Odd pain in my knee

[SkipperJohn]

I have been reluctant to ask this but it has been nagging me for a few weeks. Reluctant because some know where I did my OW diving and I don't want them to be judged.
Anyway, I did my OW cert a few weeks ago. The organization I used scheduled my 4 dives 1 on one day and the last 3 dives 2 days later. I thought it odd diving 3 dives in one day (after all my book learning) but the instructor answered: "we do it all the time". So I was in their hands.
The first dive was shallow, 25 feet so I had no worries.
2 days later we repeated the first dive, then 2 hours later dove 55 feet for 45 minutes (plus a 3 minute safety stop), then after a 1 hour SI Dove 45 feet for I believe close to 1 hour (I didn't time this dive but I burned significantly more air on this last dive-came up with only 500 pounds left).
But here is where things got weird. This being my OW certification, my assent on this final dive was my Controlled Emergency Swimming Assent. I will admit I was not watching my rate of assent but my instructor was at my side.
Anyway, by 4:00 I was done. That night some time in my sleep I noticed a pain in or slightly above my left knee. I thought nothing of it and as the day wore on I thought I may have hit it. It wasn't until the pain really began to hurt that I thought it though and didn't believe I hit it at all. It was sensitive to pressure (rubbing it made it hurt more) and often I felt like I had to move my leg to get it to subside but really nothing worked. In a few days it was gone until I took off later on around 24 hours after the pain had left. As the aircraft began to climb the pain came back. Once we descended the pain was gone again and has not returned.
I'd like to know if anyone believes this may have been any sort of decompression sickness or if I am really off base here. More importantly if it was, did I make any sort of serious mistake by not getting it treated? (& how lucky was I that it was in my knee and not someplace more serious).

 

[Steve_Dives]

Best bet is to call DAN. Their dive emergency hotline is 1-919-684-8111. If you don't feel it's an emergency, 1-919-684-2948 between 9 & 5 weekdays.

 

[Web Monkey]

Best bet is to call DAN. Their dive emergency hotline is 1-919-684-8111. If you don't feel it's an emergency, 1-919-684-2948 between 9 & 5 weekdays.

That's pretty much it. Call DAN. In fact, I'd call tonight and let them decide how important it is.

Could be just a sore knee or it could be DCS from your 3 dives and last fast ascent.

A lot of shops sign the students up for free DAN insurance that's valid during training, so you might even be covered for treatment, since it happened on your checkout dive.

It would certainly be reasonable to have someone take an actual look at it, in person.

Terry

PS DAN's information is at the top of the page:

Neither ScubaBoard's staff nor its members are able to provide accurate medical diagnosis over the internet. If you think you might be injured or have suffered any symptoms of DCS, you need to be evaluated by a doctor immediately. Please seek medical attention or call the Divers Alert Network (DAN) at 1-800-446-2671. For the international DAN telephone numbers, click here.

 

[TSandM]

If it's been a couple of weeks since you dove, there's no point in contacting DAN with any urgency, because you're way outside the window where any recompression treatment would make a difference.

It is possible that you had some significant nitrogen loading with the numbers you've posted, if you did square profiles. If, in fact, you hit 55 feet but spent most of your time at 20, you didn't have a lot of loading. You didn't do an uncontrolled ascent, because I would assume if your ascent rate was really high, your instructor would have grabbed you to slow it down.

If you have completely recovered without further symptoms, it's unlikely you did any major damage. You can get bone damage from bubbles, but that's most common in commercial divers who are exposed to high nitrogen levels time after time.

The real question is whether you have something that predisposes you to DCS symptoms, like a PFO, and I think you'll just have to see what happens as you continue diving to know.

 

[DocVikingo]

An involuntary and almost instantaneous abnormal movement of the less than optimally functioning nervous system.

As TSandM has suggested, there certainly appears no urgency in calling DAN given that the complaint completely resolved about a week ago once your plane home descended and there have been no signs or symptoms since.

It's unclear what actually did occur, but a few food for thought items:

- typically DCS-related joint pain is not made worse, or better, by rubbing the affected area.

- in joint-only DCS upper limbs are involved more often than lower limbs. The shoulder is affected far more frequently than the knee.

- it is very unlikely that an open water cert instructor would subject a student to profiles that courted DCS.

- as Dr Deco is wont to say, ""Millions of people experience problems of joint pain that have never gone diving in their life."

The diver needs to be aware that minor non-DCS related aches in joints are not uncommon with SCUBA. These can be secondary to carrying heavy luggage; moving, donning and doffing dive gear; extended periods in uncomfortable positions during air and road travel; bumping of body parts against the boat and other unyielding objects; and similar mechanical trauma.

TSandM also raises a good point regarding conditions that predispose to DCS. The individual with a history as described will want to keep a weather eye for DCS-like signs/symptoms on future dive trips. Should there be another unexplained incident, a diving medicine work up would be prudent.

