Ask a PT

[scitotalfitness]

Tim... carpal tunnel stuff is hard, I'll be honest. What did they do when they did the surgery?
So the injury comes from the nerves and tendons running through the small tunnel and the friction causes inflammation and injury. Ice is good to decrease inflammation.
Some basic stuff I would recommend:
- using wrist braces to minimize how much extension you're doing. I know these suck... You may want to sleep in them to stabilize your wrists then, and then see if you can handle them at all during the day.
- modify your work station and keyboard to minimize wrist extension (this should actually be a service your employer is required to provide if you request it)
- when you transfer, try to use fists with straight wrists rather than flat hands. Yes, it's harder, but it is much better for the carpal tunnel.

I actually think I would hold off on the thumb strengthening until the injury is a little better; I wouldn't risk aggravating the problem. Hopefully those suggestions give you a place to start. Good luck!

As for P90X - those are the workouts I lead in my gym!! My online videos are tough, but less hardcore because in person, I use equipment people don't have at home. My business could always give you workouts to complete on your own at a gym. If you're ever in California, you'll have to come in! I'm actually from NJ, so if I plan to be in the area I'll let you know

[TimR]

where in Cali? I might be in SD next summer...but I'd like a good routine before then and while I'm still motivated! I need to get in shape for skiing, a shape other than round

[scitotalfitness]

I'm in Long Beach - about 2 hours north of SD. But I'm always available online you can email me.

Yay for ski season!!

[Doe Gasque]

Pain, Spasm and exercise

I am blessed to have as a patient the most amazing young man who is about C-5 SCI for less than a year. He can feel touch to the elbow, nipple line. For a long while, he stopped exercising because he was afraid the intense, sometimes, whole body spasms, would cause more injury to his spine. He is starting over with some basic PT again, but I am wanting to encourage him to gain strength in his neck, back and shoulders. How can I help him with the pain and spasms? Will the spasms decrease in time? Thanks- Doe, FNP

[rdf]

Is he taking any meds for spasms? You might look into a Medtronic's baclofen pump. Many have one, and it's great for spasms/spasticity.

I am blessed to have as a patient the most amazing young man who is about C-5 SCI for less than a year. He can feel touch to the elbow, nipple line. For a long while, he stopped exercising because he was afraid the intense, sometimes, whole body spasms, would cause more injury to his spine. He is starting over with some basic PT again, but I am wanting to encourage him to gain strength in his neck, back and shoulders. How can I help him with the pain and spasms? Will the spasms decrease in time? Thanks- Doe, FNP

[scitotalfitness]

Great question! And an interesting situation... The spasms are unfortunately not likely to decrease. He definitely needs daily range to prevent muscle shortening, which makes spasms stronger. And he needs to try medication, possibly a baclofen pump to control the spasms.
Spasticity is helpful to keep a muscle belly, aid circulation, and let you know when something is wrong. But if it is so strong that it is painful, or that it interferes with function, then medical intervention is needed.
But about the exercise - some of the strengthening I do with newly injured (which would be gentle enough for him) include:
- basic pulley exercises with a wrist cuff for biceps, rows, internal and external rotation, and pull down if he can do that.
- proning on elbows. I stand over them to support body weight in my forearms if they can hold themselves. From here, he can do head raises, push ups, and weight shifts.
- wrist weights can be used
- supine on a mat, lifting his head, and moving his arms to learn how to use gravity for what he doesn't have

That's where I would start. Do they make sense? Good luck!!

[scitotalfitness]

I've said it before, but it's worth repeating again:
People often focus so much on strengthen, strengthen, strengthen and forego the stretch. The stretching will keep you balanced and help you to get stronger!! Yes, it takes time and is tedious, but I promise you it's worth the work! If you need to have someone help you, get someone who has an idea of how to stretch you safely.

[S.C.-SCI]

i am a c6/c7 9 years now. feeling throughout, have KAFOs - that i have in the past used at home for exercise / weight bearing. have not used for almost a year now and need to get back in the habit of using the braces. any recommendations? currently i am just standing for 10-15 minutes at a time, but i am planning for increased walking in near future.

