All you need to know about spinal cord injuries and how to treat them

Spinal Cord Iinjury (SCI) occurs when the spinal cord gets damaged following an accident, falls, sporting injuries, or following diseases, such as Polio, Spinal Bifida or Transverse Myelitis. Spinal cord injuries are classified into complete or incomplete.

Incomplete spinal cord injury refers to the preservation of some sensation or movement below the level of injury.
Complete spinal cord injury refers to complete loss of movement/sensation below the level of injury.

It is important to classifying an injury into the above categories because sparing of movement or feeling below the level of injury may provide important functional benefits to the person.

Depending on the site of the lesion symptoms may include muscle weakness, altered sensation, bladder and bowel impairment. Stiffness also is known as spasticity and spasms may also be present in the limbs.

The extent of the damage will depend on the level of injury to the spinal cord and will vary for each person. Injury to the neck will affect movements in the arms, trunk and lower limbs whereas injury to the lower back will mainly affect the leg muscles. A Physiotherapy assessment is undertaken as early as possible following injury to evaluate baseline impairments and to plan a rehabilitation program with emphasis on regaining independence.

Rehabilitation may include strength training, limb movements, balance and movement re-education and gait retraining. The key aim is to help the person live as independent a life as possible and where able to resume or become involved in leisure, sporting and work activities. Physiotherapy input, in an active or advisory role, may therefore continue for a number of years after injury depending on individual needs and personal goals.
PCA’s physiotherapy treatment is aimed at addressing the problems that can occur following SCI so that an individual can maximise their potential for recovery and therefore maximise their independence.

Whether the personal injury to that individual has resulted in quadriplegia/tetraplegia or paraplegia, treatment should be focused on what their needs are.

Once the physiotherapist has made their assessment, and the individual has expressed what they would like to achieve, an appropriate course of physiotherapy can be agreed which will aid an overall rehabilitation and maximise recovery.

Depending on the level of Spinal Cord Injury and its nature whether it be complete or incomplete, the problems associated can include:

• Muscle weakness/paralysis
• Reduced ability to breathe
• Loss of general mobility and balance
• Loss of functional movement
• Poor posture
• Pain

Treatment should be focused upon that individual and tailored specifically to their condition. A treatment programme is formulated following a thorough physical assessment which might include:

• Stretching activities to maintain muscle and tendon length and reduce or keep muscle spasms/spasticity to a minimum.
• Flexibility and strengthening exercises for the whole body.
• Breathing exercises to maximise lung function and prevent chest infection.
• Balance and posture exercises which can help to reduce pain associated with poor posture and balance impairment and ensure correct transfer techniques (in/out of wheelchair, bed, toilet/bath, car etc.)
• Functional activities to improve fundamental movement patterns such as rolling over and sitting up, and standing where appropriate.
• Walking re-education, if there is sufficient muscle activity and power in the legs.

Your physiotherapist might also be able to advise an individual on use of appropriate equipment such as wheel-chairs and pressure releasing cushions and exercise equipment.

With appropriate treatment and by challenging an individual during recovery, together with sound advice and encouragement, Neurological Physiotherapy can indeed maximise your independence.

6 exercises you can try after a spinal cord injury

Particularly in the early days after a spinal cord injury, you might be tempted to languish in bed. Moving around certainly seems counter-intuitive when you’ve suffered a catastrophic injury to your body. But the benefits of exercise don’t disappear just because you’ve been injured. Quite the contrary, in fact.

Exercises after a spinal cord injury can expedite the recovery process, in addition to offering myriad health benefits. Research conclusively demonstrates that exercise has many benefits including:

• Improving mental health by reducing depression and anxiety
• Reducing the risk of cancer
• Improving symptoms of chronic pain
• Helping you avoid chronic illnesses such as diabetes and osteoporosis
• Reducing your risk of falls
• Improving your chances of living a longer life

Yoga
Yoga is ideal for spinal cord injury survivors because the gentle stretching encourages healthy breathing patterns, and can reduce the pain of spending all or most of your day in a wheelchair. Work at your own pace, focusing on coordinating your movements with your breath, and abandoning any exercises that are painful or that cause you to lose your balance.

Water Aerobics
You might not be able to safely swim, but water aerobics are an excellent option for spinal cord injury survivors, so long as you have adequate support for your body. The water reduces pain and joint trauma, and can help support your weight even if you’ve lost a significant portion of your mobility or sensation.

Weightlifting
Lifting weights can help you regain significant muscle control. It will also enable you to maintain strength in regions unaffected by your spinal cord injury. Just watch yourself for signs of overuse injuries. Some spinal cord injury survivors end up overworking their upper bodies, creating shoulder and neck problems.

Seated Aerobics
You can still get an incredible aerobic workout from your wheelchair. Focusing on your upper body will help you maintain a healthy posture, but if you’re able to move your lower body, even slowly or with assistance, you can steadily work toward more muscle control and strength. Ask your physiotherapist which exercises are safe for you to do at home.

Rowing
Rowing is an ideal aerobic activity because it only requires movement in your upper body, but uses your lower body to stabilise your movements, making it an ideal choice for injury survivors with incomplete spinal cord injuries. Keep your back straight, and avoid twisting your torso or overextending yourself. Start with five to 10 reps, steadily working up to a more intense rowing workout.

Walking
If your spinal cord injury is incomplete or you have only sustained nerve damage, you may still be able to walk. Maximise your muscle function by walking as frequently as is comfortable, maintaining a steady gait, and an upright posture. If your mobility is impaired, you may still be able to walk in a physiotherapy pool, or with the assistance of a physiotherapist, so ask your doctor if this is a possibility.