Walking with pain

[Strider]

I guess my point is there are other options for rescue than helicopters. If you have 5 people in your group and 3 can continue safely whilst you sit it out in say a hut with a friend why would you press the button.

1. Because not everyone walks in a group.

2. Because the time taken for another group member to walk out might not be sufficient in light of the seriousness of the injury.

3. Because if the injury has occured some reasonable distance from a road, a helicopter will be needed to get that person back to medical care anyway.

[alanoutgear]

As I said Wayno, each set of circumstances will be unique, and for each incident the person or people involved will undertake a risk assessment - they may not call it that or realise that looking at their options is a form of risk assessment, but they will do it.

If I was writhing on the ground in agony I'd have no hesitation in pressing the red button, but the discussion had broadened from that to include pain and the level of pain that triggers a PLB response. There's no easy answer. Some are no brainers, like snakebite, crushing chest pain, fractures etc, but injuries like apparent sprains and strains require a bit more thought.

Let's remember too that most of us who bushwalk are not medically trained. We may have done first aid courses at various levels, but first aid is just that and it is often not possible for us to accurately diagnose the issue, nor should it be.

A friend of mine injured her knee while skiing a few years ago and was told by her rescuers that she had most likely strained a ligament, and to keep flexing her knee until she was able to be recovered from the mountain (they were snowed in). Two days of agony later, imaging showed she'd ruptured a ligament, and fractured her tibia just below her knee. That just adds another layer of complexity to the decision making.

Having been called out to numerous MVAs at night in terrible conditions, and watching extremely skilled pilots land a large helicopter on a dirt track with nearby power lines, trees, and other hazards, I just marvel at their skill.

But let's not forget too that the pilots and paramedics often put their lives on the line (sometimes literally) to save others. I'd prefer them to be doing that for the right reasons.

[zac150]

Agree Wayne, but at least emergency services have the choice I how to effect the rescue.

As per original post , we are talking about non life threatening injuries with a low chance of internal bleeding. Yes moving hurts but you won't die.

Strider - please read my previous posts! You will note that I clearly said the decision should be made based on a number of factors including how many people are in the group, if it is safe to go for help, where you are I.e can help get to to you easily or not.

Remember the original post is discussing pain not life threatening injury, yes if the injury is life threatening or there is a risk / potential of life threatening injury then yes press the button. If not assess the situation and if help can be achieved without pressing the button why would you.

[icefest]

Having been called out to numerous MVAs at night in terrible conditions, and watching extremely skilled pilots land a large helicopter on a dirt track with nearby power lines, trees, and other hazards, I just marvel at their skill.

Do you mind me asking what your background is in?

[wayno]

Agree Wayne, but at least emergency services have the choice I how to effect the rescue.

As per original post , we are talking about non life threatening injuries with a low chance of internal bleeding. Yes moving hurts but you won't die.

Strider - please read my previous posts! You will note that I clearly said the decision should be made based on a number of factors including how many people are in the group, if it is safe to go for help, where you are I.e can help get to to you easily or not.

Remember the original post is discussing pain not life threatening injury, yes if the injury is life threatening or there is a risk / potential of life threatening injury then yes press the button. If not assess the situation and if help can be achieved without pressing the button why would you.

well non life threatening injuries with low chance of internal bleeding would be ruptured knee ligaments or major muscle or tendon tears in teh lower limbs, you wouldnt be able to walk without severe pain if you'd be able to walk at all... speaking from experience... how mobile you are and how much pain you are in does come into play,,, strong pain can bring on shock in itself, while some injuries arent life threatening they can still have complications in the long run that can cause severe issues for the patients health and well being

[north-north-west]

Hmmmmmm, It's an individual thing, isn't it.
I've walked (limped, slowly) 10km with a torn knee ligament. Took 3 hours to get back to the car after the misadventure on the Weld track, barely able to breathe from the bruised ribs. Most downhills are painful from either the hip or a knee (or both). Headaches stop me - migraines are a 'take pills and put the tent up' proposition. Plenty of cuts and bruises and strains and just kept staggering on, even on long multi-day walks. Never had anything too serous happen while walking, though.
And as for this thorn in my right pinky - which has been there for the last week of walking - you have no idea just how agonising it is . . .

