The top of a man's bare feet on a wood plank floor.

SCI Workout Consideration #4 – Skin Breakdown

Anyone participating in physical activity can expect to experience skin irritations and injuries, such as cuts, scrapes, and bruises, at one time or another.  For most people, these issues are unpleasant and annoying; however, skin breakdown and irritation can be a potentially serious condition for exercisers with SCI.

What Issues Are Posed With SCI? 

In general, the loss of sensation below the level of SCI can make it difficult to realize when skin breakdown occurs. You may not be able to feel when you have a new cut or sore.

Increased friction on the skin from physical activity can lead to skin breakdown. When moving, friction occurs during skin on skin contact and from contact with clothing and equipment. Friction can also occur on areas of the body in contact with prosthetics, assistive devices, and adaptive equipment.

It’s important to note that skin breakdown experienced below the level of SCI injury can put you at serious risk for developing Autonomic Dysreflexia (AD).

There are a number of types of skin breakdown that individuals with SCI need to be aware of when exercising:

Pressure sores, or pressure ulcers, are areas of skin that are damaged due to a lack of blood flow to the area. These lesions are caused when pressure is applied to the skin and not relieved on a regular basis. They can occur from:

  • Sitting or lying in one position for too long
  • Sitting or lying on hard surfaces
  • Improperly fitting prosthetics and adaptive equipment
  • A buildup of moisture on the skin

Untreated pressure sores will gradually worsen and can cause serious complications.

Blisters are raised areas of skin filled with fluid or blood.  Blisters result from friction on the skin when it repeatedly rubs against the body, clothing, or equipment.

Abrasions, or scrapes, are caused when the skin is scraped away when rubbed up against a rough surface.

Lacerations, or cuts, are the result of the skin being cut or torn open.

How to Reduce Risk When Exercising 

To prevent pressure sores:

  • Stay well hydrated. Make sure to drink water before, during, and after exercise.
  • Avoid sitting on hard surfaces and use a well-padded wheelchair cushion whenever possible.
  • Wear clothing that is well-fitting, moisture-wicking, and appropriate for the activity/exercise.
  • Consider taping or padding areas that are prone to skin breakdowns, such as feet and heels.
  • Make sure all prosthetics and adaptive equipment are properly fitted.
  • Perform pressure reliefs, such as wheelchair push-ups, every 20 minutes.
  • Change position on a regular basis.
  • Secure yourself to equipment to reduce friction.

To prevent blisters, abrasions, and lacerations:

  • Use talcum powder, petroleum jelly, or another type of skin lubricant to reduce friction.
  • Make sure all prosthetics and adaptive equipment are properly fitted.
  • Wear gloves to protect the hands.  
  • Use plastic wheel-guard covers on wheelchairs.
  • Use caution when transferring on and off equipment.

Remember: always check your body during and after your workout for new sites of skin breakdown and pay close attention to areas that are more prone to skin breakdown, such as the hips, sacrum, feet, and heels.


Next Up…

#5 Bone Loss

Further Reading 

NCHPAD – Overuse Injuries in Wheelchair Users

Human Kinetics – Medical Conditions in Athletes With Spinal-Cord Injuries

Exercise After Spinal Cord Injury

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