23 November 2024

MEDICAL FAQs

Dive Medical questions & answers for common scuba diving conditions and illness provided in conjunction with the doctors at the London Diving Chamber and Midlands Diving Chamber.

All Categories » Bends » Muscle and Joint Pain

QUESTION

About a month ago, I went diving at less than 30m. After 30 mins, we were surfacing when I wasn't able to control my buoyancy for the safety stop. I went to around 2 m then struggled back to 5m. After the dive, I experienced a "stiff neck" which bothers me till today, even every morning when I wake up. Could you please advise me on how to get rid of it?

ANSWER

Indeed I can.

As I have said many times on these pages, the medical mantra is that any offbeat symptom that cannot be attributed to any other injury after diving

should be assumed to be a bend unless proven otherwise.
In your case, if you had been twisting your neck to put on a BCD, or slept in an odd ay on the trip back then that could be the cause.

But if there was nothing except the rapid ascent and the bounce back down, then it is always best to see a dive doctor experienced in decompression illness. I have seen cases present this long that have cleared up in the pot on a single treatment.

Most take the full initial 5 hours with a re-treat or 2 to give complete recovery. But if it is a bend, no amount of physio, massage, or anti-inflammatories will get it better. Just good old oxygen at 18 metres depth.

By the way, treatment is free, so contact your local pot.
And if you don't know where that is check out the "Chamber Finder" on the e-med dive pages.

QUESTION

On March 2002, I went to Dahab for a dive trip. We had repetitive dives of 3 in a day. All together we had 5 dives only.

Due to instability of my buoyancy control I was ascending and descending fast from 10 m up to almost 1 m and then down to 7 and so on.

My bottom time was about 40 mins and we started to ascend. While ascending there was a sudden cramp as though my knee joints locked itself up on my left knee joint. The pain was an acute pain on the upper left of the knee joint. There was so much of pain as I was ascending.

I started to limp. Thinking I perhaps hit against the dive boat, I continued dive 5. Again, I was bouncing up and down in the deep.

After my dive, I was limping to the room and applied deep heat over the joint.

The next day morning I could not even walk straight. the pain was unbearable. I did not suspect DCI as the depth was not more than12 metres.

The pain continued for a week before it subsided.

Please advise was I having DCI. Is it possible for bubbles to be trapped due to inconsistency in buoyancy control? Is it possible to have bubbles in the joints without other significant signs of DCI like rashes etc.

How can I prevent this in my next dive trip in December?

ANSWER

I think you did have a bend or DCS as it is otherwise known. What you were doing has different names such as bounce diving, yo-yo diving. I prefer the term a "sawtooth profile". When you see the printout of this sort of dive from the computer you can see why it has this name.

But whatever they call it, the end result can be the same. And that's a hit.

When you breathe nitrogen as a composite of the air, the deeper you go the more is absorbed into your tissues. The reason why we have to have slow ascents and safety stops is to let the nitrogen sloly move from the tissues back to the blood and then be exhaled. Anything that speeds up ascent will mean that the nitrogen comes out too quickly and forms bubbles instead of being evenly absorbed back into the blood for removal. Imagine a diver doing multiple dives in a day. Now imagine that the surface interval time between dives is not hours but seconds, where does that put you on your PADI tables. Yup Z and beyond. That's what sawtooth profiling does for you. So a bend it most likely was, and you should have had a recompression or surface oxygen at the very least.

The best way of sorting this out is to buy your own BCD and wetsuit so you always carry the same weight. The more you dive the better your buoyancy control will be too, it was the same for all of us when we started. But promise me one thing. If your buoyancy has an error factor of 7 metres at the moment, please don't go anywhere near coral until you have it truly sorted, as it's likely you will plough through it as you crash back down again.

For complete information on DCS, it causes, symptoms and best treatment please go to my site www.e-med.co.uk and click on the diving icon.

QUESTION

I suspect that I may have a possible bend and would like some advice. I have been a bit daft and left this a long time. I return from a diving holiday in Egypt at the beginning of June and since then have had a constant ache in my left knee (just below the knee cap) and in my left elbow. This aching has neither improved or got worse, it's just been constant. It is especially noticable after a nights sleep but surprisingly enough does not stop me from exercising (running, weights, general gym work outs) I have experienced no tingling, no nausea, no abnormal tiredness or no dizzyness etc etc, it also seems strange to me to be only on one side of my body. In both areas of discomfort I have had no previous breaks, fractures or operations.

