Heavy lifting and hernias


Bob avoids heavy lifting by hiding out in the garage

On Monday afternoon, two wiry young men backed a furniture van into our driveway and began unloading our goods and chattels. My nephew’s wise words rang in my ears – “Hopefully the movers are doing all the heavy lifting, Uncle – LOL.”

One of these blokes was wearing a knee brace. I made a mental note to ask him about it, as furniture removalists are prone to injury, hernias in particular.It turned out he had injured his knee playing soccer with his kids (sound familiar?) As you may have read (see link at the end) I had serious knee injuries in the late 1960s, so now go to some trouble to avoid doing anything which might inflame either of my knees.

Apart from our furniture, we had approximately 110 packing boxes of various sizes and weights. I did not lift any of these boxes, which came off the truck on a trolley and down a ramp four or five at a time.

Those two lads deserve a medal. Their day started early, loading the truck from a storage unit in our former town. Then they drove four hours via back roads (the Cunningham Highway was closed). It was also very hot and humid but they persevered with the work until finished. We directed traffic – put this here, take that there, but mainly instructed them to stack boxes in the garage.

As a bonus, these lads put our two beds together, having no clue as to how much domestic angst was avoided in the process. (They seemed surprised, but pleased that we presented them with a slab of beer. They promised not to drink it on the way home.)

Once they left, it became apparent how difficult it would be for two people over 70 to stick to a self-imposed ban on lifting anything heavier than 20kg.

When I had an inguinal hernia repaired in 2004, the surgeon at Nambour Hospital assured me it was so common he had done 600 repairs that year alone.

As I recall, he said the injury was most common in furniture removalists and farmers (and sedentary office workers). An inguinal hernia occurs when part of the lower intestine protrudes though the inguinal canal. The injury commonly occurs through straining (e.g. improper lifting, constipation or persistent coughing). Wind instrument players (trumpet, saxophone) are also prone to inguinal hernias.

Check out Weird Al’s disco tribute to hernias.

In my case, the hernia dated from when I bought an old ex-government desk (a heavy one with a metal frame).

“Bend your knees and don’t strain,” I instructed my son, “or you’ll give yourself a hernia.” At the first ‘one, two, go’ I felt something pop in my groin area. Next day I had a noticeable lump. Our family GP at the time took hold of the lump and told me to cough – twice.

“Yep, it’s a hernia. You’ll need to get it repaired eventually.”

He did not put any time frame on this, other than to add that if I had excruciating pain, get to hospital ASAP because sometimes hernias become strangulated.

So in May 2005 I took two weeks’ sick leave to recover from the operation. On returning to work, I found that sitting down for eight hours was very uncomfortable. I bought one of those doughnut cushions commonly found in nursing homes.

Last year, Australian surgeons repaired 100,000 hernias and many more went undetected or ignored. The lifetime risk for males is about 1 in 5 (1-50 for females). In 90% of cases, surgeons use a fine nylon mesh patch to reinforce the muscle wall of the lower abdomen, as it greatly reduces the risk of recurrence.

Updating my 14 year old story, I discovered a new medical term – ‘mesh migration’. This is when (in 5% of cases), the mesh insert moves to another part of the lower abdomen. While relatively rare, the problem does exist and can occur years after the operation. Most of the literature is contained in medical journals, but I did find one or two in blogs generated my personal injury lawyers.

Occasional groin twinges and aching knees aside, at 71 I am still relatively fit and agile. The test, as Billy Connolly once quipped, is how long it takes you to get out of a bean bag.

When moving boxes to the relevant room, we employed a much-used luggage trolley – a big one with rubber wheels. When something felt like a two person lift, I would summon She Who Had a Laminectomy Years Ago and we carefully manoeuvred the object onto said trolley.

There are good reasons to avoid heavy lifting or poorly executed lifting.

In 2013, musculoskeletal injuries comprise 90% of claims made to Worksafe Australia (our workers’ compensation organisation).

As Axis Rehab notes, lower back injuries make up the large majority of work-related injuries. They can range from less serious muscle strains, or joint sprains, to more serious injuries (disc prolapses).

“These injuries can occur from a traumatic event, but can just as often result from something as innocuous as rotating to reach for something, bending to tie a shoe lace, or picking up something unexpectedly heavy or awkward.” (So, Bob, forget about carrying me over the threshold-Ed.)

Most injuries involve large and complex joints – shoulders, hips, knees, ankles and wrists. The modern answer to chronic knee and hip paint is to replace the joint with an artificial one. If you live long enough, you may need a second one! A large study by The Lancet, which used thousands of cases in Australia, concluded that the average life span of a hip or knee replacement is 15 years.

An article in New Daily stated that hip and knee procedures are the most common type of joint replacement surgeries in Australia. More than 850,000 hip and knee replacements have been recorded in the past 20 years,

The Australian Orthopaedic Association’s National Joint Replacement Registry last year reported 63,577 knee procedures and 47,621 hip procedures,

The anterior cruciate ligament (ACL) injury is the one all professional sports people fear more than most and not just because of the intense pain. It can take six to nine months to recover full mobility after an ACL reconstruction, as the graft needs time to heal. Australia now leads the world in the number of ACL joint reconstructions.

A Medical Journal of Australia study of ACL injuries found that the incidence is rapidly increasing among young people. During the study period, (2000-2015) 197,557 primary ACL reconstructions were performed. The annual incidence increased by 43 during the study period and by 74% among those under 25 years of age. Direct hospital costs of ACL reconstruction surgery were estimated to be $142 million.

The big question is whether a young person who has had an ACL reconstruction (or two) will need a knee replacement in the future. The cost disparities are obvious. In 2013, some 400,000 inpatient primary hip and knee procedures cost Medicare more than $7 billion for hospitalisations alone. Medicare spent an average of $16,500 to $33,000 per patient for the surgery, hospitalisation, and recovery from hip and knee replacements.

Apart from being costly to the nation (and private health funds), knee replacements are quite radical operations. I know a few people for whom they did not go smoothly. Given my chequered history of knee surgery, I have decided that unless I am literally unable to walk, I will take my old knees to the grave. You read it here first.


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