MedSurg: musculoskeletal issues
Osteoarthritis (OA) is a noninflammatory joint disease associated with aging (compared with rheumatoid arthritis, which is marked by inflamed, swollen joints) (Banasik & Copstead, 2018).
DISCLAIMER: I am a nursing student and I am a scuba diver. I am not yet a licensed nurse nor have I graduated as of the date of this publication. This information is derived from my nursing school notes and should not be seen as medical advice. Resources are provided whenever possible regarding both nursing information and scuba diving. You should consult with your physician before scuba diving, especially if you have a condition which may limit your scuba diving fitness.
Pathology/Etiology: OA is the result of normal wear and tear. It is not systemic; rather, it is a localized and chronic degenerative bone disease. The effects are asymmetric; articular cartilage is progressively eroded with new subchondral bone (“sub” – beneath and “chondral” – cartilage; so the bone beneath cartilage) forming at the joint margins and a loss of synovial fluid (this is what happens when someone says “bone on bone”) (Banasik & Copstead, 2018).
Signs and Symptoms: The pain is usually worse later in the day. Morning stiffness, pain with function, and limited motion are typical manifestations. Stiff joints may appear normal externally, although bony enlargements and bone spurs may develop (hard, non-tender Heberden and Bouchard nodules). Friction is associated with “clicks” and crepitus with movement (Banasik & Copstead, 2018). You should report any swelling in the lower extremities or symptoms of heart failure to your primary care provider (Hinkle, 2018).
Limited range of motion (ROM) can impact your ability to participate in scuba diving because you may find it difficult to perform certain tasks, such as turning your tank valve, setting up your reg, and pulling zippers. Depending on the severity of your condition, the solution may be as simple as modifying your gear or asking your good ol’ dive buddy for a little assistance. However, it is SUPER IMPORTANT to continuously and honestly evaluate the impact of OA on your ability to dive, including getting on and off the boat, as well as being able to distinguish the joint pain of OA versus the joint pain associated with the bends (Diver’s Alert Network [DAN]. n.d.) – which I honestly have no way of being able to tell apart. Be mindful and keep an open dialogue with your doctor and your dive professionals!
Risk Factors include old age, being white, being female (especially post-menopausal), obesity, and previous joint damage. Congenital factors may increase the likelihood of developing OA, such as hip dysplasia or a discrepancy of leg length, as well as lifestyle considerations such as playing tennis or running (Banasik & Copstead, 2018).
Treatment options are palliative – you won’t be able to reverse the damage, but there are things you can do to relieve some of the pain and to slow the progression. Acetaminophen, NSAIDs (if Tylenol didn’t help – consider the risk for increased bleeding, though), aspirin (also an increased risk for bleeding – *DO NOT combine aspirin or NSAIDs or any other blood thinners with COX-2 inhibitors!), occupational therapy, and physical therapy are some options to discuss with your doctor. Other options (that you should still discuss with your doctor) that are less pharmacological and easier for you to do on your own include weight loss, heat/cold therapy, and exercise (Hinkle, 2018).
While you may experience some limitations in your independent ability to scuba dive, with your doctor’s clearance, scuba not only provides you with excellent exercise, but it also helps you to keep your mind off the pain while your body will actually release endorphins that act as your own endogenous pain killers (DAN, n.d.). Personally, diving and weight lifting are my two most “meditative” activities. Something that requires a lot of focus keeps much of the negativity and background noise out of my head. Diving, in particular, has this serene ability to block the rest of the world, and even my own scoliosis pain disappears for a time.
OA is worsened with inactivity, so exercise should definitely be a part of your normal routine. Scuba diving (or any water activity) is especially beneficial because it reduces the impact of weight-bearing stress due to the buoyancy of the water (DAN, n.d.).
Something I found particularly interesting regarding musculoskeletal problems and scuba diving is the altered gas exchange related to atypical blood flow in the tissues. Inflammation is associated with vasodilation, which increases blood flow, while the scarring associated with degenerative diseases can seriously impair blood flow – either scenario will impact the way that nitrogen is taken up by the body and released from the tissues (Banasik & Copstead, 2018) (DAN, n.d.) .
For a referral in your area, email medic@dan.org, or call the DAN Medical Information Line at +1-919-684-2948.
Banasik, J.L. & Copstead, L.C. (2018). Pathophysiology (6th ed.). St. Louis, MO: Elsevier.
Diver’s Alert Network. (n.d.). Fitness issues for divers with musculoskeletal problems – part II. Retrieved from https://www.diversalertnetwork.org/medical/articles/Fitness_Issues_for_Divers_With_Musculoskeletal_Problems_Part_II.
Hinkle, J.L. & Cheever, K.H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed.). Philadelphia: Wolters Kluwer.
Photo by Nick Albufairas from FreeImages
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