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Posts Tagged ‘Exercise and stretching’

OR: FINALLY, A MEDICAL EXPLANATION HOW THIS INCOMPLETE PARAPLAEGIC’S WALKING CONTINUES TO IMPROVE

I came across an article from the University of Washington that blew my mind. I am excited, delighted and vindicated.

Some highlights:

Spasm caused by spinal cord injury can prevent voluntary movement of weak muscles. Sounds pretty simple. Except it’s not. Spasm can be complex and the cause, other than the obvious one that it is caused by sci,can be difficult to identify. Pain that is not felt can cause spam, so pain killers can help reduce spasm. Stretching can help reduce spasm. Weight-bearing and walking can reduce spasm. Good postural alignment whether sitting or standing can replasma spasm.

I’ve already learnt this through experimention. I take a cocktail of prescription drugs from muscle relaxants, to pain killers, to anti-epileptics, to a neural enhancer. I exercise five days a week at the gym under the supervision of a personal trainer who creatively extends my range of movement and improves mobility through gentle exercises that target weak muscles, and finds ways of reconnecting neural pathways. I stretch at regular intervals during the day.

Here’s the eye-opener though.Spastic muscles not only inhibit weak voluntary opposing muscles, they also take up residence in synapses and axons and make them unavailable to voluntary muscles! So get rid of the spasm, and nerves can reconnect to voluntary muscles! That goes a long way to explaining rapid improvement in my walking over the last two years – since my spasm was finally under control.

It still doesn’t explain why muscles that had no movement, have gradually become enervated, suggesting that the central nervous system can repair itself!

So never, never, never give up!

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The iPad and exercise sounds more like an oxymoron than a marriage. Yet the iPad has freed me from the chains tying me to the pc, and everyday, while I’m using the iPad I’m exercising and stretching.

Most people spend their day in flexion, hunched over their computer, slouched on a couch or just sitting around. We didn’t evolve to spend our days sitting, we evolved to STAND STRAIGHT. Sitting shortens our hip flexors and weakens our hip extensors so that when we do stand up, our posture is terrible – our shoulders are rounded, and we  lean forward from the hips with our heads thrust forward. You might not notice this when you’re 25, but you sure will notice it when you’re 55. Look around. If that’s not enough to pursuade you to stop sitting so much, think about your internal organs. They’re designed to hang inside, not be squashed up so that end up with digestive and “other problems. If you have a spinal cord injury it’s even more important to get out of flexion.

When I was sitting at the pc I had a timer beside me (given to me by a daughter who cares) so that every 20 minutes it beeped at me til I stood up and went for a walk or did some stretches. Otherwise I’d soon end up with painful spasm and find it really difficult to walk. Ok, I’ve had an incomplete spinal cord injury since 1993 and spasm has always been a problem for me, and I’ve not been able to tolerate sitting for long, but getting down on the floor is just as useful for more able bodied people, you just don’t know it til you hit your fifties and you think being stiff and sore is part of growing older.  Nuh uh … Being stiff and sore is because you spend too much time sitting  and you’ve lost your flexibility.

Muscles get used to the range in which you use them. It’s not enough to occasionally stretch, it takes weeks of regular stretching to increase muscle flexibility. And if you stop, the muscles will likely tighten up again. You have to keep stretching. If you have a spinal cord injury you have to spend more time stretching and make sure that you are using the full range of movement. Otherwise, if you’re in a wheelchair you risk contractures, and if you walk you risk shortening muscles to the point where you can no longer use them. My right hamstring shortened to the point where I could not stand on it, let alone walk. My calf muscles shortened so that I only avoided surgery by doing lots of stretches. I need to keep stretching my calves, hamstrings, hip flexors and adductors every day, three times a day, to keep mobile. And I need to stretch other muscles too.

This is how my iPad and I became good friends*. We roll around on the floor together, we lie down together, we sit crossedlegged together, we do yoga together, we do pelvic tilts together, we extend and flex our internal obliques together, we rotate our hips around my spine together … I’m still discovering exercises we can do together, but pretty much any movement I can do on the floor I can do with my iPad.

I’m writing this while I’m lying prone on the floor.  I’ve rocked my pelvis, I’ve gripped my glutes.

I’ve pretty much had a work  out with my iPad this afternoon.

I’m an advocate of living on the floor, but if  you can’t bring yourself to moving the furniture out, at least get yourself an iPad and free yourself from the chains that bind you to a chair in front of a pc. (whether you’re able bodied or have mobility restrictions). Your body will love you for it.

*My son, the computer whizz, saw my predicament.  He saw how difficult it was for me to sit at the computer. He had the answer. Using the iPad, he said,would allow me to stand at the kitchen bench, lie on the floor , be virtually anywhere and able to do pretty much anything the pc would do. It took some persuading on his part to convince me, but a big, big thanks for his persistence!

