In 2004, 547,000 ladder-related injuries were treated in hospital emergency rooms and clinics, said Laurence Laudicina, an orthopedic surgeon in Albuquerque, N.M., and a spokesman for the American Academy of Orthopaedic Surgeons.
Dr. Fischer suspects that many of them are men.
"When we're near a ladder, we believe that gravity doesn't apply to us," he said.
About six weeks ago, Dr. Fischer decided to clean some windows and got out his power washer and ladder.
"I was up cleaning the second-story windows, and the ladder did something I didn't know it could do," he said. "That is, it slid away from the house."
Dr. Fischer landed on his hands and feet and the resulting force crushed the L1 vertebra in his back. He spent agonizing weeks wearing a bulky brace and taking breaks between seeing patients to lie flat. But as he started to tell patients his story, he began to see how common his problem was.
"Every man I talked to had a ladder story," Dr. Fischer said, "where they had done something stupid on a ladder and either hurt themselves or nearly killed themselves. And I realized that the average weekend warrior around the home doesn't respect ladders and doesn't know how to use them."
The biggest mistake is not using the right size ladder, said Butch Beasley of Butch Beasley Home Improvement.
"Most people, they're trying to do too much with the wrong size ladder," he said. "Most of the time they try to get it too high."
Getting up high on the ladder can result in a strange sort of instability and shift of pressure on the ladder, Mr. Beasley said.
"The more pressure you have at the very top of a ladder, the less pressure you have at the bottom," he said. "It sounds weird, but it's true because of the angle that it's on."
If no one is there to stabilize the bottom of the ladder, Mr. Beasley said, his crews will position a car or truck against the bottom of the ladder to hold it.
Falls of even a few feet can result in injuries, some of them severe and long-lasting, Dr. Laudicina said.
A common one is a fracture of the calcaneus, or heel bone, he said.
"It's an impact fracture," Dr. Laudicina said. "The majority of the weight-bearing goes through that bone.
"And they unfortunately can be severely debilitating."
People can get creative getting into the situations that led to the injury, he said.
"As an orthopedic surgeon, it is amazing the different ways that people can find, and discover new and exciting ways to hurt themselves," Dr. Laudicina said.
Injuries most often happen when the person is working alone without someone to help stabilize the ladder, he said. And from the stories Dr. Fischer heard, it is usually the husband working without proper supervision from the wife.
"I'm sure it is a male thing," he said. "A lot of people did it when their wife wasn't around. We don't want them to see we are doing these risky things because they're going to give us a hard time."
Even when it is deserved and might one day prevent the ladder from suddenly crashing down.
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.
With many people who don't use a ladder very often clambering up to clean out gutters or put up Christmas lights, now is the time to take a few precautions to avoid joining the 500,000 people a year injured using a ladder.
Here are some tips from the American Academy of Orthopaedic Surgeons:
- Inspect the ladder -- make sure it is secure, with no loose parts;
- Clean off any mud or slippery surfaces;
- Set it up properly on a firm, level surface;
- Follow the 1-to-4 rule: The bottom of the ladder should be one foot away from the wall for every four feet of ladder height;
- Don't sit on the ladder between tasks;
- Use the right ladder for the job;
- Use caution when moving materials up and down the ladder;
- Position the ladder close to the task and avoid overreaching: A good rule of thumb is your bellybutton should not go past either side of the ladder;
- Use proper footwear;
- Get help if you need it to stabilize the ladder, but only one person at a time should be on the ladder.