Resistance Training Guidelines for Spinal Cord Injury
There are approximately 250,000 to 400,000 people living in the United States with a spinal cord injury (SCI). Eighty-two percent of these injuries occur in young males in the age range of 16 to 30 years. The most common causes of SCI are motor vehicle accidents (44%), followed by acts of violence (24%) and falls (22%) (National Spinal Cord Injury Association, 1999). Persons who have sustained a SCI will lose nerve innervation to various musculature depending on where the spinal cord has been damaged. For example, if a person's injury occurs between the fifth (T5) and sixth (T6) thoracic vertebrae and is a complete lesion (some injuries result in an incomplete lesion, which allows some muscle innervation), loss of function will occur from the point of injury to all nerve innervation below it. In complete lesions, the musculature has no innervation and a resistance training program will not be effective for the involved muscle groups. Instead, the emphasis should be placed on maintaining good range of motion while focusing on strengthening the muscle groups that are still functional. Table 4. provides a brief listing of the functional level at each injury site.
Resistance Training Guidelines
1. Many individuals who have sustained a spinal cord injury will require a significant increase in upper body strength in order to manage transfers, push a wheelchair, and perform activities of daily living (i.e., bathing and dressing). Pushing a wheelchair up a ramp or curb cut can be a significant physical challenge to persons with SCI who are deconditioned. The fitness instructor should have a good understanding of what muscle groups are still functional and should develop adequate amounts of strength in those muscle groups since they will be used more often to assist with transfers and performing ADL and IADL.
2. Individuals with a complete SCI will use a manual or power wheelchair to ambulate. High cervical injuries usually require a power wheelchair, while lower level injuries result in enough muscle innervation in the hands to use a manual wheelchair. However, there are some individuals who have the necessary muscle and nerve innervation to use a manual wheelchair, but prefer to use a power wheelchair in order to preserve energy.
3. Persons in SCI must do everything possible to avoid pressure sores (also known as decubitis ulcers or pressure ulcers). If left untreated, pressure sores can cause tissue necrosis, which often has to be removed surgically. One way to avoid pressure sores is to perform wheelchair pushups every 15 to 20 minutes. This requires the person to lift his or her body out of the chair by grabbing the armrests and pressing up with the arms. The position should be held for 5 to 15 seconds in order to allow blood flow to the tissues that make contact with the chair (primarily the gluteals and hamstrings). Clients with injuries C6 or higher will not be able to perform this exercise independently because of damage done to the nerves controlling triceps innervation. Some clients may be able to pull one side of the body off the chair by using the biceps to grab a bar or other object located on the side of the wheelchair at approximately shoulder height. The fitness instructor should develop biceps and forearm strength to help facilitate this important movement.
4. Many persons with SCI may have a condition known as autonomic dysreflexia (AD). Individuals with SCI at the T6 level or higher have the greatest risk (National Spinal Cord Injury Association, 1999). This condition results in an excessive rise in blood pressure that could be extremely dangerous if not treated immediately (Phillips et al., 1998). AD often occurs when an individual has a distended (full) bladder. Symptoms include headache, facial flush, perspiration, and a stuffy nose. It is important for the fitness instructor to make sure that the client has voided his or her bladder before starting the program. It is also important to measure the individual's blood pressure and monitor how the person feels before each exercise session to assure that AD is not present.