Woman flexing biceps in the sun, shown from the back.

SCI Workout Consideration #6 – Muscles & Joints

Of course, all physical activity engages the muscles and joints. Everyone that exercises regularly eventually experiences some muscle soreness or joint pain or stiffness. Usually, these conditions are temporary and are easily treatable with a little rest and proper self-care; however, individuals with SCI need to be particularly aware of several conditions affecting muscles and joints that can be extremely painful and potentially debilitating.

Spasticity 

Spasticity is due to increased tone in a muscle.

What Issues Are Posed With SCI? 

A spinal cord injury disrupts communication between the brain and the part of the nervous system responsible for muscle control below the level of injury. This disconnect can result in a common condition that individuals with SCI need to consider when exercising – spasticity.

Spasticity typically occurs in the muscles below the site of injury and can make it challenging to exercise since it can be very painful. It can lead to abnormal posture, cause deformities in the bones and joints, and can be further exacerbated by exercise.

Symptoms 

Symptoms of spasticity include:

  • High muscle tone
  • Hyperactive stretch reflexes
  • Spasms: Quick and/or sustained involuntary muscle contractions
  • Clonus: A series of fast involuntary contractions
  • Contractures: A permanent contraction of the muscle and tendon due to severe lasting stiffness and spasms

Steps to Reduce Risk When Exercising

There are several steps that you can take to reduce spasticity and make exercise safer and more comfortable.

If you experience spasticity, try:

  • Regular stretching several times per day. This is the best way to reduce spasticity.
  • Aim to hold stretches for 10-30 seconds.
  • Use a partner to assist you in stretching of the non-functioning muscle.
  • If you take medication to control spasticity, try to coordinate the time you take the medication and the time of your exercise session to minimize spasticity during your workout.

To avoid further complications from spasticity:

  • Do not bounce or perform ballistic stretching.
  • Do not exercise when you are experiencing severe spasticity.  Work with your doctor or therapist to reduce spasticity before returning to exercise.
  • Do not exercise when you have an infection. Urinary tract and other infections can increase the risk of spasticity,
  • Do not exercise in cold temperatures, since cold air can increase spasticity.

Overuse Injuries

Individuals with SCI (particularly those that use a manual wheelchair) are susceptible to several overuse injuries. The repetitive motion of pushing a wheelchair puts significant stress on the muscles and joints of the upper body, namely the wrists and shoulders.  

Some of the most common overuse injuries experienced within the SCI community are carpal tunnel syndrome, rotator cuff strain, and shoulder impingement.

Carpal Tunnel Syndrome 

Carpal tunnel syndrome results from chronic pressure on the wrist that causes swelling.  The swelling compresses the nerve that runs through the wrist to the hand, the medial nerve, causing pain and weakness.

What Issues Are Posed With SCI? 

Manual wheelchair users are very susceptible to carpal tunnel syndrome because the act of the hand repeatedly gripping and pushing the wheels places a significant amount of force on the hands and wrists.  Studies show that as many as 90% of long-term manual wheelchair users suffer from carpal tunnel syndrome.

Symptoms 

Symptoms of carpal tunnel syndrome affect the hand and wrist and may include:

  • Pain
  • Tingling
  • Numbness
  • Weakness

Steps to Reduce Risk When Exercising 

Like most overuse injuries, the best way to keep carpal tunnel syndrome from affecting your ability to exercise is through prevention.

Some steps you can take to reduce your risk include:

  • Wearing padded gloves.
  • Using good body mechanics when pushing your wheelchair.
  • Making sure your wheelchair is fitted properly and equipment is well maintained.
  • Using padding push rims to reduce pressure on the hands
  • Applying ice to the wrists for 20 minutes at the end of each day to reduce any swelling.
  • Incorporating a wrist flexibility and strengthening program into your routine.  

Rotator Cuff Strain & Shoulder Impingement 

The ball-and-socket structure of the shoulder joint makes it extremely mobile but also very vulnerable to possible injuries. For manual wheelchair users, the shoulder joint is the primary joint used during transfers and propulsion. This puts wheelchair users at particularly high risk for developing shoulder injuries.

Rotator cuff strain is most commonly caused by muscle imbalances in the shoulder.

The rotator cuff is a group of muscles and tendons around the shoulder joint that are responsible for moving and stabilizing the shoulder joint. The motion of pushing a wheelchair causes certain muscles of the shoulder to be used more than others, leading to muscular imbalances. These imbalances can result in injury to the rotator cuff.

Additionally, individuals with SCI tend to have weak internal and external shoulder rotators.  This weakness can also contribute to rotator cuff strain.

Symptoms of a rotator cuff strain include pain and/or an aching sensation in the shoulder joint.

An image of a man using a wheelchair and holding a dumbbell.

Shoulder impingement is another common injury among wheelchair users because the biomechanics of pushing a wheelchair creates a significant amount of pressure on the shoulder joint. This pressure is 2.5 times higher for wheelchair users than for non-wheelchair users!

Also, long periods spent in a seated position require that wheelchair users frequently reach overhead to grasp objects and perform tasks. Once again, the biomechanics of this movement put considerable stress on the shoulder joint.

Steps to Reduce Risk When Exercising 

You can reduce your risk of developing shoulder injuries by taking the following preventative measures:

  • Always use good body mechanics when pushing your wheelchair.
  • Try to balance out the time pushing in your chair with other types of physical activity that use different movements and muscles.
  • Make sure your exercise routines are well balanced, including stretching, aerobic exercise, and strength training.
  • Incorporate strength training exercises to help reduce muscular imbalances in the shoulder. Be sure to include exercises to strengthen the shoulder’s internal and external rotators!

Conclusion

As you can see, being aware of a few common conditions associated with SCI that can impact exercise will help you take the necessary steps to minimize your risk so that you can exercise safely. Exercising with SCI doesn’t have to be intimidating or scary, and the benefits of exercise are well-worth the investment!

Looking for SCI-friendly exercise guides? Visit our website at inclufit.com to view our exercise videos, equipment, and training tips.

Further Reading 

NCHPAD – Overuse Injuries in Wheelchair Users

NCHPAD – Spinal Cord Injuries

Spasticity

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