Home exercise programs are particularly important for people with spinal cord injury, not only to increase function and maximize recovery, but to prevent further physical limitations.
While spinal cord injuries are non-progressive, patients are likely to experience muscle atrophy or develop joint contractures from poor positioning, lack of movement, and muscle tightness. People with spinal cord injury are also at high risk for cardiovascular disease.
Home exercise programs should be tailored to a patient’s individual needs, as there are many individual factors that affect participation and optimal outcomes. A physical or occupational therapist can assist with customization, but home programs should include cardiovascular exercises, exercises to maintain range of motion, and muscle strengthening.
Cardiovascular exercise involves increasing the heart rate and rate of breathing. Cardiovascular exercise improves the way the heart and lungs function. Depending on the level of injury there are many ways to accomplish this using just the upper body, including: pushing a wheelchair, using an arm bicycle, seated aerobics, rowing, and Wii or Kinect video games (boxing, dancing, etc). You just gotta get that heart pumping!
Make sure to check in with your physician before starting an exercise program. Of particular note: people with spinal cord injuries at or above the T6 level are at risk for autonomic dysreflexia, which is simply the body’s protective responses going into overdrive which can have serious consequences if intervention is not given rapidly. Prior to starting an exercise program, patients should be aware of their baseline blood pressure and the symptoms of autonomic dysreflexia.
Maintaining Range of Motion
Passive range of motion is needed to maintain movement in a joint. If you don’t move it, you lose it! Think of the movement like opening and closing a door. Each time you move the joint, it’s like putting oil on the hinge of a door. If you don’t ever open the door, the hinge will get rusty and you won’t be able to open the door easily. We want to keep as much joint mobility as possible because tight joints make getting dressed and showering much more difficult.
Depending on the level of injury and whether a spinal cord injury is complete or incomplete will determine which joints need to be passively moved through their range of motion. This can be done by either the patient or caregiver.
Strengthening of a muscle happens with repetitions of muscle contractions to the point of fatiguing the muscle. Think of a person at the gym doing a bicep curl. To build strength you need to use enough weight that the muscle is fatigued after 10-15 repetitions of movement. Typically for strengthening you would complete 3 sets of 10-15 repetitions with 1-2 minutes of rest between each set. To build endurance, you would use a lower weight and complete 3 sets but increase the number of repetitions to 20 or 30 with shorter rest breaks between sets.
Even if you’re not using weights, simply activating that muscle and moving through the range of motion using the same parameters will build strength. The other important thing to consider is gravity. It makes a huge difference! If a person is able to activate a muscle, but cannot move against gravity, they can try repositioning their body at a different angle that takes gravity out of the equation. Once they gain strength in a gravity eliminated plane, they can progress to against gravity, then light weights, then slowly increase the weight.
The other way to strengthen is by participating in your daily activities to whatever extent you are able. Everytime you push your arm through the sleeve of your shirt you are activating your tricep muscles. Everytime you eat and bring your hand to your mouth, you’re activating your bicep muscles. It’s a balance of allowing someone to assist and taking on as much as you are physically able.
Staying Engaged in Exercise
Finding motivation to complete a home exercise program is a universal problem throughout rehabilitation, and yet it’s so important! It’s impossible to gain strength in the 1-2x a week session a patient is seen for OT or PT. To combat this, make sure your exercise program is tailored to your interests. Involve friends and family who will follow along with your progress and hold you accountable.
Ultimatelly, maintaining motivation is worth more than just a physical payoff the long run. It’s not just about strengthening, it’s about finding what activities matter to you. It’s the meaningful activities we do everyday that improve our quality of life.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Neofect website is solely at your own risk.
- Clarice Torrey, OTR/LClarice is an occupational therapist, product designer, and health writer based out of San Francisco, CA. Clarice works for RAD Camp as a Community and Product Manager.