Now that he’s seen how successfull the iPad has been, he ‘s suggested the next step. There are some things I still use the pc for, mostly design and publishing. He has suggested we reconfigure the physical set up of the pc so that I can use the keyboard on the floor with a flat screen that can also be use on the floor ….

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My mantra “determination, persistence and commitment” would be just words if it weren’t for The Dictator. The Dictator shouts and yells, he snarls and barks, he pushes and shoves, he cracks the whip. The Dictator gets me to the gym every day, he makes me go where I’m scared to go, he makes me stretch and exercise when I’d rather go to bed or watch TV. The Dictator calls me names and relentlessly keeps me moving forward. The Dictator denies temptation, keeps the troops in line, roots out subversion and keeps me on the straight and narrow. Yet The Dictator is not abusive and does not swear or curse. The Dictator says “DO IT” and I do.

What happens if the Dictator crumbles? If the voice cracks or is lost? Then the troops slow down, lose direction, become confused. Life becomes harder, the world darker.

That’s when I need inspiration from outside. Someone to listen is best, or maybe following the faint memory of routine brings me into contact with someone and I rediscover my self.

The world can be hostile when your mobility is impaired. Simple things can seem impossible. Anxiety and panic can immobilise you. Negative thoughts can creep in and overwhelm the optimistic, confident self.

I need some means of rediscovering the inner voice, the voice that gives the orders, pulls the troops back into line. I listen for an echo or a whisper “Do it”, or fake the orders until they become real, and the Dictator returns. I need the voice that says “DO IT”. I need The Dictator within.

That’s why routine is so important, particularly going to the gym. There, not only do I experience all the benefits of exercise and socialising, but that’s where The Dictator’s voice is loudest. Exercises that take me to the edge of what I can safely do, that test and recruit physical weaknesses, and that make my brain work out harder than my body, need the voice that says “DO IT”. It’s a challenging environment but it’s also a safe and happy place. That’s often where I’ll find My Dictator.

The Dictator

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Spinal cord injuries (sci) are complex. No two injuries present in the same way. However, it can be helpful to compare symptoms and to try treatments that others have found useful. I believe that exercise and stretching are critical to successfully managing the nasty symptoms that I experience – pain and spasm. The older my injury (it’s been over eighteen years since I damaged my cord at T7/T8) the more fervent my belief in the power of exercise becomes.

And here’s why.

List of recommended Surgery:

Lengthen my Archilles tendon
Insert baclofen pump in my spine
Treat trigger thumb
Treat carpel tunnel syndrome

Actual treatment:
Instead of surgically lengthening my archilles tendon the surgeon injected botox into the gastroc and soleus muscles (muscles that make up the back of the calf). He did this four times over a year, providing a window during which time I could intensively stretch, exercise and stimulate these muscles, with the help of a physio, personal trainer and osteopath. These muscles had progressively shortened because of spasm and tone, and I could no longer put my heel on the ground – not good for the small amount of walking I can do and would quickly reduce my mobility. That was about two years ago and as long as I continue to stretch these muscles every day I’ll be fine. I also walk on a “stone board” every day to continue to stimulate the sensory nerves in my foot. Exercise 1, Surgery 0 (The surgery and after care in hospital would have cost ACC $70,000)

Instead of inserting a baclofen pump in my spine the same surgeon changed and added to my medication to manage spasm, and injected botox into my left quad, right hamstring, and both adductors. The injections in my hamstring and adductors were one offs, I have had three injections into my left quad and no more are planned. My spasticity is complex and extensive, but the botox and on-going medication allow me to stretch and exercise so that spastic muscles no longer pull my body out of alignment and mask and prevent any voluntary movement I have. I now walk using an Odstock rather than a dictus (a brace to lift my foot into a flexed positiuon). I walk for an hour on a treadmill every day, exercise at the gym to improve my posture and alignment, and frequently stretch shortened muscles every day. I religiously exercise and stretch every day. Exercise 2, Surgery 0

The surgeon in both these cases works in the Burwood spinal unit and I have found that people who work here take an holistic view to treatment and surgery is considered one of many tools. Not so other surgeons …

Instead of surgically lengthening the tendon in my thumb I independently embarked upon a programme of intense stretching and massaging my thumb. A physio later endorsed this. The trigger thumb was probably caused by my using crutches. Surgery would have meant that I would have lost my mobility for months, and that I would have needed help with personal care. This particular surgeon was adament that surgery was the only treatment if I wanted to straighten my thumb. Turns out he was wrong. (I subsequently spoke to two men whose surgery was unsuccessful and were having to have it repeated, one for the second time.) Exercise 3, Surgery -2

The same surgeon has recommended surgery for carpel tunnel in both my wrists. He says that without surgery the nerves to my hands and fingers will die. However, surgery will for months prevent me using crutches and I will require 24 hour care including someone doing all my personal care for me. Not if I can help it! An osteopath has given me exercises and stretches to help release constriction of nerves through the carpel tunnel; I have found web sites that show how to do other exercises; I have a dynaflex to exercise my wrists; the Odstock I use reduces the pressure I put through my wrists onto the crutches.

