Exercise Program for people with Spinal Cord Injury (SCI)
Since I was 13 years old exercise, working out, and sports have always been a centerpiece in my life. Whether I was having a bad day, stressed out, simply wanted to stay in shape to fit in a bikini or just generally tried to be healthy I was always able to exercise.
When I was exercising I would enter this Zen like state where I was in my own space and no one else could bother me. After my accident I simply didn’t know how I was going to continue to exercise as a C6 quadriplegic, paralyzed from the chest down with some arm movement, and no hand function.
I participated in rehabilitation where I would go see a physical therapist who would roll me around on the mat, engage in range of motion exercises, build my strength, etc. This was great, don’t get me wrong, but insurance only pays for so many physical therapy sessions a year and so many folks don’t have the ability to get out 3 to 4 times a week to work with their physical therapist. It’s just not realistic.
I wanted to find a way to be able to exercise on a regular basis five days a week from home. There are so many fabulous ways to build community and get exercise in the spinal cord injury world such as joining a quad rugby team, hand cycling with the group, playing basketball, etc., but many of these options do not offer quadriplegics the opportunity to maintain a workout regimen 3 to 5 times a week on a regular basis. As we all know it’s important to exercise.
THE CHALLENGE I WAS PRESENTED WITH WAS:
- How could I create a workout routine at home that would require minimal help from caregivers other than helping to set me up?
- What kind of equipment could I use that was not outrageously expensive so I could share it with fellow quadriplegics?
- How could I create a program that was sustainable in the long run just like going to the gym or working out to a DVD at home when you’re able-bodied?
Over the years I’ve perfected my own exercise routine based on my needs and what I can physically do. Many of the suggestions and equipment I mention below apply to all spinal cord injury folks, but more specifically to quadriplegics who have limited use of their hands and arms. Exercise is even more important for those of us who have very limited mobility, but it is possible, doable, and I can prove it 🙂
In any exercise program there are key elements that need to be addressed on a regular basis. First off, you need some sort of cardiovascular exercise to get your heart pumping for at least 20 – 30 minutes, 3 – 5 times a week. Secondly, improving muscle mass through weightlifting in whatever capacity is also key for your muscles that are not paralyzed.
BUT WHAT ABOUT THE MUSCLES THAT ARE PARALYZED?
No problem, there is something called neuromuscular electrical stimulation, which I discuss below, that essentially sends electricity into your paralyzed muscles to promote blood circulation, prevent pressure sores, and improve muscle mass.
Another key element is stretching and being able to move the lower half of your extremities that are paralyzed. There are several approaches and types of equipment folks can use, but essentially the use of some sort of stationary bike and regular stretching by a caregiver or loved one is key.
Lastly, weight bearing is another essential exercise that many able-bodied people don’t think about because they walk around throughout the day.
When you are paralyzed and sitting in a wheelchair all day standing up in some sort of frame can be extremely beneficial to involuntary muscle spasms, flexibility, reduction in pressure sores, and some say improvement of motor function, but this has not been proven in the medical field yet (at least there is no evidence from only standing a few hours a week).
The challenge for many with standing up in some sort of frame is that it does require help from a caregiver or loved one, especially if you are a quadriplegic, which can be quite tedious and unrealistic for some. I will tell you I don’t stand any more, which I will further elaborate on shortly.
CARDIO
As a quadriplegic there are a few ways to get cardio workouts every day from home and have minimal help from caregivers if you have moderate upper body movement. I am personally aware of two easy ways to get cardio exercise.
The first is on a machine called the VitaGlide, which is essentially a rowing machine. It allows you to strap in your hands and then you literally just push back and forth for your desired time. I do it 4 times a week and I have to tell you it’s a hell of a workout. The challenge with these machines is they are quite expensive costing about $2,500.
I purchased an older version for about $700, but they are very durable and if well maintained can last many years. The company stopped manufacturing these machines in 2010 and recently started making them again last year.
The second piece of equipment, which is far more affordable and packs just as much punch as the vitaglide is a stationary hand cycle, which you can put onto some sort of countertop or table you can roll your chair into.
Again, your caregiver just has to strap your hands in and you are off cycling at home while listening to a great audiobook, music, or watching your favorite TV show. There are so many out there, but here are a few I found within the several hundred dollar range:
Confidence Fitness Motorized Electric Mini Exercise Bike
Sammons Preston Magnetic Resistive Exerciser
WEIGHTS
Lifting weights in a wheelchair is one of the easier exercises to be consistent with at home every day with minimal help. Even if you can’t get your hands on some sort of cardio machine you can purchase some strap on wrist weights or stretchy rubber Therabands you then can tie onto the edge of the table.
