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This new member indicated that they were similarly injured and asked what exercises they should be doing in their condition. I will start this by describing myself. I am a middle aged male, father of 2 kids 16 and 11. I am now single but still maintain living in ah house and raising my kids myself. My injury is a completely severed spinal cord (4 cm is missing from my spine). My paralysis is complete from the T3 area down. This being said I still have fairly good use of my hands and arms although I have been known to punch myself in the face when they spasm...
I have absolutely no control over anything below the armpit areas including my side and stomach muscles which seriously screws with my balance. If I lean over, I fall over. One of my real issues is pain and I initially started an exercise and stretching routine in order to help with that.It has been long known that exercise and stretching contribute to lower pain levels. It can also help with spasticity (spasms). There is good theories surrounding this. Exercise works to strengthen the muscles which them means less stress is put on other areas of the body. The stronger you are, the easier it is for you body to cope in other areas where you are struggling. Exercise itself can result in a short term high when you body gives off the pheromones generated by the exercise. I maintain that you only usually get that benefit if you push yourself to some degree though. Stretching helps maintain flexibility which becomes doubly important in the para who needs to be able to do a lot of innovative things to make up for areas we struggle in. Over time in a wheelchair our bodies start to take on that folded position. We sit that way, we sleep curled up. It starts to become hard to straighten out if we do not take the time to stretch enough. While straightening up may not be all that important, I find that to operate in daily life I may often have to contort my body in strange ways which require flexibility beyond what many normal males my age have. I simply refuse to give up my rights to parent my children in a normal house despite my condition. If I let my condition slide my ability to provide for myself comes into question and certainly my ability to be a normal parent also becomes compromised. That being said I now use exercise on a regular basis to help with all this.
Starting probably 6 years ago I formally joined an exercise program run by the local university. They are good enough that they have installed a number of bits of equipment so that people in wheelchairs can do exercises independently like I do, or go through exercise programs with the help of volunteers. Here is a description of the program I do by myself twice a week at the university. Most of this can also be done at home with simple setups.
3 sets of 10 repetitions of rowing: sitting and facing a pole (might have to be strapped in if you have no core strength like me), using tension bandages or weight machines, pull the weights towards yourself in a rowing motion. Pull both arms towards yourself until your hands touch your sides, hold briefly and let back slowly. The slow is important. If it is easy either increase the weights being pulled or increase the tension of the bandages http://www.thera-band.com/ Lots of places sell this stuff under different names.
3 sets of 10 bench press. If you have no weights, again mock up some theraband so you have your back to a door/pole/post where the theraband is tied to and push away from yourself. Some times instead of pushing the maximum amount, start with a lower amount and push and push and push until you are completely worn out.
3 sets of 10 arm curls: With free weights or any kind of weight tied so you can lift them, support your arms at the elbow and curl your arms up, lifting the weight. In my case I fall over forward because of my lack of stomach muscle control. AN easy way is to prop a chair in front of yourself. Lean over forward with your elbows supported by the back of the chair. Then with the free weights or any weight tied to you hands pull your arms towards yourself until you touch your chest. I know a lot of you understand what I am saying. I am trying to be obvious so people from other countries who may not be familiar with terms like "arm curls" will understand.
3 sets of 10 wide arm pull downs. With some sort of overhead bar. Grab the bar so your hand positions are wider than your shoulders. Pull down until the bar is under your chin. You could use a strong broom handle tied to theraband, which is in turn tied to the roof above you some how.
3 sets of 10 narrow arm pull downs. With the same setup, grab the bar (or broom handle) with your hands about 30 cm (1 foot) apart. Pull down until you have the bar below the chin and slowly let up. Remember, the slow is important as it strains different muscles during the pull down and release back motion.
3 sets of 10 inward arm curls down. With the same setup as above, grab the boom handle with your hands tight together, side by side. Then keeping your arms straight, pull the bar down until your hands are touching your knees. Keep your arms straight at all times so you are working the upper chest and muscles in around the shoulder.
