Important Considerations When Exercising
- Incontinence (flaccid or neurogenic bowel/bladder) - Individuals with lesions above the sacral level experience a loss of control with their bowel or bladder.
KEY: Monitor urinary cycle, be sure to empty your bowel and bladder before starting exercise.
- Spasticity - This condition is characterized by high muscle tone and hyperactive stretch reflexes. It typically occurs in the muscles below the site of injury and is exacerbated by exposure to cold air, urinary tract infections and physical exercise.
KEY: You should stretch spastic muscle groups often. When you are at home you should extend your legs as often as possible.
- Autonomic Dysreflexia - A sudden rise in blood pressure resulting from an exaggerated autonomic nervous system response to noxious stimuli below the level of injury, usually due to bladder/bowel overdistension or blocked catheter. Symptoms include profuse sweating, sudden elevation in blood pressure, flushing, shivering, headache, and nausea.
KEY: Get rid of noxious stimuli if possible or seek medical attention immediately when it occurs.
- Orthostatic hypotension - A drop in blood pressure (greater than 20 mmHg for systolic blood pressure and greater than 10 mmHg for diastolic blood pressure). It occurs in upright postures, especially moving from supine to upright sitting/standing/head-up tilt. Symptoms include nausea, dizziness and light-headedness.
KEY: Monitor blood pressure throughout exercise, avoid quick movements, perform orthostatic training (if available), maintain proper hydration, and use compression stockings and an abdominal binder. If orthostatic hypotension occurs, lie in a supine position with your feet elevated. Sometimes holding your breath while changing positions can help reduce the chance of orthostatic hypotension taking place.
- Thermoregulation - Irregular body temperatures are often experienced by individuals with SCI.
KEY: Wear appropriate clothing, drink plenty of fluids and take precautions in certain environments; in warm environments, a fan and water spray will aid in cooling, and in cold environments, wear extra layers.
- Pressure sores (decubitus ulcers) - Damage to the skin or underlying tissue caused by prolonged sitting, using old wheelchair cushions, sitting on hard surfaces, shear forces or as a result of a fall.
KEY: Check skin regularly and perform wheelchair push-ups or pressure releases often. (See strength training section for protocol.)
- Transfers - Be sure to follow appropriate guidelines.
- Balance - Use straps or other physical assistance to hold the trunk in position during upright exercise.