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[headsqueeze]

Joint discomfort in a situation such as yours should not be dismissed as standard joint pain outside DCS. In other words, I think your pattern indicates a good probability of DCS. The dive profiles, a 3 minute decomp stop and the flight pain. A one time occurance probably won't cause problems; DCS hits on MRI of the brain are asymptomatic. So, DCS can occur and yet not be recognized clinically because our modern tests are not accurate to find it and our bodies are blessed w/ a lot of organ reserve. I see similar clinical situations in atherosclerotic disease in my own practice (micro or mini strokes from microemboli). You wanted to pass your tests no doubt, so may have been reluctant to chide your instructor. Even so, now you can follow your own safe profile and be careful with whom you dive.

The bottom line - dive as safe a profile as you can and don't be afraid to call your own profile while underwater and the rest of the dive party is simply following the (erroneous) leader. It's the only way. Also, how many times do I have to hear how "my dive computer is so conservative that I violate the ascent every time ....".

 

[DocVikingo]

In other words, I think your pattern indicates a good probability of DCS. The dive profiles, a 3 minute decomp stop and the flight pain.

Hi headsqueeze,

Thanks for the input. A couple of questions, if I might:

1. As a technical matter, wouldn't the 3-min stop reported by the poster more correctly be described as a safety stop than a "decomp stop?" While of course the diver is decompressing during a safety stop, that stop is not obligated. I believe that this is the basis for distinguishing between no stop recreational dives and technical dives with required deco hangs.

Perhaps this is somewhat old school thinking on my part, but making the distinction is useful in training. More importantly, the distinction makes a heck of a lot difference to the functioning of one's dive computer and what is to be done when a "stop" is missed.

2. In your mind, what about the reported 3-min safety stop raises the index of suspicion of DCS?

3. You make mention of the "flight pain."

The poster stated: ""It wasn't until the pain really began to hurt that I thought it though and didn't believe I hit it at all. It was sensitive to pressure (rubbing it made it hurt more) and often I felt like I had to move my leg to get it to subside but really nothing worked. In a few days it was gone until I took off later on around 24 hours after the pain had left. As the aircraft began to climb the pain came back. Once we descended the pain was gone again and has not returned."

Of course the recrudescence of signs/symptoms of DSC at altitude has been reported in divers who were asymptomatic at the time of boarding. However, given that the poster didn't fly until ~24 hrs after the knee pain had entirely disappeared, and accumulated only a modest at best nitrogen loading during OW training dives, doesn't it seem somewhat unlikely that his in flight discomfort was DCS-related?

Thanks,

DocVikingo

 

[headsqueeze]

It is my opinion that DCS is not given proper attention by a good number of divers, including some instructors. For concern of scaring divers out of scuba I wonder if financial conflicts interefere w/ an instructors teaching and tolerant behaviour of an occasional rapid descent. DCS is preventable, so why not do our best to prevent it? After all, it's recreation.

For me personally it is clarified most by my children w/ whom I became certified. If they were to develop DCS to any degree and suffer from it then no one is to blame but me, and I don't think I would ever get over it. On the other hand, they have access to a world which few really know and I can't hide them from risk of life either.

Although NAUI and PADI have some not so major differences, I still don't understand PADI like I do NAUI. You can take some PADI dive profiles and get a violation w/ NAUI. It's like a different dialect for diving philosophy. There is no dive table that can guarentee DCS free diving even if followed to the second, but why not increase the safety margin and improve chances of safe outcomes? So, I usually default to the most conservative dive schedule, be it the table or my computer (which has an ability to set for higher altitude diving - a more conservative schedule). In my personal view as a diver and professional view as physician, any physical complaint that presents outside a most conservative profile is suspect for DCS. Just like in medicine, how easy it is to simply explain this or that symptom away to something that makes the patient feel better and relieved. In reality their lives may be in harms way or at risk for loss of organ reserve. When they present w/ their own diagnosis I always ask if they would like a second opinion. Those whom I have been their personal physician (some for over 15 years) already know I will not accept 'easy explanations' for their symptoms.

 

[DocVikingo]

Hi headsqueeze,

I entirely agree, sir.

Now, if could answer my specific questions I'd be most grateful.

Thanks,

DocVikingo

 

[TSandM]

There is really an excessive fear of DCS, in my mind. To begin with, if proper technique is utilized, it is quite rare. The majority of cases that DAN reports involve some violation of limits, either of depth, time, or ascent rate. Secondly, if you are worried about DCS when you are within recreational profiles, just spend more time in the shallows. If you spend the last ten minutes of each dive between 20 feet and the surface, you're going to offgas the fast compartments that are likely to cause severe symptoms quite thoroughly.

The concept of moving to a more conservative decompression algorithm has no end to it . . . You go for a conservative computer like a Suunto, but it's more liberal than NAUI tables, so you use them, but they're more liberal than PADI tables, so you switch . . . At what point have you built in enough conservativism to satisfy you? (Five minutes of bottom time isn't enough for me ) At some point, you have to do some rational risk analysis and decide on something that makes SENSE. For me, a lot of that is controlling my profiles to pad time in shallow water.