3 sets of 10 (per side) triceps curls. With your theraband tied to a post/door/anything behind you. Lift one of your arms until you are pointing directly in front of you. Then holding the portion of your arm, from the shoulder to the elbow solid, continue raising the arm and hand until it points straight up. Your arm should not be to the side of you. Then curl your wrist so the palm of your hand faces away from you. Grasping the theraband and holding the elbow to shoulder solid. Curl the arm away and down, until you are pointing directly away from yourself. Slowly left the arm be pulled back upright and repeat 10 times. Switch to the other arm and repeat. The tricept muscle is really important if you want to have the strength to help move yourself around.
For people like me who have no control of your stomach and side muscles, you will want to increase your core strength to help in sitting up. You will need a friend for this next one. Sitting up in the chair, have the friend gently push you sideways in your chair with a finger. As you start to fall over sideways, try to make yourself sit upright. The friend needs to find the right amount of pressure to keep you going over, but not pushing you over. As you start to fall,then need to gently stop the pushing so you can come back upright. It can be a very fine action. Just enough push to get you moving sideways but always letting off so you an come back upright. If done properly you will only move 1-2 inches (4-5 cm). Just enough so you can fight the push. Over time as you get stronger your friend will have to push a bit harder. Repeat this to both sides and getting pushed from behind. Use only your core/stomach/side muscles to help you. No use of the arms. If you do not have a friend. Put your hands palm to palm together in a prayer fashion in front of you. Hands directly in front of your face as if you were praying. With the elbow to shoulder straight out in front of you and sitting upright in a chair. Move the palms side to side. This should cause you to fall to that side. Keep doing this for up to 5 minutes, moving side to side just enough so you do not fall over. Over time you should be able to go longer and further to each side.
Wrist curls. Get a piece of broom handle 40cm (15 inches) long and bore a hole through side to side in the middle of the bar. Tie about a meter (3 feet) of string onto the bar through this hole. Then tie a 1KG (2 pound) weight onto the other end of the string. With your arms out in front of you (they can be supported by a chair) twist your wrists so you slowly wind up the string around the handle. Keep winding the string up until the weight comes off the floor and all the way up to your fingers. Then wind it all the way back down until the weight is on the floor. Repeat this as many times as you can. Once your wrists are in good pain, rest for 5 minutes and try it again. The object is not to work the arms in any way but to work the wrists.
3 sets of 10 Side arm pull inwards. Sitting in your wheelchair attach the theraband to a door/post/etc. Turn your wheelchair until the theraband is directly out to your side. Grab the theraband and with your arm straight and stiff pull the theraband from your side, out until you are pointing in front of you and continue until you have crossed your arm across your body. This may take a fairly soft piece of theraband as you are moving completely from one side of your body across to the other. Try to keep your arm straight instead of the tendencey to curl at the elbow as you cross in front of your body. It's okay to not get all the way. You really want the main tension to be from the side of you body until you are pointing your arm straight out in front of your body.
3 sets of 10 Reverse arm twists. Tie a piece of theraband on one arm of your wheelchair out near the front tip. To be honest I just wind it around a couple of times and hold it with my hand. Put your arm naturally straight down at your side, hands on your legs in front of you. Grab the theraband and twist your arm away and out to the side of your body. This feels a bit unnatural. You want to keep the portion of your arm from the elbow to shoulder tight to your side. The elbow to hand is straight out in front of you parallel to your leg. You grab the theraband and pull the hand away from your body. This means the theraband which is tied to the other armrest is being pulled straight out across your knees and away from the body. Try to hold the elbow to the side. Do with each arm.