Theraband is a very well-known company that makes a variety of therapeutic exercise equipment. Specifically, they have Velcro wrist weights that don’t cost more than $20-$30, and from the comfort of your own wheelchair, if you lift your arm rests up, there are multiple different type of arm routines to build strength. I’ll demonstrate in some videos below.
Even easier than putting on wrist weights is taking a piece of rubber stretchy band, which Theraband + other companies make, tying a knot to make a circle and attaching it to the leg of the table. You can wrap this stretchy band like material around your wrists and pull from different directions. Here are some of the links if interested:
https://www.amazon.com/TheraBand-Resistance-Professional-Non-Latex-Exercise/dp/B003YR7G8K
https://www.amazon.com/TheraBand-Weights-Comfort-Adjustable-Walking/dp/B002WCAVDK
STANDING / WEIGHT BEARING
Physical therapists generally tell us how important it is to have some sort of weight-bearing exercise in our daily routine. I don’t disagree that weight-bearing is fabulous for blood pressure issues, preventing pressure sores, possibly improving osteoporosis (maybe – there is not a lot of clinical evidence on this to date), improving flexibility, and improving blood flow.
I am not disputing the benefits of standing, but I would like to point out for many quadriplegics who are dependent on others to take care of them and don’t have someone around all day — it’s not always realistic to try and stand every day, which is what many suggest is needed to do to get the full benefit of weight bearing.
If you are a quadriplegic and you have a standing frame at home, more often than not, you need someone to get you into the frame, strap you in, and watch to make sure your blood pressure doesn’t go too high or too low. For those of you who can do it regularly I commend you to the highest level.
I also stood several times a week for the first two years after my accident. Personally, it made me miserable because it took a Herculean effort to get me strapped in. When I was finally standing up I would have to go up and down, and up and down again because of severe blood pressure issues. By the end of my standing session I felt like I had just run a marathon and I was completely exhausted the rest of the day.
I also developed severe osteoporosis over the years from being immobile in a wheelchair. My osteoporosis developed at an alarming rate and I ended up breaking so many bones from my kneecap — shin bone — ankles — pelvis … the list could go on. Anyway, about a year and a half ago I called it quits to standing for fear of further injury.
There are several companies out there that make standing frames, but a leader in the field is called Easystand and they make a standing frame called the Easy Stander! These pieces of equipment are several thousand dollars. You can usually find them cheaper on eBay, but I can’t stress the importance of getting this machine custom fit to your body.
It’s imperative you work with a physical therapist to get the proper measurements. Depending on your insurance, some insurance companies will cover these devices if you have a phenomenal physical therapist who makes a great case that this machine is medically necessary for your survival 🙂
https://www.standingframes.org/
BIKE
There are so many different type of bikes out there that allow you to drive your wheelchair into an electric bike, strap your feet in, and bike your legs for you. If you can’t stand regularly for any reason biking allows your flexibility to remain intact and allows blood to flow to the paralyzed parts of your lower body.
Restorative Therapies up in Baltimore, Maryland is a company that is a leader in functional electrical stimulation in combination with the bike. Restorative Therapies manufactures a bike called the RT300 and they are really expensive. However, they are fantastic, customer service is phenomenal, and the results are impressive. The catch 22 is that sometimes insurance companies will pay for these bikes and sometimes they won’t. It is quite a long grueling process that took me over 14 months of going back and forth with the Restorative Therapies staff up in Baltimore and Blue Cross and Blue Shield’s to get my bike approved.
There are certain bikes that cost tens of thousands of dollars, like the RT300, which include an electrical stimulation portion to the bike (electrical stimulation described below) to bikes in the several thousand dollar range. A few bikes are even as low as a hundred dollars where you can just strap in your feet to a small motorized unit.
https://www.ebay.com/bhp/motorized-exercise-bike
https://www.completefitnessco.com
https://www.restorative-therapies.com/rt300-sl_fes_rehabilitation_therapy_system
ELECTRICAL STIMULATION
I find electrical stimulation to be an essential part of my exercise program. There are many different fancy terms thrown around such as functional electrical stimulation, which I’m sure you’ve heard from your physical therapist or a rehabilitation center.
The “functional” part of electrical stimulation just implies that you are engaging in electrical stimulation while performing some sort of function like riding a bike or walking while having these little electrodes send jolts of electricity through your body to flex your paralyzed muscles.