I am a 35 year old male who is generally fit and healthy and have been diving for over 6 years. Some advice would be most helpful as to whether this sounds like a bend to you or whether I'm just getting old!!!!

ANSWER

And once again the divers medical mantra..

Any problem not experienced before diving, that appears after, must be assumed to be a bend. Unless there's a really good explanation.

So if whilst in Egypt you decided to spend your pre-flight downtime cage fighting against 2 stocky Danes, you won with a left elbow/ knee pile driver as they both lay defenceless on the floor, then that would be a good reason for the pain.

But if you hadn't done this, then you have to assume it is a bend.

Egypt is classic for this. Maybe 3 dives a day, a bit of dehydration and a bit of a runny tummy. All this can add up to decreased off gassing of nitrogen.

Call your local pot.

N.B He came to our facility, and after one long and 2 short treatments, made a full recovery. Even this late after onset of symptoms it is worthwhile treating sometimes.

QUESTION

Following the DM course 27/28/29 of Sept, I started having an ache in my right knee, three days after the course, it comes and goes. Today my right elbow is aching. I only had three dives that weekend. Friday 7.2m for 11 mins and Sunday 14.4m for 43 mins followed by 1hr 24mins surface interval then 4.5 m for 23 mins. On the first dive on Sunday I felt cold and a bit ill (red wine and beer the night before) so I surfaced for 3 mins after 25 mins then went back down. I felt completely fine after I surfaced for a few minutes.

Apart from a dull ache in my knee and elbow which comes and goes I feel completely fine.

Should I worry or is this just pesky English weather??

ANSWER

It would be the pesky English weather if you had arthritis, or one of those conditions that always seems to worsen with the weather.

But I assume you are a fit young bloke embarking on getting some pro-dive qualifications, and not my granny.

So we have to assume the worst I am afraid. The 3 dives would have surely been fine, except for that bounce dive on the first. I know it was only a shallow dive but reading between the lines, you may have been well dehydrated from your alcohol combination the night before. On top of that, if you are cold on a dive, then it can affect your off-gassing of nitrogen. Your peripheral vessels will constrict to retain heat, and don't perfuse the tissues like they are supposed to. Add all this up and it could well be DCS. Good news though, if its just in the joints and you have no neurological symptoms, e.g. tingling or numbness then if you are deemed appropriate for recompression treatment, it should be better in no time.

QUESTION

I am probably wasting your time and apologise if so. However, I often read in the Sport Diver magazine of people getting the bends even in mostunlikely circumstances and since I am going skiing in the Alps on March 7th I thought it is better to ask now than be sorry later. I have recently turned 55, am a female in good health who regularly works out but going through the menopause. I am not taking HRT or any other medication except glucosamine. I get the usual hot flushes and have aching limbs, particularly shoulder/neck (result of an old whip lash injury) and lower back. Sometimes the aching is really quite severe. I was in the Bahamas in early June and went scuba diving on two occasions, about 5 days apart. Each dive day consisted of two dives in the morning. I do not believe the first time could have caused a problem, since I buddied up with the dive master and did first a 45ft dive, bottom time of 30 mins, surface interval of about 30 mins followed by a second dive to 40 ft with a bottom time of 30 mins.

The second occasion (5 days later), the first dive was a wall dive where I only wanted to go to 50 ft. But the visibility was so good and so clear that before I knew it I was at 55 ft plus. I came back up to 50 ft immediately but then found myself drifting down again. I did not go more than 55-56 ft and certainly not down to 60 ft. Bottom time was 30 mins. We came up slowly and had a safety stop. After a surface interval of 15 mins we did a shallow dive to mostly 15 ft but a max. depth of 25 ft for 45 mins bottom time and that was that. We flew back to the UK two days later. I cannot say for sure that my aches and pains are any worse since coming back and I have put it down to age and time of life! But given the little bit of bobbing up and down on the wall dive I would be grateful if you think I could have a problem which should be seen to before going up into the mountains.

Many thanks in advance for your response.

ANSWER

I think you're OK here.

The profiles are fairly shallow. The surface intervals long enough, especially with the 4 day break between the 2 sets.

Yes, you did have a bit of a yo-yo, but not enough to fizz you up inside.