This next one is for endurance and heart rate. You can do the same by simply wheeling your chair until you drop but in this I am trying to push the heart and conditioning, not the whole body. We tend to exercise a lot of different parts of the body when we wheel around in our chairs and we tend to stop when one part of our body gives up and we may not have stressed the cardiovascular system as much as we could. Many hospitals have the typical Monark hand pedal machine. Here is a link for those that are unfamiliar with what I am talking about. http://www.fitnessru..._ergometer.html These are stupidly priced and you can lterally make your own quite easily for $25 or less. Buy an old stationary seated pedal exercise machine and chop off all but the pedals and wheel. Change the pedals to hand grips or simply remove the pedals and hold onto the post and you have the same device. There are millions of these in the used newspapers from people who bought the stationary bicycles in an effort to drop weight. The ones with the smaller solid wheel are much, much better to modify and the ones with the larger wheels often get in the way of the operator. Something like this works well http://www.canadiant.....%2B7576BK.jsp
Pick a light tension. At first you might want to start with almost no tension. Over time you will increase the time duration and I suggest you try to get up to at least 21 minutes. Watch TV if you have to while your hand pedal bike is on a desk or table. If you are able to go more than 6-9 minutes, try a little tension as this will strain the heart a lot more than time alone. Pedal forward for 1/3 of your total time. Say we are using 9 minutes total time. Pedal 3 minutes forward. This works one group of muscles. Then reverse direction for the next 3 minutes. This provides more of a pull motion instead of the more natural push motion the forward pedal did. Finally go back to the forward pedal for the last 3 minutes. Over time try jumping 3 minutes at a time, adding one minute to each direction. This exercise is less about strength and more about cardiovascular conditioning. As we sit in our wheelchairs our hearts start to weaken. You will find after a year you may pass out from low blood pressure if you are stood up because your heart which may have pumped blood to your full height before becoming disabled, has weakened off and only has to pump blood to your seated height which is much less. You can use a standing table to work on this condition, but I will leave this off for now, although I believe it is still important.
This should help the strength portion of your training. The next step is the stretching. As I have said, I regard stretching as an essential part of my bi-daily routine. Some people may want to work on strength one day and stretching on the other. I think without stretching I would have a much harder time dressing myself. I guess I will go through it as I do it myself.
Usually I start out laying in bed after sleeping. Stretching is a good way to get yourself going for the day and I am really stiff and hurting after a night in bed. Any position for any length of time hurts me, but I digress. Start sitting up with your legs straight out in front of you. Legs straight. Reach forward and grab your feett which should be sticking straight upwards. Use this to pull yourself forward. If you cannot grab your feet you might have to make some fabric slings or velcro slings to wrap around your feet to help in this. Try to pull yourself forward as far as you can and hold that position. Don't over pull and sort of bounce as you may strain or pull a muscle. The object is two fold. You want your legs to be as straight as possible because they are bent all the time. You also want to create a pull at your lower back which spends so much of it's time sitting straight up or laying down.
Then while sitting in this position rotate your leg so the foot turn inside the other. I can only do one side at a time. I find that over time my legs start to turn outwards sort of in a duck walk. I don't know why, but I think it unnatural so I compensate by rotating the legs inward and holding this position for a while. Obviously, do the other leg too.
Then with one leg straight, I pull one leg until the heel of my foot in touching my groin. This tends to lift the knee off the bed. That's okay. Once the heel is touching y groin, I gently push the knee out and down until it touches the bed again. Hold it there for a while. It may take days or months to get to the next level. In the second level you pull both feet in until yu touch your groin. While the feet are sole to sole together, gently push the knees down at the same time until the knees touch the bed at the same time. A large number of people will not be able to do this for a long long time. Don't rush it because you will probably not be able to feel any pain if you are like me (I could do this before my accident too). Just realise that you only push the knees down gently. IF you need much force, you are stressing the muscles/tendons/whatever, too much. Just gently push and hold for a couple of minutes. Over time you will be able to do more and more. This exercise really helps in being able to dress yourself. Pull your foot up, put on a sock and shoe. Dress in your chair? No problem to lift your foot up put in on the other legs knees and do your socks and shoes at any time. But you need that flexability.