I agree that performing some sort of function with electrical stimulation is best, but it is also not realistic for most folks on a regular basis, nor is it cheap. If you want to get the benefits of electrical stimulation you can purchase these little boxes and electrode pads that you stick on different muscle groups of your body.
These little sticky electrode pads have thin little wires in them that conduct electricity when the box is turned on to flex your paralyzed muscles to improve blood flow, reduce the incidence of pressure sores, reduce muscle spasms, and improve muscle mass to prevent further atrophy of the muscles.
The challenge when you type in “electrical stimulation unit” into Google, 9 times out of 10 the results show up for these little boxes called TENS (Tran cutaneous Electrical Nerve Stimulation) units. Be careful because TENS units use electrical current to stimulate the nerves for therapeutic purposes only.
The type of electrical stimulation unit you are after is something called NMES (Neuro- Muscular Electrical Stimulation) units. They can also be called EMS (Electrical Muscle Stimulation). These little boxes use electrical muscle stimulation to cause excitement in the muscle tissue. The stimulus is designed to mimic the same type of signal the brain sends to the muscle when working out. They are used to prevent atrophy and many sports players actually use them as well when recovering from an injury.
When purchasing a box make sure it is in an NMES / EMS unit. There are so many out there and I recommend asking a physical therapist to help you find the right one or myself.
Some devices combine TENS & NMES together, so be careful when purchasing. You can purchase a unit that has both, but just make sure you get the settings right. Generally, you place two electrodes on each muscle group that you would like to stim.
You can purchase several of the boxes and stimulate multiple muscle groups at a time, which would make things more efficient, but it depends on your budget. You will need to change the electrode pads every month or so once they start to lose their stickiness. Unfortunately there’s no way around this.
http://www.medi-stim.com/stims/nmes.html
STRETCHING
If you can’t afford a bike, stretching is a great free alternative to make sure you get enough blood flow and movement to your legs. You can have a caregiver or loved one stretch you. It only takes about 10 minutes a day and really helps in every way possible.
MY EXERCISE PROGRAM
Hopefully, I’ve laid out multiple solutions for folks to exercise on a regular basis on various budgets.
As for my daily exercise routine:
I exercise five days a week and depending on the day the week I perform the following exercises each week:
1. Cardio – Four times a week for 30 minutes using the Vitaglide
- I usually put my Bluetooth in my ear and listen to a book on tape or rock it out to some 50’s rock ‘n’ roll 🙂 It just makes the time go faster so I’m not just staring at the wall.
2. Lifting Weights – Four times a week for 30 minutes using wrist weights and stretchy bands.
- I generally do 3 exercises as a set. In each set I do 15 to 20 reps. I do 3 sets for the 3 exercises. I then go on to the second set of three exercises. In total, I do 9 different exercises, 3 sets of each, and 15 to 20 reps each set. This takes me approximately 30 minutes.
3. Bike – Two times a week for 30 minutes to 45 minutes.
- I was fortunate to get the RT 300 electrical stimulation bike paid for by insurance, but I also use it just for regular biking when I am not attached to the stimulation part.
4. Electrical Stimulation – Two times a week for 30 minutes in my bed if I do not stim with the bike
- I have three small electrical stimulation units. Each unit can stim one muscle group. So, one box can accommodate four electrode pads. For example, if I want to stim my glutes (butt) I put two pads on one butt cheek spaced several fingers apart and two pads on the other butt cheek. So, one box can stim the entire butt at the same time.
- Generally I stim my butt muscles, quad muscles, and hamstring muscles. These three boxes allow me to stim all three muscle groups at the same time for 30 minutes. If I had more time in my day I could then do another 30 minute session on my calves or my back or my stomach, etc.
- Honestly, if I had more of the boxes I would probably stim more muscle groups at one time, but time is an issue in my day since I don’t want to spend too many hours on exercises as I have a full-time job, have to attend to bowel and bladder care, dressing, caregiving duties, living life, etc. 🙂
5. Stretching Four times a week for 15 minutes with my caregiver
I work out about 1 – 1 ½ a day, which is exactly what I would do if I wasn’t injured at the gym. However, it does take me about 1½ – 2 hours several times a week when I do electrical stimulation because I have to have someone help me set this up, put the electrodes on me, and press the buttons for me.
There you have it … an exercise routine where there is something for everyone. Even if you can only get your hands on a set of wrist weights because you are alone most of the day doing something, anything, is better than nothing!
Here’s to healthy living for all my Spinal Cord Injury Friends!