[scitotalfitness]

S.C. - the only concern I have is your hips... You have significant bone loss from 9 years of injury, and a year off is quite a bit. I would definitely start by increasing your standing time - are you standing in a frame or on the KAFOs?

You may want to consult an MD who specializes in SCI to ask about your bones, and how quickly you can build up. It's the part of your femur that angles up to the hip joint (femoral neck) that you don't want to fracture.

You will certainly have to start walking again slowly - like only a few steps to start, then adding a few more steps each time. I think it's a wonderful activity, and I think it's great you get back into walking again - just do it safely.

[S.C.-SCI]

scitotalfitness - just KAFOs and a walker. i have an annual appointment with a SCI MD where we discuss overall health, etc. thanks for your input. for now standing seems logical and it helps my spasms tremendously

[LIP26]

Pn

I have a cauda equina injury (t12), how should i use the electronic stimulation to wake up my nerves? Also...i have very weak calves/hamstrings...i have been working on strengthening them for months and do not see much inprovement if any. will the muscles still strengthen even if the nerve isn't working properly?!

One thing that is important I should have mentioned when writing about electrical stimulation - the parameters I gave are for injuries above L1, and only for injuries of the spinal cord. The parameters are for upper motor neuron injuries - not peripheral nerve injuries (which cauda equina injuries fall under) So if you have a lumbar level SCI, estim is not in your treatment plan.

Now, onto balance training. Doing balance activities would help (always do in a secure setting so you can catch yourself or someone else can help):
- practice just standing without using your arms
- once that is easy, close your eyes. See if you sway
- keep your eyes, stand with your feet as close together as you can get
- try walking the line
- if this gets easy, try a softer surface

The bigger issue is the lack of sensation going back to your brain to tell your muscles to adjust for balance. That you can't train, you need to compensate for it. Have you ever tried walking with braces? Some AFOs may help. I know people don't like them, but they could make it safer to walk without the canes and can be hidden under clothes. If you get articulating ankle joints, you are not preventing motor recovery. Those are the 2 biggest reasons I hear from people who would benefit from braces but don't wear them.

Good luck!

[rdf]

Hi scitotalfitness, thanks for your help to so many.

I have a question please. Can I use a standing frame after 25 years being in the chair, with the only standing a few months early on 20+ years ago?

The local PT said no problem, but I'm worried about fracturing any bones, or doing some damage. Thanks for any input.

-Bobby

[zevobru]

My son had a baclofen pump and was in a wheelchair for about 6 months. When the baclofen dosage was reduced, he was able to stand holding onto a walker. He can move his legs (make walking movements) laying down but gets exhausted when he takes a step or two. We been trying to rehab him ourselves. Is their any damage of pushing him to walk? He seems pretty strong now.

[scitotalfitness]

LIP26 - estim really hasn't been proven effective for cauda equina... however, I also don't see any harm in putting it on set at a sensory level and seeing if it helps. This means the stim is on at a level you can feel (if you put it somewhere that you can't feel normally, then test it on your arm) but not strong enough to contract the muscle. Try for an hour at a time - like I said, it can't hurt, but it may not do much.

On a positive note, if you have movement, even if it's weak, you can strengthen it. As a cauda equina injury, your progress will be slow, but keep working! You may never reach full strength, but you certainly won't get stronger if you don't try. Do you have a good exercise routine?

[scitotalfitness]

Bobby - I have put people on standing frames after years of injury without issue, the majority of fractures I've heard about involved impact. But I think there are some things to consider:
First, do you have an IVC filter? Have you ever had a problem with clots? It's worth checking out if you have any possibility of having a DVT. If you have a lot of spasms, that likely helps your circulation, but you can never be too careful.
Second, the way the standing frame lifts you should be safe even for weak bones because there isn't any impact, and the force goes straight up the long bones. You could raise slowly so you aren't overloading the system if it makes you feel more comfortable.
Hope that helps!