The Importance of Physical Therapy in Spinal Cord Injury Recovery

Spinal Cord Injuries: The Importance of Exercise

The moment a spinal cord injury occurs, life changes in an instant. The physical, emotional, and social aftermath can be overwhelming, leaving individuals and their loved ones grappling with a new reality. The path ahead may seem daunting but hope lies in the power of comprehensive rehabilitation. At the heart of this journey is physical therapy, a vital component that can help individuals with spinal cord injuries reclaim their mobility, independence, and overall quality of life.

Spinal cord injuries are complex and can vary greatly in their severity and impact on bodily functions. In Canada, approximately 4,300 individuals live with a spinal cord injury, with an estimated 1,785 new cases occurring each year, according to Spinal Cord Injury Canada. The leading causes include falls, vehicle crashes, sports-related accidents, and acts of violence. Regardless of the cause, the resulting damage to the spinal cord can lead to partial or complete loss of sensation and movement below the level of injury.

The road to recovery is rarely easy, but with the right support and dedication, individuals with spinal cord injuries can make significant strides. Physical therapy is pivotal in helping individuals rebuild strength, regain function, and adapt to their new circumstances. Through a personalized approach tailored to each individual’s needs and goals, physical therapists work tirelessly to help individuals maximize their potential and achieve the highest possible level of independence.

The journey of spinal cord injury rehabilitation is not just about physical healing; it also encompasses emotional and psychological well-being. Physical therapists understand the profound impact of these injuries and approach their work with empathy, compassion, and unwavering support. They become healthcare providers and partners in recovery, offering encouragement and guidance every step of the way.

Central to the rehabilitation process is the crucial role of exercise. Physical therapists emphasize the importance of regular physical activity in helping individuals with spinal cord injuries maintain and improve their overall health and well-being. Exercise helps rebuild strength and endurance, promotes circulation, prevents secondary complications, and boosts mood and self-esteem. By incorporating exercise into their daily lives, individuals with spinal cord injuries can take an active role in their recovery and work towards achieving their personal goals.

Understanding Spinal Cord Injuries: Types and Consequences

There are many different ways the spinal cord can become injured, and each type affects the body differently. Depending on where and how the spinal cord is injured, spinal cord injuries are categorized in several different ways:

Based on the Location:

• Cervical spinal cord injury: Injuries to the cervical region, also known as C1-C7. These injuries can affect the arms, neck, and hands and may cause quadriplegia that impacts all limbs.
• Thoracic spinal cord injury: Injuries to the thoracic region, also known as T1-T12. These injuries can affect the legs and chest and may impact the lower half of the body, leading to paraplegia.
• Lumbar spinal cord injury: Injuries to the lumbar region, also known as L1-L5. These injuries can affect the legs and hips and potentially lead to paraplegia but may have less impact on upper body function.
• Sacral spinal cord injury: Injuries to the sacral region, also known as S1-S5. These injuries affect the backs of the thighs, the buttocks, hips and pelvic organs. They can result in reduced function of the legs and hips.

Based on Severity of Symptoms:

• Tetraplegia/Quadriplegia: typically caused by cervical spinal cord injuries, this involves paralysis of all four limbs and the trunk.
• Paraplegia: typically caused by lumbar, sacral, or thoracic spinal cord injuries. This involves paralysis in the lower half of the body, including both legs.

Based on the Extent:

• Complete spinal cord injury: Characterized by a complete loss of sensory and motor function and all voluntary movement below the injury site.
• Incomplete spinal cord injury: Characterized by a partial loss of sensory and/or motor function below the injury site. Some voluntary movement may be possible, the degree to which varies widely.

Based on Syndromes Within Incomplete Injuries:

• Anterior cord syndrome: A loss of motor function and temperature/pain sensations below the injury site. Touch and proprioception (the body’s ability to sense action, movement, and location) may remain intact.
• Central cord syndrome: It can cause varying sensory loss but generally features greater weakness in the arms than the legs.
• Brown-Sequard syndrome: Ipsilateral (occurring on the same side of the body) loss of proprioception and paralysis with contralateral (opposite sides) loss of temperature and pain sensation.
• Posterior cord syndrome: Loss of proprioception and sense of vibration, but motor function and pain/temperature sensation are preserved.

Regardless of the type or severity, a spinal cord injury is serious and often comes with devastating consequences. Your entire life is changed, including the ability to execute even the smallest everyday tasks. Keeping up with the house, spending time with your family, engaging in hobbies and activities, and performing well at work become challenging or even impossible, often for an extended time.

Physical therapy is one of many treatment avenues, and the earlier you can start, the better.

The Importance of Early Treatment for Spinal Cord Injuries

When it comes to spinal cord injury recovery, time is of the essence. Early initiation of physical therapy can significantly improve a patient’s long-term outcomes and quality of life. It’s been shown that the sooner you begin rehabilitation after a spinal cord injury, the better your chances are of regaining function and independence.

