By Matt Lalande in Spinal Cord Injuries on October 30, 2018
A decline in strength, endurance, and functional capacity are always a major health concerns for the individual living with a spinal cord injury. After an SCI, your body no doubt goes through many physiological changes such as muscle deconditioning – which happens when your muscles do not get enough activity and get used to reduced or lower levels of activity. Your specialist – most likely your physiatrist, would likely tell you that deconditioning can lead to life-long complications including obesity, diabetes, lung problems, hypertension, urinary tract infections, osteoporosis and cardiovascular disease. Medical studies have shown that increased body mass is one of the earliest and most common medical complications for spinal cord injury victims. In a recent article in the journal Spinal Cord Injury Rehabilitation, Sue Ann Sisto and Nick Evans tell us that:
Obesity is a major public health concern and is more likely to exist among populations where physical inactivity, sedentary behavior, and poor dietary habits are widespread. Obesity is highly exacerbated in SCI due to reduced capacity to incorporate all muscles for exercise benefits resulting in the dramatic loss of muscle mass and an increase in whole body and regional adiposity. This accumulation of fat mass can interfere with insulin and lipids metabolism, resulting in detrimental levels of circulating lipids (high level of triglycerides and low levels of high density lipoprotein cholesterol (HDLc), known to be risk factors for cardiovascular disease, type 2 diabetes, and metabolic syndrome
Unfortunately for many people with a spinal cord injury, exercise options are more limiting, and in many cases, muscle paralysis that occurs high enough in your spinal can make exercise very difficult or barren. Other times, financial issues that interfere with PSW assistance or transportation may hamper exercise engagement. Without proper financial funding or support, proper exercise can be difficult to achieve for many people liing with an SCI.
There is no doubt that exercise, even minor but consistent exercise, is an absolute fundamental element in maintaining a degree of physical capacity and cardiovascular health for persons with a spinal cord injury. Regular and consistent exercise can decrease obesity, provide strength and strengthen muscles, energy, provide psychological benefit and increase blood flow to lower extremities. Exercise can also increase flexibility, improve sleep, cholesterol, blood sugar and decrease pain. Below are a few recommendations for improving cardiovascular health, muscular strength and endurance, and flexibility for people with SCI.
Cardiovascular Health – meaning health that is related to your heart, arteries, veins, and blood vessels that carry oxygen throughout your body. Lowered levels of physical activity along with the reduced stress on the heart from less muscle activity causes the cardiovascular system to become deconditioned – leaving you with little energy and breathless. Aerobic exercise is particularly good for cardiovascular health.
Weight Management – Studies show that many persons with a spinal cord injury actually lose weight initially. However, over time, weight actually increases significantly because of lowered activity levels. Weight gain can result in a multitude of negative issues, including transferring and pushing your wheelchair. Movements like this will get harder to do and could cause an increase in shoulder pain. Increase weight in the side areas can also cause your hips to rub against your wheelchair, which can in turn lead to bothersome skin issues.
Muscle Atrophy – As mentioned above, muscles shrink and weaken if you do not use them. Although muscle atrophy is unavoidable to some degree for persons with paralyzed muscles – muscles that can be voluntarily activated should be exercised with resistance training exercise. Persons with spinal cord injury rely heavily on their shoulder and arm muscles for mobility and for performing activities of daily living – and if these core muscles become too deconditioned, there can be a major decrease in your functional ability to perform activities self-care activities, work activities, and household responsibilities. Exercise is a major support to physical capacity and independence.
Strong Bones, Joints and Muscle Stiffness – If you don’t move your body as much as you can, the joints in your limbs can stiffen and contract. This can happen in both paralysed
limbs and limbs with partial muscle function. An adequate joint range of motion is essential to maintaining mobility and decreasing the risk of injury. Regular stretching is highly recommended to prevent and treat muscle and joint stiffness. Focus should be on your shoulders, knees, hips, knees and ankles. It is important to get proper instruction from your doctor as caution should be absolutely be taken not to overstretch limbs where paralysis exists, as this can lead to overstretching and excessive stress and injury on joint structures. Always run your proposed exercise routine through your doctor and rehabilitation specialist.
Activity and exercise is essential for health and quality of life for people living with spinal cord injury (SCI). However, it is important that you always pay special attention to the surface where you sit or lay while performing exercises as repetitive movement may increase pressure or friction in the skin, causing inadvertent skin breakdowns.
Also, persons with spinal cord injuries may not be able to monitor or keep a safe body temperature when exercising. For most, sweating normally cools the body during exercise. If you don’t sweat below the level of the injury, you can overheat rapidly – or conversely you may not be able to stay warm when you exercise in the cold.
In addition – watch for headaches, sweating, nausea, goosebumps and high blood pressure during your exercise routine. Why? Persons with spinal cord injuries sometimes do not respond to pain, irritation or bodily discomfort. Instead, your body will find other wells to tell you what is wrong. This is called autonomic dysreflexia (AD). Anything that would cause pain below the level of spinal cord injury can cause AD. Some examples could be a broken bone, a urinary tract infection, constipation tight clothes, pressure sores or blistered.
Questions about funding? Contact our Hamilton spinal cord injury law firm for more information
Spinal cord injuries can have calamitous effects on people resulting in a reduced ability to perform physical activities, which in turn decreases overall fitness and increases the risk of diseases related to sedentary lifestyle. Exercise is an absolute necessary to improve fitness and reduce long-term health complications after SCI. Decreased physical capacity is associated with an increase in secondary health complications, as well as a decrease in function and ability to perform activities of daily living (ADLs) such as self-care activities, work activities, and household chores – which is something you want to avoid if at all possible.
 Gater DR Jr. Obesity after spinal cord injury. Phys Med Rehabil Clin N Am. 2007; 18 2: 333– 351, vii.
 Sisto and Evans Activity and Fitness in Spinal Cord Injury: Review and Update, Curr Phys Med Rehabil Rep (2014) 2:147–157