[wayno]

while strains may not come under the category of needing immediate evacuation they can lead to sfurther more severe damage if the damaged tissue is put under continued strain, increasing likelihood of them turning into significan tissue tears in some situations

[zac150]

Wayne I understand your angle and yes if someone blows a knee out they won't be able to walk but where do we draw the line? I remember a storey a few years back where a group hit the button on a plb because they were exhausted and the weather had turned and they were afraid of hyperthermia, no injury but they were concerned by the risk of potential injury.

Now I am not suggesting you support the above. My point is somewhere we need to draw the line as to how bad the situation needs to be to make it acceptable.

I guess I am saying we choose to go walking, we choose to place ourselves in positions which may be dangerous so at times we may need to take actions ourselves.

[TerraMer]

How much pain is too much depends a lot on pain tolerance.

As a kid the term "No pain no brain" was often directed at me because my threshold is very high for most kinds of pain

Some people have a low pain tolerance, which isn't a bad thing because pain is a very important part of our survival instincts.
Some people have an incredible ability to completely block the pain and, as has already been expressed, that is both advantageous for getting out of a bad situation but no good if it is causing serious long term damage.

Having EPIRBs, PLBs, SPOTs, sat phones, etc is fantastic for calling help and these services should be used, especially by old school who have grown up learning to get themselves out of trouble instead of asking for help. "Improvise and overcome" isn't really needed anymore when the safety risks are too high and we have the technology at our disposal. I carry a sat phone with RFD numbers programmed into it so I can call for advice if I'm not in an emergency and can sit tight for a few days. For me an emergency would need to be immediately life threatening, eg, snake bite, concussion, femur fracture...

It varies a great deal from person to person. If you're a leader or guide of a group you'd definitely be calling for a chopper much sooner for a member of your group than an individual making decisions for themselves.

I worked for almost 3 weeks with a hairline hip fracture before the captain noticed I couldn't stand up or walk without assistance. By then we were only 2 days away from shore leave and my body had just about reached it's maximum ibuprofen limit. If he had noticed earlier he would have called an evac. I didn't know it was a fracture at the time, had just been given a trial promotion and I was earning over $2,000/week so I soldiered on. In hindsight I should have been evac'd. Same happened on another ship when I dislocated a shoulder, it popped back in straight away but pinched something. I wasn't evac'd because my pain tolerance was high enough to wait until the scheduled fly out 4 days later. Neither of these were immediately life threatening but evacuation was a legit option so it really does vary from person to person. I was evac'd from a ship in the Persian Gulf one summer. I had heat stroke presenting as heart attack after a day working in full PPE on a +60C deck. I was evac'd to the Kuwait Hilton after 10hrs under observation in hospital

[icefest]

I worked for almost 3 weeks with a hairline hip fracture before the captain noticed I couldn't stand up or walk without assistance. By then we were only 2 days away from shore leave and my body had just about reached it's maximum ibuprofen limit. If he had noticed earlier he would have called an evac. I didn't know it was a fracture at the time, had just been given a trial promotion and I was earning over $2,000/week so I soldiered on. In hindsight I should have been evac'd. Same happened on another ship when I dislocated a shoulder, it popped back in straight away but pinched something. I wasn't evac'd because my pain tolerance was high enough to wait until the scheduled fly out 4 days later. Neither of these were immediately life threatening but evacuation was a legit option so it really does vary from person to person. I was evac'd from a ship in the Persian Gulf one summer. I had heat stroke presenting as heart attack after a day working in full PPE on a +60C deck. I was evac'd to the Kuwait Hilton after 10hrs under observation in hospital

What were you doing to break you hip? I'm agog at that pain tolerance.