The first few months after a spinal cord injury are known as the “golden period,” during which the most significant neurological recovery usually occurs. If you wait too long to begin therapy, your body will start adapting to its current state, and your brain will lose the ability to rewire itself. Thus, physical therapy in this stage is paramount to regaining sensation, function, and control over your body.

For example:

• Early gait training, such as with body weight support or parallel bars, can help you relearn proper walking patterns and improve balance.
• Functional electrical stimulation stimulates muscles and improves movement in paralyzed limbs.
• Passive range-of-motion exercises involve a therapist moving a patient’s limbs through their full range even if they have not yet regained control. Active/assisted range-of-motion is when you can partially or independently move your own limbs through their range of motion. Either way, these exercises help maintain strength and flexibility.
• Isometric strengthening exercises contract muscles without joint movement—a common treatment in the early stages that starts rebuilding strength and preventing atrophy.

These are just a few of the techniques used in physical therapy for a spinal cord injury. Specific treatment plans are tailored to each patient’s needs, goals, and current abilities.

If you wait too long to start physical therapy and miss this “golden period,” recovery becomes more difficult. Failing to exercise and engage in regular weight-bearing and movement activities can make you more susceptible to muscle weakness, joint issues, and even osteoporosis. Developing these additional issues will diminish your quality of life, making timely treatment crucial.

Physical Therapy Management for Spinal Cord Injury Victims

Physical therapy plays a crucial role in helping spinal cord injury patients maintain muscle strength, range of motion, and overall health. The specific therapies used depend on the level and severity of the injury.

In the acute phase immediately following injury, physical therapy focuses on preventing complications like pressure ulcers, contractures, blood clots, and respiratory issues. This involves frequent repositioning, range of motion exercises, and breathing exercises.

As individuals move into the rehabilitation phase, physical therapists work on functional skills like wheelchair mobility, transfers, standing, and, in some cases, walking. Stretching and range of motion continue to be important for maintaining joint health. Strengthening exercises target muscles below the level of injury that still have some innervation. Even if these muscles can’t be voluntarily controlled, electrical stimulation may help maintain muscle mass. For those with incomplete injuries, gait training and balance exercises can help retrain the nervous system and potentially restore some walking ability.

A consistent physical therapy routine remains important for lifelong health in the long term. Techniques used include:

• Daily range of motion exercises for all joints
• Stretching to prevent contractures, especially in commonly tight muscles like the hips, knees, and ankles
• Strengthening of core, arm, and leg muscles to the extent possible
• Cardiovascular exercise using arm bikes, functional electrical stimulation, or gait training
• Breathing exercises to maintain lung capacity
• Balance training and fall prevention strategies

Physical therapy can optimize function and prevent secondary complications after spinal cord injury by focusing on flexibility, strength, and cardio fitness. A personalized therapy plan carried out consistently over the long term is key to maintaining health and maximizing quality of life. Working closely with a knowledgeable physical therapist can make a world of difference in outcomes after spinal cord injury.

Another reason early intervention through physical therapy is important is the prevention of secondary conditions. Left untreated, spinal cord injuries and their effect on the body can lead to a variety of additional health and medical conditions, all with symptoms and challenges of their own. This makes recovery much more challenging and poses an even greater risk to recovery and quality of life.

Some of the conditions include:

• Pressure sores. These are caused by prolonged pressure on the skin due to lack of sensation, poor circulation, and immobility. Physical therapy gets you moving and/or teaches you proper turning and positioning techniques to help relieve pressure on vulnerable areas if you’re bedridden.
• Muscular atrophy and contractures: A lack of weight-bearing and movement can lead to muscle wastage and the shortening of muscle fibres, which results in tightness and lost flexibility. Range of motion, strengthening, and stretching exercises help prevent this; physical therapists can teach you the best ones and how to do them.
• Respiratory complications: Spinal cord injuries can lead to weakness in the respiratory muscles, reduced lung capacity, and trouble clearing secretions. These things can cause a variety of respiratory issues, including pneumonia. Physical therapy includes deep breathing exercises and manual techniques to mobilize the chest. It can also include training on assistive devices and teach proper positioning to optimize respiratory function.
• Osteoporosis: Hormonal changes and reduced weight-bearing can lead to increased bone loss and a higher risk of fractures. Weight-bearing exercises are common in physical therapy and help stimulate bone maintenance. Your physical therapist can also work with other healthcare professionals to ensure optimal nutrition and/or medication, if necessary, to help maintain bone mass.

These are only some of the secondary conditions you can develop after a spinal cord injury. Early engagement in physical therapy gives you the best chance of preventing them or managing the symptoms should they occur.

