Q&A on Orthopedic Problems and Diving
By Fred Bove
Back Pain Improves after Diving
Q I have chronic lower back pain caused primarily by spinal stenosis. The only times I've been pain-free in the past two years have been while on diving vacations, doing two to five dives a day. There seems to be a connection between the additional pressure at depth and the pain relief, but when I've mentioned it to doctors, they write off the connection as anecdotal. The pain relief begins the first day of diving, and pain starts to come back 24 to 36 hours after the last dive. The difference seems remarkable to me. Has there been any research on the effect of increased pressure on lower back pain?
A I have heard both positive and negative comments from divers about back pain. In some people the pain gets worse when diving because the weightbelt bends divers in the wrong direction when underwater. However, some people have gas pockets in their intervertebral disks, and if the disks are compressed, there is the possibility that the bulging disks would be reduced in size, thus causing less pressure on nerves. Other divers have commented on arthritis causing less pain and stiffness after diving. Swimming is often used as a back exercise, and I wonder if the exercise itself is helping your back.
Artificial Knee Joint
Q I am a 62-year-old female diver. I had a total knee replacement nearly five years ago. I am not aware of any trouble with my prosthetic knee before, during or after diving. In fact, everything usually feels much better. Have I just been lucky?
A There are many people diving with artificial joints. As long as you are able to use the knee normally, you should have no problem with diving.
Aseptic Bone Necrosis
Q A friend developed a bone injury called aseptic necrosis that has caused him some disability due to injury to his hip. Is there any relationship between bone necrosis and diving?
A There is a well-known association between diving and aseptic necrosis of bone. Numerous papers have been published on the topic, and several workshops have been held with the purpose of reducing the risk of bone necrosis from commercial diving.
The Occupational Safety and Health Administration (OSHA) requires long bone X-rays in commercial divers to detect the disease early before permanent joint damage occurs. You will find a chapter on this topic in my textbook, Diving Medicine, published by W.B. Saunders, 1997.
Q I have been diagnosed with ankylosing spondylitis. I currently have a kyphosis [curvature] in the thoracic spine, degenerative disc disease in the thoracic and lumbar spine, and my neck has been fused at the C-5, C-6 vertebrae. My current medications are Celebrex, Flexeril, hydrocodone and Norflex. I would appreciate any recommendations you could provide or concerns that come to mind relating to diving.
A Ankylosing spondylitis is a chronic arthritic disease that causes inflammation, pain and deformity in the spine. Your ability to dive is compromised by the spinal deformity, not the medications. I would not recommend using hydrocodone on diving trips unless you use it after your last dive of the day for pain that is not responsive to milder medications.
You are prone to injury because of limited mobility and would have difficulty getting into and out of dive boats comfortably. The physical activity involved in getting into and out of the water is likely to be the most important limitation, not diving. You will need a dive partner who is willing to provide support with the physical part of the sport.
There are no studies indicating that diving would worsen your condition. Warm water and shallow diving (about 100 feet max) would be tolerated best. You should also have an echocardiogram to evaluate your heart valves, as these sometimes become involved with ankylosing spondylitis.
Q Two weeks ago, I underwent a laminectomy to repair a ruptured lower lumbar disc. The surgery was successful, and I will be returning to work later this week. When I questioned my doctor about diving, he indicated that I should not dive any longer due to my increased risk for an embolism and DCS.
A There is no evidence that disk surgery makes you prone to DCS or AGE. You need adequate time to heal from the surgery, and with bone healing, the minimum time is eight weeks. I usually advise divers to wait three to four months before they return to diving.
An important consideration is the confusion between symptoms of a herniated disk and decompression sickness. You need to have a careful neurologic examination to determine if there are any residual abnormalities. Carry a note summarizing the findings so that you avoid being treated for DCS based on the residual findings after your surgery.
Q About two months ago, I dislocated my shoulder. The shoulder was relocated by an ER physician. As a result of this injury, I was told by my orthopedist that I stretched or slightly tore ligaments and tendons in the shoulder area. At present, I'm undergoing physical therapy to restore strength and motion. There is no indication of damage to the rotator cuff. I'd like to go diving in about four weeks. Is there any risk of decompression sickness should the ligaments and tendons not be fully healed by that time?
A There is only anecdotal information that an injury makes you prone to decompression sickness at the site of the injury. You should not have a problem with your shoulder and DCS from usual sport diving exposures. If you are doing deep, mixed gas (technical) diving, you might be at some risk for DCS due to exposure, but the shoulder would be less likely than the spinal cord to be involved. Be careful when lifting tanks and climbing the boat ladder. You could dislocate the joint again by putting excess stress on your shoulder.
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