The best story I have is when I thought I had an infected mosquito bit on my leg a week after coming back from a hiking trip. At some point I got bored and tried to see if it was an abscess or cyst. Before I got to use the scalpel I managed to squeeze a 1cm long thorn/stick out of my calf (in the soleus lateral to the gastrocnemius aponeurosis, just inferior to the base of the lateral head).
Nothing in comparison to yours. :S

[north-north-west]

I worked for almost 3 weeks with a hairline hip fracture before the captain noticed I couldn't stand up or walk without assistance. By then we were only 2 days away from shore leave and my body had just about reached it's maximum ibuprofen limit. If he had noticed earlier he would have called an evac. I didn't know it was a fracture at the time, had just been given a trial promotion and I was earning over $2,000/week so I soldiered on. In hindsight I should have been evac'd. Same happened on another ship when I dislocated a shoulder, it popped back in straight away but pinched something. I wasn't evac'd because my pain tolerance was high enough to wait until the scheduled fly out 4 days later. Neither of these were immediately life threatening but evacuation was a legit option so it really does vary from person to person. I was evac'd from a ship in the Persian Gulf one summer. I had heat stroke presenting as heart attack after a day working in full PPE on a +60C deck. I was evac'd to the Kuwait Hilton after 10hrs under observation in hospital

What were you doing to break you hip? I'm agog at that pain tolerance.

Actually, it's not all that hard. I found out recently that at some stage in the past I fractured my hip - probably during martial arts training some 15 to 20 years ago, but possibly even earlier. Never noticed it at the time, just thought it was the usual soft tissue problems.
Not as serious a fracture as TerraMer's, of course. But a hairline fracture would be easy from a fall and falls are easy on board in rough weather, or while working.

[TerraMer]

I worked for almost 3 weeks with a hairline hip fracture before the captain noticed I couldn't stand up or walk without assistance. By then we were only 2 days away from shore leave and my body had just about reached it's maximum ibuprofen limit. If he had noticed earlier he would have called an evac. I didn't know it was a fracture at the time, had just been given a trial promotion and I was earning over $2,000/week so I soldiered on. In hindsight I should have been evac'd. Same happened on another ship when I dislocated a shoulder, it popped back in straight away but pinched something. I wasn't evac'd because my pain tolerance was high enough to wait until the scheduled fly out 4 days later. Neither of these were immediately life threatening but evacuation was a legit option so it really does vary from person to person. I was evac'd from a ship in the Persian Gulf one summer. I had heat stroke presenting as heart attack after a day working in full PPE on a +60C deck. I was evac'd to the Kuwait Hilton after 10hrs under observation in hospital

What were you doing to break you hip? I'm agog at that pain tolerance.

Actually, it's not all that hard. I found out recently that at some stage in the past I fractured my hip - probably during martial arts training some 15 to 20 years ago, but possibly even earlier. Never noticed it at the time, just thought it was the usual soft tissue problems.
Not as serious a fracture as TerraMer's, of course. But a hairline fracture would be easy from a fall and falls are easy on board in rough weather, or while working.

Yep, fell down some stairs, while carrying boxes from the bosun store to the lab 3 decks down in rough weather. Concussion, sliced quad, fractured hip, dislocated shoulder, heat stroke, i was stacking the odds before quitting a career at sea

Last edited by TerraMer on Mon 10 Mar, 2014 10:40 pm, edited 1 time in total.

[Gadgetgeek]

Not saying anyone is right or wrong, as I don't know what would cause me to push the button. I do know I don't want a bureaucrat deciding after the fact if my injury was "bad enough" to warrant rescue. I've got some pretty decent first aid experience, and I feel my assessments are pretty good, but if moving isn't an option, is it cheaper in general to hit the button, or not show up at the parking lot, and make your family wait the 24h before the search starts? I'm a fan of "active survival" but the chance is always there that whatever you do to get yourself out may make things worse.

To anyone who thinks sprains are no big deal. look up compartment syndrome. not something you want in the bush.

As much as its "wasteful" for people to push the button when things aren't that bad, people have died because either pride or inexperience told them they could handle it. On the flip side, there will always be those who get themselves into trouble, or who will treat the cell phone, sat phone, gps, or epirb like a license to turn their brain off.
I guess at the end of the day, its up to the person in the situation to make that call. I'd rather a culture of bushwalkers that is accepting of that, rather than someone feel like they should tough it out, and ultimately pay a higher price than is needed. It would be awesome if something like SPOT worked well enough to be trusted in an emergency, but until then I guess its a one button system.

I wonder if there is enough traffic on the trails to support a per-use rescue insurance fee?

Anyway, This has been on my mind as I've been thinking about doing some solos, and the general responsibility of it. I would definitely take an epirb if for nothing else than to make my wife feel better about it... or to make me feel better about my wife not being worried...

