment plan to improve or eliminate the symptoms to a level that restores stability, significantly reducing a patient’s risk of suffering a fall and related injury. Diagnosing a vestibular disorder can require performing a battery of tests and compiling patient health data to determine the central or peripheral cause of a patient’s complaint(s), such as:

  • Hearing/vision exams;
  • Head/brain scans;
  • Balance/posture exams; and
  • Specialized testing (e.g., electronystagmography (ENG), rotational chair, calorics).

A clinician may also review a patient’s medical history, including any past or recent injuries, to determine if an underlying health condition(s) could play a role in the onset of symptoms.

Treating construction employees with vestibular disorders

Vestibular therapy may include general strengthening and flexibility exercises, and active head and body movements that focus on motor skills in response to changes in body/head position, as well as visual-dependency exercises to help stabilize vision through repeated exposure to specific movements or visual stimuli that provoke dizziness. Therapists who specialize in this population can also perform manual canalith repositioning maneuvers to resolve positional vertigo. Therapy can also include the use of assistive devices, such as balancing tools that help regain balance and other techniques designed to reduce symptoms and regain normal function.

As a general practice, it is recommended that contractors view construction teams as industrial athletes. And because construction employees often perform physically demanding, repetitive tasks—comparable to professional athletes—vestibular therapy can serve as an invaluable resource for this working population based on the physical and environmental nature of their work.

Vestibular rehabilitation can help patients recover from health issues resulting from a head injury or whiplash-associated event or due to an inner ear issue or disturbance in the neck muscles—work-related injuries that can cause complaints of dizziness or hearing/visual imbalance. From an occupational health perspective, vestibular and balance exercises can also be integrated into a company’s workplace safety program. Construction firms can adopt these exercises as safety awareness techniques designed to help employees avoid injury or reinjury.

Adopting vestibular therapy for fall prevention and recovery

The vestibular system helps maintain or regain balance by detecting motion of the head in space and generating reflexes that secure normal head and body posture. Vestibular therapy can help retrain the eyes—independent of the head—and brain to both tolerate and correctly interpret stimulation often responsible for imbalance, dizziness and other symptoms that can result in falls. Because a construction workforce can be exposed to several environmental conditions that place them at higher risk of fall-related injuries, construction firms should implement worksite strategies that promote prevention and recovery of vestibular dysfunction.

The occupational impact of working with vestibular dysfunction can be critical. When construction employees suffer the effects of vestibular dysfunction on the job, falls and missed workdays may ensue. If symptoms of a vestibular disorder are not addressed and treated, they may persist, which can hamper an employee’s ability to function safely at work and in everyday life.

by Michael Morgan
Michael Morgan, DPT, OCS, Cert. DN, Associate Director of Clinical Services, Concentra. With 15 years’ experience in physical therapy practice and board certification in orthopedic physical therapy, Michael is highly skilled in treating acute musculoskeletal and vestibular work-related injuries and developing rehabilitation and injury prevention strategies with employers and for onsite health programs. His clinical model recommendations continually enhance key performance indicators for customers. Michael earned his Doctorate in Physical Therapy degree from the University of Pittsburgh.

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