Ask a PT

[TimR]

I've been through all that already, hot and cold therapy, wrist splints etc at night... I took a medical leave this Spring which helped some but now I'm back at the 925 and its the same chronic pain.
My fear is I'm doing more damage by continuing this type of work (bad pun there) that will catch up to me and be more debilitating than having lost use of my legs... ofcourse the employer just wants the work done and I don't want to get fired. At what point is 'disability' justified? Its already making me less active and having pain and difficulties with adl stuff. This could easily take a year to rehab properly.

[scitotalfitness]

Okay Tim - I put the question out there to an international group of therapists, and here's what I got:
First and foremost, everyone said to get a power chair (I assumed you were in a manual?) Look for a rental for a couple of months as a way to decrease one stress. It would also be helpful if you can decrease the number of transfers you do throughout the day, and see if there is a way to do them without the typical wrist extension.
Second, are there any devices that would help you do your job with less typing, i.e. voice command software.

Australia has a surgical program that requires 6 weeks to recover... I obviously have heard of surgical options, but I always think this is a last option and it should definitely be done only by surgeons who have experience with SCI. It is a huge risk to lose grip strength. Talk to others who have had it done before considering.

Alternative medicine was also suggested - Thai massage by the Thai therapist (PT is clearly different over there!) and acupuncture.

So again, everyone said to modify your lifestyle for a couple of months as your "rest" while pursuing treatment, because as you said, with the same stresses, it will never get better. I am sure your doctor could also give you a prescription for OT/PT and you can get additional treatment as well as life modification advice. I would hate to think this is the end of your career, I'm hopeful that you can get better even if that means making some undesirable life changes...

[MFlounlacker]

scifitness- I have another question if you don't mind. As you may recall i am a T-12 and have had tremendous return. I currently walk with the use of fore arm crutches and very rarely use my wheel chair anymore. For the most part things are going great. I do have some remaining deficiencies that I am working on.

My question is my abductor on my left side appears weak. It seems want to move but I think it might be fighting tightness in my groin muscle which is very strong. Are there any stretches you can recommend that may loosen that groin muscle? I do the butterflies but they are not really working that great. I have begun surfing on my knees and I cannot straddle a board anymore. I am using one of my short boards as well so it isn't that wide. I never had a problem sitting on my board prior to my injury so I am guessing the muscles have tightened up and need a good stretching and the butterflies aren't cutting it.

Any thoughts?

[scitotalfitness]

No mind at all - ask away
You could be very right about groin tightness - these are your adductors, and they can also help with hip flexion (as a compensation for weakness.) So with a lot of use, as well as their large size, they can certainly get tight and strong. The abductors are small and generally weak in comparison.
Butterflies are a great stretch, but you are targeting your internal rotators more than your adductors. You want to straddle to stretch those muscles. Sitting with your legs in a V, or using a strap to bring a leg as far out to the side. The key is to keep your toes/knees pointed towards the ceiling. If they turn out, you're again getting the rotators. Or if you can do it standing with your legs wide - lean your hips to one side. You will probably easily feel the tightness if you're stretching the adductor if you put your hand on the inside of your thigh during the stretch. Remember to hold it for a prolonged time to allow some lengthening.

[flying]

Hello Scitotalfitness
I have been riding a stationary bike at home for about a year. I do not have any muscles that work below my knees. I strap my feet, shoes and all, into some Velcro deals so that I can peddle all the way around. Coming around the top of the circle, I have to be careful not to push at some point, or my toes get pointed forward, and then flop back to about the 90 degree point. Well now I have a trike that I am peddling outside, with my old clip-on bike shoes. I have tried riding with just the clip-on shoes, and then tried riding with my AFOs in my clip-on shoes. With the AFOs I can peddle all the way around, with helps a little bit, with speed, but noting to wright home about. Bear in mind that my legs are pretty weak (I can walk about 450 feet with arm crutches). My question is do you think that since I can't feel my lower legs very well, that I could be doing any harm to my ankle tendons, by not riding with my AFOs. Seems like I would have notice something by now. Its very hard to get my AFOs into my riding shoes, but could come up with some other way to do it, if necessary. What do you think?

[MFlounlacker]

Thank you scitotal. I will give those a try. I like to stretch while standing now, so those will work great. Kind of work balance in at the same time. Thanks again.

[scitotalfitness]

Flying - that is a really good question...
First, I want to say great work on problem solving how to cycle!! That is a great exercise
Okay, AFOs definitely protect your joints and ligaments. And you are obviously at risk for injury when you're muscles aren't working as they should be and your sensation is impaired. However, more injuries are caused by the foot rolling inwards, or there is more lateral force. It sounds like this cannot happen with your set up and you also are not bearing your body weight so the forces are lower. It seems like the risk of injury is low, but not zero. Do with that what you wish.
I would not walk without your AFOs - that would risk significant injury.

[flying]

Scitotalfitness If you don't mind, I would like to get your opinion on E-stim, for my calf's and gluts. From the knees down, is becoming completely atrophied, and my golf ball size gluts leave me without much to sit on. Could a person E-stim those muscles so that one would have more to sit on, and better calf's to strap on the AFOs? Do you know anybody how has tried, and do you think it would be worth the effort? Looks like you can buy a stim unit for about a 100 dollars. PS the bike is working great without the AFOs thanks.