If the pains you have now are in a completely new area and of a type you have never had before then it may be worth a consult with a chamber. But in all likelihood menopausal aches can flit around, and you had them before. So I am 99.9% you do not have DCS but something that would respond better to a HRT patch than 5 hours on a Table 62 recompression.

QUESTION

I returned from a diving trip in Sharm last week, during my last days diving (14th), dives to 29.5m and 23.4 metres with a 1hour 11 minute surface interval were done in the morning and I skipped the pm dive. During the 2nd dive I started to experience a stiff neck, but put this down to diving posture. In the days that I have been back I have experienced minor discomfort in my left elbow and my neck is still 'stiff & heavy'.

Can I take your advice.

ANSWER

You can indeed. Its time for you to see a dive doctor to have a check as to whether you have the bends. Back to the old mantra, that any abnormal symptom, especially aching and joint pain, must be assumed to be a hit, before any other reason is sought.

Yes, of course it might be that you were constantly looking over your shoulder on the dive, looking for a missing buddy. And that's why the pain developed in water. But for it to be still there, and to then get an elbow pain as well, makes me raise my suspicious eyebrow.

A point worth noting is that a lot of dive docs may not be that familiar with DCS. They just sign off medical forms, so the best one to see is someone who works at or alongside a recompression chamber. So contact your local chamber and get seen there.

On the www.e-med.co.uk dive medical page, is a "chamber locator". This gives a list of all the UK chambers and their contact details. So start there if you don't know your local one's details.

QUESTION

I have recently returned from a holiday in Tenerife. 3 days ago. I did a dive to 30m. This was a dive that started at around 15m and went gradually deeper. At the end of the dive I found that my computer (Vyper) had a diver attention symbol showing and that I had over gone the depth time limit (30m) by approximately 1 minute. My computer is set to the conservative setting. I had only done a safety stop of 5 minutes before surfacing. Since then I have developed pain in my left shoulder joint that comes and goes especially after lying on it. I may have done something to cause this whilst passing my equipment back to the boat crew but wasn't aware of any injury at the time. I have no other symptoms at all. Could you advise of any prognosis and if need be where in Somerset I can get in touch with any Dive Doctors.

ANSWER

Pay attention everyone, this is interesting. It encompasses so many aspects of bends issues, as well as conflicting stuff that can throw doctors.

The bottom line is you have shoulder pain after a dive. Its still there and so must be suspected as a bend.

However on the other hand, you could have hurt it on the kit hand over, shoulders do hurt when you lie on them, and finally when you set a comp to a lesser physiological state than you really are, it can put you into deco when you probably are ok.

I did this once, deciding after a big brekky in Grenada to see what P3 on the Suunto Stinger would do on my next dive. Well, I reckon it was more conservative than a bunch of spotty faced Eton boys at a BNP rally. Within 5 minutes of a 23 metre dive it was a pinging and a beeping on my slow ascent. I kinda knew I was well within limits, experience being the greater truth. But it did make me realise that you really have to be over 16 stone and unfit to use that setting. So that could count on your non-DCS side. But the one curve ball you have is this. If it still hurts this long after the dive, and it was related to kit passing, then you sure would have felt a pang when you were handing over. It’s like hitting your thumb with a hammer. For your thumb to still hurt x days later, you have to hit it y hard. And you would notice that at the time.

My gut says it’s a 50/50 DCS call here, but you do need to see a doc with experience.

DDRC is your nearest pot.

QUESTION

I wonder if you could give me some medical advice. I took up scuba diving about 6 months ago and very shortly afterwards developed pains in my muscles, which was then diagnosed as being a virus called Polymyalgia Rheumatica.

I have been taking steroids for this ever since.

I hadn't dived in the intervening period and the pills have given me a pain free existence.

I went diving again about three weeks ago and the next day felt the muscle pains again, even though I was still taking the same dosage of steroids.

Could it be that I got the virus as a result of scuba diving? Is it possible that my diving I am reducing my chances of getting rid of this virus?

ANSWER

Hmmm, a big long scratch of the head here. Here's what goes through my mind. You develop muscle pains "shortly" after diving. It is diagnosed as PMR, for which the true causes have not been elicited really. When you're not diving and on steroids, you feel OK, but as soon as you dive the pains come back. I wonder if this is in fact a bend, then misdiagnosed, and another hit post dive. It could be PMR though, yes, but let's consider the alternate. I think you need to see a diving rheumatologist, if they exist. Failing that, a complete blood work up and even a trial of recompression if it occurs again after a dive.