So, hopefully, Exercise 4, Surgery 0

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My physio came to the gym today to film me walking. First I walked with a dictus and then with FES (yep, bionic woman) to compare the difference in gait pattern. The dictus lifts my foot at the ankle then I swing my leg through while I go up on the toes of my other foot. FES lifts my foot at the ankle, helps bend me bend at the knee, and I can swing my leg through while keeping the other foot flat on the ground. FES wins hands down! And it takes so much less energy to walk!

So, while I had my physio in the gym, I asked her to help me get on the treadmill to see if I could walk on it using FES. (Not possible with the dictus). Wow! Wow! Wow! Ok it was at 1km/hr, and after 10 metres my leg was scuffing, but i was walking normally! And after a half minute rest, I could do it again with a normal gait. Rest, walk, rest, walk, rest, walk. Get off. Do something else. Go back to the treadmill. Fantastic. What a life!

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Warning: this post may be seen as lecturing …

Furniture, furnishings, possibly art or decorative pieces usually provide focal points in living rooms. Not so in our home! Sure we have couches and a coffee table, paintings on the walls, piano, side tables and nic nacs, but in our living room everything is pushed back to the walls to make space for me on the floor and to use the toys and tools that I use to help me stay mobile. House and Garden we are not!

Living On The Floor

In some ways the juxtaposition of piano and Swiss balls is quite charming, and the space cleared in the centre, an invitation to use it … I haven’t used the comfy couch for over a year. Instead, I use the floor to sit, lie, sprawl, wriggle, stretch and exercise as I read, watch TV or use the i-pad. (I’m spread out lying on my stomach as I write this on the i-pad. This position helps stretch my hip flexors and flexes my lumbar spine.)

LIVING ON THE FLOOR

If everyone used the floor instead of furniture, not only would they save lots of money not buying chairs and couches, but they’d be a lot healthier! Young people think that they’ll never get old and stiff and older people think they’ll never get stiff. Sitting on the floor stretches and strengthens muscle groups that don’t get used when you sit in/on a chair.  Everything you can do in a chair you can do on the floor – read a book, use your I pad, watch TV, or chat to someone – plus you get the benefits of sitting on the floor:

Stretching your adductors:

Sitting on the floor reading while stretching adductors

When you’re on the floor you can read or watch TV while you sit on your heels stretching your quads, then lean back and stretch your hip flexors. You can sit upright with your legs straight out in front of you to stretch your hamstrings. (I can only do this while holding onto some webbing or theraband):

Sitting upright with legs straight out, while watching TV

Not only does sitting on the floor improve flexibility, but sitting on a hard surface puts pressure on muscles that are in contact with the floor, causing them to eventually relax. This is similar to when massage therapists stimulate the golgi tendon organs through deep tissue massage, causing the muscles to relax. Living on the floor is comfortable and good for you!

There is no reason why you should be stiff when you’re old. YOU HAVE BEEN WARNED!

I began to stretch because if I don’t, tension, tone and spasm increases in my muscles – despite the diversity and quantity of muscle relaxants I consume. The more I stretch, the better I feel, and the better I walk. I have a low boredom threshold so I’ve nagged my physio and personal trainer for equipment and techniques that allow me to multitask while I stretch. No problem in either case – the physio is sympathetic to my needs, and the personal trainer is a proponent of living on the floor. In fact he introduced me to the concept.

I also need to recruit weak muscles and try and redress gross muscle imbalance. I can do some exercises in the gym in a social environment, but some exercises are repetitive and can be done at home. I could put all my equipment in a spare room, but it’s much nicer and more likely to happen if I can do the exercises in a shared living space, another benefit of living on the floor.

I can exercise on the floor while chatting to others

The whole family can play on the wii, but the balance board gives me fantastic feedback – I have no sensation or propriception so I’ve no idea whether I’m leaning to the side … And the walking frame gives me something solid to grab if I start to fall.

Playing on the wii

I can use the Obie foam roller to massage my hamstrings, calves, glutes, lumbar spine and thoracic spine. I can use it to exercise my obliques:

Using the Obie foam roller and non-slip mat while chatting and watching TV

I can use the Swiss balls for active sitting, for activating hamstrings, and for strengthening my left glutes and around my left knee:

Using the small swiss ball

These toys and tools are great for me, but even without them, just getting down and living on the floor has been a great move. As an aside, I’ve noticed that it’s younger people that take most easily to this idea. Little kids will do it naturally but it seems the older we get, and the more affluent we become,the more out of touch with our bodies we become.

Think about this: more than half the world’s population live on the floor. That includes the elderly, who in our society creak and groan as they get up out of a chair.  Yet you don’t have to be stiff when you get old … and you don’t have to have problems with mobility to live on the floor!

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