[walkon]

Seem to recall a bloke near lake eildon who had a helicopter come to his rescue only to have the lifting cable shear off above tree height. So getting a chopper isnt without risks.

Just checked and it was some part of the lifting device that was allegedly the problem. The man had a broken ankle which was a fair call to get the chopper in.

Appart from his family, I really feel for the rescuers that would be devastating.

[Taurë-rana]

Just got back to this thread - have been avoiding the forum because I don't know when or even if I'll be able to bushwalk again so it's too depressing! It's an interesting discussion, and lots of different points of view.

My knee is still sore and a bit swollen, but I have no diagnosis other than 'it's not tracking properly'. I've been given some exercises to do, but I think I'll be pushing for an MRI to get it checked properly. I certainly caused more damage by continuing to walk, but to call a helicopter in 'just for a sore knee' when I was still capable of walking is not something I could have done.

It didn't really occur to me to press the button while I was out walking anyway, because although it was so painful, it was fully functional, it wasn't so painful that it made me faint to walk, although the pain was affecting my breathing, and I was only a few hours from the car. It also stopped hurting if I wasn't walking so that gives some relief from the pain. If I had been out further I don't think I would have got back though - I could hardly walk for quite a few days, and I did lose stability in my knee so it would have become dangerous, quite apart from the fact that there is a limit to how long I can cope with that much pain for. I have always thought that I could get myself out with any injury other than a broken leg, but now I'm not so sure.

When I was walking back alone from Junction Lake to Lake Myrtle, I did meet up with a couple of walkers who were most concerned that I was walking back alone - they were concerned about the increased possibility of a worse injury, but I had all my first aid and safety gear with me, the weather was perfect and my companions were behind me so I felt safe enough.

I think in some cases it must be fear that makes people call for help - fear of getting stuck in the big wide wilderness. I think that how much pain and possible damage you're willing to put up with depends on a number of things - I'm very independent and tend to only ask for help with things if I absolutely can't find another way round it. I've also had quite a few injuries, and I get migraines so lots of experience with pain and putting up with it. I've noticed that people who haven't had an injury before often find it much harder to deal with, and something that would be a (relatively) small thing for me is a big thing for them, especially older people.

[wayno]

have you had an opinion on a torn cartilage? the knee usually swells with a torn cartilage. that can be quite painful, usually the surgeon snip out the smallest possible piece if it's been catching and you can make a good recovery, i've had that plus torn ligament was catching, had it sorted out in my teens, been OK since

[Taurë-rana]

My doctor is reluctant to send me to an orthopod, but I think I will be pushing to go if it doesn't improve dramatically in the next couple of weeks. It's a bit ridiculous not being able to go for a walk

[wayno]

get another opinion, if you can find a dr who sepcialises in sports injuries or go to a physio who specialises in sports injuries, i had the same problem with my knee, my dr called it a strain that would go away,, i had a torn ligament and cartiage
You need to find out whats going on in your knee if its dragging on like this.
i now go to a sports dr , since about the only time i need a dr is when i'm injured and where i live is full of elderly people with medical people more orientated to care of the elderly thqan serious sports injuries

[Nuts]

Have the MRI, see a surgeon (privately imo). My knee was effectively cactus. I couldn't manage a serious load or walk without the thought that it would collapse. When it did was like being hit under the knee cap with a sledgehammer.

The knee couldn't have been much worse but the pain was simply the torn piece from meniscus. A few hours and it was back to new (pain and stability wise).

(Unfortunately for me the other one has gone now, and I have to save for the op myself this time, but I wouldn't hesitate).

[GPSGuided]

The timing to operate is an individual one. If it's bad enough, then you will ask and demand. Until that point, the family doc is most likely to be right. Especially artificial joints, they dong last forever. And each re operation adds more risks and complications. Take care when young is the word.

[Gadgetgeek]

Get it checked. End of story, most GPs are not great with soft tissue injuries, and often they are overlooked by medicine in general. I used to do first aid for a few junior sports teams, and the company policy was to treat doctors like first aiders at best. We had all manner of cases where docs signed off on players being recovered, only to have the player re-injure themselves the first game back. Players would come back with all sorts of conflicting advice for treatment, often stuff that was state of the art in 1950 or worse. Do what you need to get the referral to a specialist, fake it, buy it, whatever. But at the end of the day, the longer you leave any potential damage, the worse off you'll be, get the repairs done now, and you'll keep your own knee intact for much much longer. Knees operate under surprisingly tight tolerances, get them out of whack and like an old transmission, they grind themselves to junk. Worse yet, with a high threshold of pain, you'll be able to do far more damage to it than someone who wimps out.