The Best Types of Physical Therapies for Individuals with Spinal Cord Injuries

The best types of physical therapies for individuals with spinal cord injuries (SCI) are tailored to the specific level and severity of the injury. However, some of the most beneficial therapies include:

• Range of Motion (ROM) Exercises: These exercises are crucial for maintaining joint flexibility and preventing contractures. Passive ROM exercises, where the therapist moves the patient’s joints through their full range, are important for paralyzed limbs. Active ROM exercises are used for muscle groups that still have function.
• Stretching: Stretching helps maintain muscle length and prevent tightness that can lead to contractures, pain, and reduced function. Common muscle groups targeted include hip flexors, hamstrings, calf muscles, and elbow flexors.
• Strengthening Exercises: Resistance training is used to maintain or improve strength in muscles that still have innervation. This can include exercises with free weights, resistance bands, or weight machines adapted for SCI patients. Even if muscles can’t be voluntarily controlled, electrical stimulation can be used to cause muscle contractions and prevent atrophy.
• Gait Training: For patients with incomplete injuries who have some lower extremity function, gait training on a treadmill or overground can help retrain walking patterns. Assistive devices like parallel bars, walkers, crutches, or braces are often used.
• Transfer Training: Learning safe and efficient methods to transfer from bed to wheelchair, wheelchair to car, or onto a shower bench or toilet is crucial for daily functioning and preventing injuries like pressure ulcers or falls.
• Respiratory Therapy: Breathing exercises and manual techniques performed by a respiratory therapist or physical therapist can help maintain lung capacity, mobilize secretions, and prevent respiratory complications that are common after high-level SCIs.
• Cardiovascular Exercise: Maintaining heart health is important for overall health and stamina in SCI patients. Upper body exercises like arm cycling, wheelchair propulsion, or using an arm ergometer can provide a cardio workout. Functional electrical stimulation (FES) bikes can allow patients to pedal a stationary bike using their paralyzed legs.
• Balance Training: For patients with some ability to sit unsupported or stand, balance exercises can improve core strength and stability, reducing the risk of falls during functional activities.
• Aquatic Therapy: Exercising in a pool provides a low-impact environment that can make ROM, strengthening, and gait training exercises easier and less painful. The buoyancy of water can assist movements and support body weight.

The most appropriate mix of these therapies will depend on an individual’s injury level, personal goals, and stage of recovery. A comprehensive physical therapy program carried out consistently over the long term is crucial for preventing complications, optimizing function, and enhancing quality of life after SCI.

Do I Need a Personal Injury Lawyer for a Spinal Cord Injury?

The answer is that it depends. A person would only need the services of a spinal cord injury lawyer if he or she suffered injuries due to someone else’s carelessness, for example, in a car accident, a motorcycle accident, a pedestrian accident, a bicycle or trucking accident. In these types of cases, there would not only be a potential lawsuit against the negligent motorist(s) but also access to accident benefits. Accident benefits in Ontario provide financial support for medical expenses, rehabilitation, and income replacement following a car accident, regardless of fault. They are complicated due to the intricate regulations, varying coverage levels, and the need for detailed documentation to access and justify claims – and because of this, a Hamilton Spinal Cord Injury Lawyer is highly recommended.

In addition, navigating the complex legal landscape of spinal cord injury cases requires specialized knowledge to ensure victims receive fair compensation for medical expenses, lost income, and pain and suffering. Equally vital is the role of an occupational therapist (OT), who works closely with the lawyer to provide a holistic approach to the victim’s recovery. OTs develop personalized rehabilitation plans that address the multifaceted needs of daily living, helping individuals regain independence and adapt to new life circumstances. Together, the lawyer and OT form a crucial support system, advocating for the victim’s rights and fostering a path toward physical, emotional, and practical recovery.

Call Our Hamilton Spinal Personal Injury Lawyers Today For a Free Consultation

Since 2003, Hamilton Spinal Cord Injury Lawyer Matt Lalande has dedicated his practice to representing spinal cord injury victims, including those suffering from complete or incomplete paraplegia or quadriplegia. Our firm is deeply experienced with catastrophic spinal cord injury claims and adept at ensuring your insurance company and the at-fault party’s insurance company provide you with the compensation you deserve. Our spinal cord injury lawyers will meticulously project your future needs, ensuring you achieve both economic stability and peace of mind.

While no amount of money can replace the pain, suffering, and loss caused by a spinal cord injury, financial compensation can significantly alleviate the burden of current and future medical costs and other damages associated with the injury. We aim to ensure that you receive the necessary funds to support your ongoing recovery and adapt to new life circumstances.

Call our Hamilton Spinal Cord Injury Lawyers today, no matter where you are in Ontario, at 1-844-LALANDE or local throughout Southern Ontario at 905-333-8888. We are here to answer any questions you may have. Alternatively, you can contact us online, confidentially, by filling out a contact form or having your social worker or nurse practitioner reach out to us on your behalf if you are unable to do so.