Frequently Asked Questions on Diving Medicine

Generally speaking, as far as rib fractures are concerned, once the fracture has been well consolidated, all clinical and imaging evidence has been obtained, and full functional capacity has been regained, recovery should not be a problem, but we recommend that you start diving with a low decompressive load. In fact, there should be fully functional recovery even in situations of intense stress and effort.

Diving is temporarily contraindicated if the fracture is not yet consolidated.

The phenomena of bone remodelling and repair may in fact lead to changes in the absorption and release of inert gas during diving, with the possibility of local decompression sickness and alteration of the healing process, not to mention that local pain or functional limitations may compromise diving safety. Once the fracture is well consolidated and the ability to resume moderate to intense physical activity has been confirmed by the orthopaedic specialist and/or sports physician and/or diving and hyperbaric medicine specialist, we recommend diving with low level of decompression load for at least a few months. We therefore recommend the following low-bubble profiles.

In these cases, resumption of diving is generally possible, especially if recovery and functional recovery are rapid and effective. The only caution is to allow sufficient time for proper and complete osseointegration of the prosthesis to ensure that it will hold. In general, the recommended waiting period is at least 6 months, but this may vary depending on the opinion of the treating orthopaedic surgeon regarding the surgical result and the estimation of full functional recovery without significant limitations, even in the case of intensive use of the limb and physical exercise. Once you have regained full functional capacity, we recommend that you start diving with a low decompression load, at least initially. In fact, there must be fully functional recovery even in situations of stress and intensive use of the limb; finning causes considerable stress, with orthogonal leverage and axial torsion mechanisms, so it will be important to determine the optimal functional recovery.

We recommend that you follow low bubble production profiles:

• When possible avoid dives with mandatory decompression stops;
• Avoid repetitive dives as much as possible or, if you want to make them, respect sufficient surface intervals (not less than 3 hours, preferably more); in any case, repetitive dives should be shallower and more conservative;
• limit your bottom time to a maximum of 70% of the No Decompression Dive Time indicated by your computer when you reach the maximum expected depth, or as indicated in the table; if you are using conservative factors, it is a good idea to read your computer’s manual carefully and determine which setting corresponds to the recommended bottom time suggestion;
• Conduct the dive by immediately reaching the maximum planned ascent, avoiding yo-yo profiles (continuous ascents and descents), respecting the ascent speed recommended by the dive computer/tablet, and making the safety stop with good buoyancy control. Ensure that you ascend slowly to the surface from the safety stop to the surface;
• if your computer allows more advanced settings, such as Gradient Factor, set GF High not higher than 80. Caution, only use this setting if you fully understand how it works and how it will affect your planned stops. If in doubt, consult a qualified instructor or contact us;
• if possible, use enriched air mixes with computer settings or use tables set for compressed air, if compatible with the type of dive (note maximum PO2 and time limits);

Remember that diving deeper than 25 metres (80 fsw) is associated with greater bubble production and an increased risk of decompression sickness. It is always advisable to have a good general fitness check by a diving and hyperbaric specialist before resuming activity after a long period of illness/convalescence.

If you were symptom-free for four full days, then it is unlikely that subsequent symptoms are related to decompression illness and your dive. The nitrogen you absorbed during your dives has to follow the physiology of basic gas laws – it cannot stay in the body tissues once the partial pressure of nitrogen in the ambient air we breathe drops down to sea-level pressures. Although nitrogen leaves the body in a much slower fashion than we take it on, it still must leave. After diving, you should be equilibrated to ambient nitrogen in 24 hours. If the pain can be produced with movement of the affected joint only, then it is more than likely a musculoskeletal strain or injury. The pain generally associated with decompression illness is not affected by movement or lack of movement and usually remains fairly constant. The ability to reproduce the symptom with movement indicates a stress or repetitive movement injury. If you have not seen your personal physician it would be wise to do so. Appropriate therapy is indicated to prevent permanent injuries.

Normally you should wait until the implant has is properly osteo-integrated. This can vary from case to case. In general, if the dentist is satisfied with the osteointegration and the tightness of the implant and you can chew without any particular restrictions, there are no serious contraindications to scuba diving.

Much depends on the progress of the extraction, whether or not stitches have been placed, and the discomfort that using a mouthpiece may cause. It is probably not wise to dive during the first few days and expose the part to the risk of infection and mechanical stress from the mouthpiece.