The next is to flex the achillies tendon. Over time you will find you start to get a condition I think is called drop foot. Your rear ankle tendon starts to shorten and tighten until your foot wants to point down and away from you. I definitely get this. While it does not really hurt anything that I know of, I just go through the paces of stretching it in the hopes it helps spasticity and the belief that all types of stiffness contribute towards some pain conditions. In any case I'm in an easy position to stretch it, so I do it. This will sound pretty weird. With one leg straight and out of the way, I bring my heel back into my groin area to get it situated right. Say this is my right leg. I take my right arm and wrap it out, around and under the bent leg so the big muscle of my right arm (elbow - shoulder section of arm) is outside but touching the area around the outer knee/thigh of my right leg. Depending on the length of you arms/legs etc I put the the muscle of my left arm under the sole of my right leg. Essentially the leg is positioned so the knee is sort of in the meaty muscle of the right arm, the foot is in the meaty muscle of the left arm. I grab my arms together, or have my right hand grab the elbow of my left arm and pull them together. This exerts a lot of pressure on the foot to push the toes towards the shinbone. I don't find that just pulling on the toes while the legs are straight will do much of anything. I find a LOT of pressure has to be exerted or that tendon at the back of your ankle does not get stretched. Boy I wish I had a series of pictures for this one.... Might just edit it later for that addition. I know it is easy to just skip this step. But it's already there from the last exercise so it's easy to do and I would rather do a full body stretch then just bits and pieces.
Lastly for the legs is a pretty ungainly one. Leave one leg straight out forward. Take the second leg and bend the leg at the knee so the ankle is now pointing out to the side of your body. Put your hand under the bent thigh and try to move/wiggle/walk the leg further out to the side as far as you can go. This may cause you to fall to the opposite side, or you may find that by leaning to one side you can have someone pull your leg further back. If you get good at it you should be able while sitting, to have one leg straight out to he front while the other leg, from the waist to the knee is almost straight out to the side shin/ankle folded behind or under you butt. From there try to take both your arms and reach and touch your straight legs toes. Hold that position for 30 seconds. Do not try to just fall over or force the position as you can tear things you cannot feel. Once it starts to become difficult you probably are far enough over for now. Then keeping the same position try to fall backwards. Make sure your arms are behind you to keep you from going all the way because if you do fall back you are going to be stuck permanently. Without the proper mobility you will never get out of this position by yourself and may well tear something. Doing this properly, the second step will pull a lot on the thigh muscle, of the leg which is bent backwards. Repeat the exercise with the other leg bent back.
Doing these stretches will only take a few minutes but will really improve the way in which you can dress and do other chores. I usually use a transfer board to move from my wheelchair to my bed. Once I am siting sideways on the bed the next chore is to get one leg up on the bed. With this flexibility you will find it easy to pull one leg up on the bed, laying it straight forward, down the length of the bed, while the other leg is still standing on the floor. You can then pull the second one up. I really don't know how difficult it would be to do the same thing if I was always fighting a tight body. It simply makes life easier and has the side benefit of easing tight muscles/body that may then cause pain or cramps. I do find that when I get lazy and start skipping these things my body starts to get cranky and has more spasms.
Next while sitting I put one arm straight out in front of my body. I take the other arm and pull the straight arm across the front of my body until the arm is pointing away from my other side. This should pull the outside muscles in the shoulder area. Repeat on the other side.
Next put the arm straight up and over until it points over your back. Your elbow should be sticking straight up in the air. If you can, use your other arm to push it over a bit more. This usually causes me to fall over but I try. You can even do this laying straight down if there is nothing above your head.
There are a number of other exercises and in particular stretches we do as a group in the university program but these are all things you can try to do in bed or at home. If you want to source the theraband, just about every hospital I know has it in there physiotherapy area. It's cheap to find and order over the web but if you think about how the exercise goes you can probably make up your own program to do the same thing, just like the exercise bike device from a garage sale and a hacksaw. This is probably more than you asked for Addis8, but never say I did'nt answer you.....
Edited by AHolland, 28 March 2010 - 03:19 AM.
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