How Mumbai’s local trains are killing your knees

Doctors say jumping off train to alight on platforms is landing Mumbaikars in a host of problems such as peculiar knee joint injuries and damage to ligaments

local-train-1It’s the most common thing that you find on railway stations, more so on open-door local trains of Mumbai where boarding and alighting in minimal time is an achievement and art! But, next time you prepare to jump out of a train slowing down at a station, think again.

Doctors say this habit of Mumbaikars is landing them in a host of problems such as peculiar knee joint injuries and damage to ligaments.

Rupture in anterior cruciate ligament (ACL) — one of the four major ligaments of the human knee — is now becoming increasingly common, says a paper presented by Dr Sushil K Sabnis and Dr Anish P Kadakia.

Titled ‘Mumbai suburban railway platform injury, a new mode of anterior cruciate ligament injury’, the paper was first published in The Indian Journal of Orthopaedics in July 2003. It dissects risks involved in dangerous habits of commuters.

“Many patients have been coming to my hospital and these findings are based on various cases. It (jumping out of trains) is a common habit of Mumbaikars, but it could lead to serious knee complications,” Sabnis, who led the project, said.

Sabnis, who is former head of department of orthopaedics at Harilal Bhagwati Municipal Hospital in Borivli, said most cases he encountered are from his private clinic outside Goregaon railway station. Kadakia was the registrar and has now moved to UK.

“We have come across a new mode of ACL injury occurring in Mumbai suburban railway commuters. It is necessary to make everyone aware of such injuries so that these are diagnosed and treated early,” doctors said in the paper.

“Retrospective study over a period of 10 years is on patients who are office-goers, who travel daily in overcrowded suburban trains,” Sabnis said.

The paper classifies injury patterns broadly into three types

In type A, the person is pushed out on the platform by crowd when train is slowing down. The person does not know when he actually lands on platform. He lands at 90 degrees to the motion of train and rotates on his flexed knee due to his momentum. It causes pivot injury due to knee rotation.

In type B, the person tries to get off the train as it is slowing down to halt. Here, he tries to suddenly decelerate after landing on platform. It causes deceleration injury. There is a sudden deceleration force acting on knee joint as partially-flexed knee and posterior-tilted body (in order to counteract momentum of forward moving train) hits platform. This combination of movements put ACL under tremendous stress. In this situation, rotation injury can also take place if the person slips on landing.

In type C, the person, instead of using overhead bridges to go from one platform to another, tries to take a short-cut and jumps off platform on tracks or gravel in a hurry to reach other side. As he lands on irregular ground, the foot slips or turns. The unexpected foot position due to uneven surface of tracks alters knee patterns, placing ACL at high risk.

“Most patients were from type B injury, meaning that more people get these injuries trying to get off a moving train. Most incidences occurred in younger individuals who tend to take risks by jumping off on a platform or alighting on before the train stops,” the paper adds.

Rajendra B Aklekar has been a journalist in Mumbai for over 20 years, having formerly worked with newspapers like Mumbai Mirror of the Times of India Group, Hindustan Times, DNA, Mid-Day, Sunday Observer and Daily. He is also the author of Halt Station India, best-selling book on India’s first railway.