[scitotalfitness]

There is actually a study going on right now about the effectiveness of estim being used as way to bulk up gluts for protection from pressure sores!! Sounds like a great idea, doesn't it? I don't know how they are going to quantify effectiveness, but we'll see. That being said, I think it's a great idea - for those who estim works on...

As I've explained in previous posts, estim to promote neurorecovery is only effective on "upper motor neuron" injuries, and at T12/L1 you could fall into either category. However, you are not trying to promote neurorecovery, you are trying to bulk muscle. I will ask an estim expert out here her opinion. She's actually been a consultant for the study that is being done.

[scitotalfitness]

Here is the response for Dr. Lucinda Baker:
IF you can elicit a contraction with a standard NMES unit then the muscle IS INNERVATED. Muscle bulking is a form of muscle strengthening. So you will want to go for a vigoras contraction. There actually was a series of papers out last year about using stimulation to increase blood flow and bulk the muscles of the gluteus last year. I don't remember the journal (and I was an author!), but the anchor author was GE Loeb. I am on two of the three papers (LL Baker). The lead author is H? Kaplan (I don't remember if he uses a middle initial or not, or what that initial is). The third paper in the sequence is probably of most interest, as it provides data on a small sample clinical trial.

Hope that helps! I will definitely be looking for those articles

[november]

Here is the response for Dr. Lucinda Baker:
IF you can elicit a contraction with a standard NMES unit then the muscle IS INNERVATED. Muscle bulking is a form of muscle strengthening. So you will want to go for a vigoras contraction. There actually was a series of papers out last year about using stimulation to increase blood flow and bulk the muscles of the gluteus last year. I don't remember the journal (and I was an author!), but the anchor author was GE Loeb. I am on two of the three papers (LL Baker). The lead author is H? Kaplan (I don't remember if he uses a middle initial or not, or what that initial is). The third paper in the sequence is probably of most interest, as it provides data on a small sample clinical trial.

Hope that helps! I will definitely be looking for those articles

So NMES should work on abdominal muscles as long as you elicit a strong contraction? When I use NMES my abs clench and it's pretty intense not a small movement. I've had drs and therapists give me varying answers though on how effective it would be on toning.

How are NMES currents any different than an FES bike or is it? A FES bike does add muscle bulk.

[scitotalfitness]

NMES and FES should be the same currents to elicit the contraction but times on/off are likely different - Functional Electrical Stimulation for the function of pedaling a bike (or walking if you use it for that) versus Neuromuscular Electrical Stimulation which I use for strengthening with say 8 seconds on, 24-32 seconds off, and I focus on one muscle group at a time.

Could you use the same principle of muscle bulking on ab muscles? I don't see why not... however, toned abdominal muscles are generally a smaller problem to the layer of belly fat most people carry over their muscles Interesting idea though to see if it tightens your muscles to do a better job at supporting your organs - share with us if you see benefits! But do not expect to have a 6 pack simply from using the NMES - or everyone would be chillin' on the couch with their units working.

[MFlounlacker]

SCITOTAL- Hope you can give me some info on PT strategy. I currently walk with the help of forearm crutches. Using the crutches my gait is pretty normal, but not quite. I can walk for very long distances over various terrain. I regularly hike our defunct landfill which has the biggest hill around. Where I live is very flat. I work on my strenngth through cycling and resistance training also, but my legs are still very weak.
I don't try to walk unassisted very much. I plan to wait until I am stronger when I feel more capable. My balance reflex makes it very hard to lift my good leg off the floor and rather than move in a natural way I tend to hobble. I figure that this would lead to a funky gait and I think that continuing to use the assistance will help keep my gait more natural. Does this make sense to you?
I have always thought from the beginning that the only way I would get better and stronger at something was do it more. I am not seeing a therapist anymore and am trying to continue keeping my progress rolling. Am I on the right track in waiting until I am stronger or should I work more unassisted walking into my exercises to try to retrain that balance reflex?
With the crutches that reflex is held at bay. But when my brain knows I am on my own it locks down. That's the best way to describe it. Any help would be appreciated. Thanks.

[scitotalfitness]

I would say I'm "pro-crutches" because of the increase safety of using them more than the normal gait. I wouldn't worry about testing your balance while you're out working on your strength. If you fall, that would certainly be a step back in progress. A better gait pattern is another benefit of the crutches, so you hopefully aren't stressing structures.
Definitely keep up your resistance training and cycling outside of your walking!! That is very important.
Now for weakness... you can certainly work on your strength until the cows come home and hit a threshold. Don't give up the hard work, but also do not get frustrated if your body is hitting a plateau. Your body is going through a lot, keep pushing yourself while respecting your body's response. It sounds like you are doing great!

[MFlounlacker]

Thank you so much for your reply. It is so hard to keep up with all the muscles are nuerons involved in regaining the ability to walk. I just try to bite it off in bunches and switch up every so often. There is only so much time in the day. I may get back into working on my balance again. I just have to figure out a safe way to do it.
As always thank you so much for the help.