Slips and Falls in the Shower: One Cause that no-one tells you about!

Slips and falls are among the most common causes of back and neck sprain and injury that I see each year.  Falls of one type or another injure about a quarter-million seniors every year. 

Falls in the bathroom can cause serious back and neck injuries, and result in fractures, severe sprains, and even death.  We all know we need to be careful getting in and out of the tub, to be careful in the shower, yet I get a call about once every month from a patient that needs to be seen because they fell in the shower.

If we all know better, why are falls in the bath or shower so common?
 
First: Physics is against you!

To start with, age or infirmity aren't the only problem.  Falls happen to everyone, of every age, and usually for similar reasons:

The floor of the shower or tub starts off with a smooth, slippery surface, which gets much slicker when wet, and can become absolutely treacherous when soap or shampoo spills onto it.  Changing position or even leaning just a bit to reach for something can be like slipping on ice: one second you're fine and the next you headed for the floor!

The surface you're going to land on is hard and unforgiving.  The shower walls and floor are tiled.  They offer no "bounce" or cushion when you land. If you hit on a "meaty" part of your body, the impact will hurt and jar your whole frame.  If you hit on an elbow or hip, a fracture can easily occur.  

​And, if you're in a tub, a fall across that tub edge can break ribs, crack vertebra, or cause a serious head injury.

The walls of the shower typically provide no help.  Unless you've put them there, there are no supports or railings you can use to catch yourself or prevent the hard fall that can cause so much harm.  There's often no way to "self-arrest" or stop your fall before it happens, and no way to break the impact of the fall before you hit the floor.

Second: Your physiology is against you!

Whether you are fit or frail, the process of getting in and out of that shower involves a bit of ballet that we aren't always careful about.  Stepping over the tub railing or the shower sill involves a bit of balance, particularly when going from dry ground to a wet, slippery surface.  Going too fast?  Carrying stuff with you?  Not paying attention?  This is often when patients - young and old - find themselves getting hurt.

But once in the shower, we tend to do crazy things, balance wise, and this is one thing I haven't seen mentioned in blogs or healthcare literature you may have read in the past:

The process of washing involves alot of bending and twisting.  We are particularly likely to lose our balance when trying to wash feet and toes or twisting to get to those hard-to-reach spots on our back side, BUT, most of us recognize that those are the situations where we need to be more cautious.  Where patients often get in trouble, in my experience at least, is when they go to wash their hair!

Think about it: what do you do when you wash your hair?

You close your eyes, tip your head way back, get your hands up where they can't help you balance, and then roll your head around in a random serious of oscillations that can make the surest of us a little unsteady. 

In anyone with a balance problem - like those with diabetes, Parkinsons, or history of a neurologic problem affecting their neck or back - closing your eyes and tipping your head back is the quickest way to throw your balance off.  That's what the police do when they want to see if someone is sober, and it's a test your neurologist will use to see if a person has a neurological disorder affecting their balance or coordination. 

And it's what my most recent, very healthy, shower-victim was doing just before he hit the floor!  Fortunately he just had bad strains and bruises, but it could have been worse.

Finally: Advanced age and illness don't help a bit.
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Progressive weakness, stiffness of joints, poor balance all set us up for a fall and severely limit our ability to avoid a fall if we start to slip.  Osteoporosis and weaker bones set us up for fractures after even modest slips and falls.  Any condition that can cause black-outs - heart disease, diabetes, or neurological disorders - can lead to a hard fall in an unforgiving space.

What can you do to prevent a bad fall in the shower or bath?
There are a few simple precautions you can take, and a few pro-active home modifications anyone should consider:

Change that slippery floor to a non-slip surface.  Put down a non-slip tape or texture or change your tile to a non-slip product to limit the likelihood of that first slip.

Make sure that first step out of the tub or shower is also onto a non-slip mat or floor covering.

Install properly placed and designed hand rails that you can use when getting in and out, and when bending or twisting in the shower.  These should be professionally installed so they can hold your weight if you do start to fall.

Get a shower seat or stool that you can sit on while you tend to your toes and wash your hair without teetering.  Make sure it's a stool you easily get back up from, though!

Clean up after yourself or others - don't let soap or shampoo collect or drip onto the floor, don't let loose rugs present a trip hazard, and don't leave anything on the floor of the shower you might step on or slip on.

Design your bath area for safety and ease of use.  Plan ahead so that towels, or anything where you might be tempted to try and reach for, are in or right next to the shower.
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And don't get in a hurry.  One of the joys of a nice hot shower or bath should be that it gives you a chance to relax a bit.  Don't rush to get in and out if that means you're going to get careless with your health!

​I hope you found this discussion helpful and interesting.  Please let me know if there are other topics you'd be interested in learning about, and check out my Facebook page for updates on future topics.