[wayno]

try a physio for advice, remember a surgeon is more likely to say operate a physio could have a more balanced viewpoint but they tend to know their soft tissue injuries, a lot of GP's are jacks of all trades and masters of non in medicine or they have some specialty that has nothing to do with soft tissue injuries.... i've got a collection of intersting pet theories from various dr's over various medical conditions i've had in the past.

[Tortoise]

My doctor is reluctant to send me to an orthopod, but I think I will be pushing to go if it doesn't improve dramatically in the next couple of weeks. It's a bit ridiculous not being able to go for a walk

Hey Taurë-rana. I'd be finding another GP. It's been too long going nowhere. If it's the same as another specialty, if an orthopod orders an MRI, you won't pay the hundreds of dollars you would if a GP ordered it.
Hate to see you sidelined like this.

[walkon]

. If it's bad enough, then you will ask and demand. Until that point, the family doc is most likely to be right. .

Taure-rana or anyone else who has a high pain threshold don't trust what the local gp thinks. Ie

If your leg was broken you wouldn't have walked in. Was a broken Tibia wouldn't listen to what I was telling him

My so called strained calf called by 2 gp's. Was a torn Achilles and further damage to it cost me 2.5 years from walking normally all up
And lots more instances, the local gp is taught using pain as an indicator which doesnt work for the likes of us, goodluck Taure and all my wishes for a fast recovery

[wayno]

dont under estimate your pain threshold
i did my neck in,, i left it for a week and it was still a bit sore so i went to the Dr, he examined me and asked what pain killers i'd been on, I told him none... he was amazed, he said for my injury people need pain killers, he was amazed i could sleep at night. to me it was painful but not painful enough to warrant pain killers...

[Gadgetgeek]

My dad got a knee replacement done a few months ago, still bashing out the recovery before they do the other one. its the result of several motorcycle and car accidents, as well as other work related injuries. The consulting surgeon had to double check he had the right person, in his opinion, no one with that amount of damage should have been able to walk. Pain is a terrible method to determine injury level.

[Taurë-rana]

Thanks for the supportive comments, it's really hard not being able to go walking, and not knowing how long that will last or how to fix it. Who did you see, Nuts? If anyone has confidence in a good surgeon for knees in the north of Tassie, please pm me. And in defence of my own GP, I had a lot of trouble after an arthroscopy on the other knee a few years ago which is why he doesn't want me to have one, but that one was quite damaged already, and it did come right eventually.

[Nuts]

Come to think of it, I didn't even have the MRI in the end. I was skeptical at first but I think he knew what the problem was before I'd sat down..
I'm sure the public system works fine, I just wanted to choose the surgeon. Used Bernie Einoder in Launnie (professor of knees ) T/a, I don't recall any pressure to operate with the initial consult. A friend works with another surgeon over there who iv'e heard a couple of times- is apparently also very good. I'll message his name when I next talk to her.

[GPSGuided]

Pain is a terrible method to determine injury level.

Unfortunately it has to be. It's a strictly functional problem and not a decision that can be made by looking at an Xray, MRI or clinical examination. So yes, the decision must come from the individual. Also, joint operations aren't risk free, so that's why GPs and orthopedic surgeons will most likely take the conservative line. Not that they are incompetent but more often are in consideration of the potential risks involved. In this case, a previous complication would make one even more restrained. All with good reasons. Not being able to do 10km bushwalk is insufficient reason to take on certain risks, but intractable pain while resting at home or with basic daily activities are reasons to take on the risks. Forum discussions without consideration of the full picture tend to have a degree of bias.

[Moondog55]

Let's talk about pain management while out and about.
My doctor just put me back on Celebrex; and he has me taking my Panadol 3*500mg twice a day rather than 2*500mg 4 times a day and that is working better. So pain isn't a barrier to getting out; you just have to find a regime that works. He also prescribed me some very powerful painkillers just in case I need them; and those really are for emergency use only.