Core Strength

I really wanted to do a post on the recent snowmageddon that hit NYC, but it’s one of those things that doesn’t work unless you have lots and lots of pictures.  I lack these pictures, but just imagine a bunch of slushy and poorly-shoveled curb cuts, with dirty puddles everywhere.  Now imagine sticking your hands in them (because whatever my wheelchair rims go through, my hands touch).  That is my snow experience every year.  Blizzards.  Not fun.  I should consider traveling to Melbourne.  Where the Australian Open is happening.  Because that way I get to be warm and watch tennis (and not have to wait until 3:30am to watch Federer play Djokovic).

This post wouldn’t be much if I just talked about how I spent my time snowed in (but if you were curious, I baked cookies and watched “Armageddon” for the Bruce Willis and Ben Affleck bromance), so I wanted to ramble about something that often gets overlooked when people think about paralysis (or regaining the ability to walk): the importance of core strength.  Sure, there’s always that movie/television montage where someone’s holding a walker in front of them or wearing leg braces, or regaining some other limb movement, but how often do you see someone doing exercises to strengthen their back or abs (unless it’s a weight-loss montage, in which case that is most of what you see)?  Fun fact: you’re going to have a really hard time using a walker if your core isn’t in it.  Why?  Because, among other things, your blood pressure is going to plummet and you will faint.  There are probably other things that will happen, but the first thing I ever notice when I’m standing (with a lot of assistance) is feeling like I’m going to faint.  Also, note: core and trunk (basically, your torso) might not be interchangeable terms, but I’m going to use them as if they’re interchangeable.  Apologies to readers who know more about anatomy than I do.

So why the lack of core coverage in the media? It could be because we’re conditioned to associate paralysis solely with loss of limb function.  Or it could be that planks, while great for your core, require very little visible movement and are kind of boring to watch, even in a montage to your favorite 80s song.  But let’s go with the association between paralysis and limb function.

Your core is ridiculously important.  I knew this as a runner, but realized just how much I depended on it when I became injured.  If you’re dealing with quadriplegia or certain T-level injuries, you may have lost a significant portion of your core/trunk muscles.  I remember during my freshman year of college, I told a floormate that I was a quadriplegic.  She scoffed and said I was lying, which was rude for two reasons: 1. My grip was not at 100% and my right hand routinely tightened up, so she was in no position to judge my physical abilities; and 2. Someone with a C-level injury generally does not have the same balancing capabilities and strength as someone with a T-level injury (particularly if it’s a low T-level injury).  That means if you have a C-level injury, that means more slouching, more awkward wheelchair transfers, and a lot of falling forward if you try to reach out for something in front of you.

In college, people met me after I had spent my gap year going boot camp on my core (more on that later).  But those who visited me in the hospital after I first got injured (especially those who showed up to my physical therapy sessions while I was inpatient at NYU) knew that my core strength was kind of non-existent.  I didn’t just lose the use of my legs when I first got injured – I lost the ability to sit up straight, to suck in my stomach, to arch my back, even my ability to cough (there was a time when I had to punch myself just below my chest so that I could cough if I felt like something needed to come out).  Come to think of it, my coughing and sneezing is definitely weaker than it used to be, which is probably why my sneeze is adorable now (and often mistaken for an awkward cough).  I also lost some of my vocal range (turns out you need to brace with your abs/some other nearby muscle to hit high notes).  I wore this abdominal binder (think of a Victorian corset, and make it as unattractive as possible) so that my blood pressure wouldn’t drop, because I couldn’t regulate that.  There’s also a lot of bladder and body function stuff that got affected, but more on that another time.

The first time I realized my core strength had vanished was a couple of days after I got moved out of the ICU.  A physical therapist at Dartmouth-Hitchcock (amazing hospital, by the way) said we were going to try an exercise where she reclined my hospital bed so that I sat up.  Then, she would move the bed back down and hold my shoulders so that I stayed up in my seated position.  I was instructed to put my hands behind me and place them on the bed, and continue sitting while putting my weight on my arms (so, basically how I used to sit on my bed when I was sleepy).  I thought the exercise was silly, until I put my arms behind me on the flat bed and felt the physical therapist let go of my shoulders.  It was then that I realized, holy crap, people are heavy.  My arms felt the weight from my hips and up completely bearing down on them, without my abs or back to help.  I kind of sunk back to the bed in what felt like comical slow motion.  You could try this at home, I guess, but your core muscles might kick in anyway.

One more thing about your core: you kind of need it to get dressed.  Imagine, if you will, attempting to put on a bra when you can’t sit up straight, can’t balance, and can’t grip the bra well enough to hook it.  My mom and my sister once tried to put my bra on while I was inpatient at NYU (so…at least a month after my injury if I’m remembering correctly).  This was extremely difficult, because I kept falling back onto my hospital bed.  My sister or my mom needed to hold my shoulders while the other person tried to put the bra on, but whoever was holding my shoulders realized that, holy crap, people are heavy.  Eventually we got the bra on, but it took over ten minutes, which I spent alternating between laughing and wondering what the hell happened to my life (because it was funny, but it wasn’t).  I spent a few years sleeping with my bra on because it made my life easier (also I couldn’t feel my chest all that well, so I didn’t realize how uncomfortable it was).

My core strength began to return while I was inpatient at NYU, but it came back very slowly.  So slowly that my physical therapist didn’t believe me, and thought I was imagining things.  She refused to let me work on whatever trace sensation or movement I felt, and instead made me practice wheelchair transfers and bed mobility (I literally practiced lying down on my stomach, and flipping myself over onto my back).  When I went back to high school to finish my senior year, I had to wear an abdominal binder (the unattractive Victorian corset) everyday.  It was restrictive and made breathing unpleasant, but it kept me from fainting in class (also it made me not look terrible in t-shirts, so there was that).  When I took notes in class, I leaned on my wrists, my hands, basically anything to support the upper half of my body, which would constantly fall forward.  Then I learned a trick where, if I didn’t sit far enough back in my chair (which was all the time because it was too difficult to adjust my position), I’d slouch, and then there was no fear of falling forward.

Fast forward to about a month after my high school graduation, when I first started going to Push to Walk (gym for people with paralysis and other neurological conditions), which felt like boot camp.  I told my trainer that I wore an abdominal binder.  He told me not to wear it anymore.  I spent the following year working on my core strength (with, thank goodness, someone who didn’t think I was imagining things).  I did ab exercises (e.g. super modified sit-ups), back exercises (including my favorite, which involves putting a big-ass box behind your back and forcing you to constantly straighten your back against the box while you do other exercises), and exercises that didn’t look like they were meant for my core, but it turns out that they were.  There was also montage-worthy treadmill work, but that’s not the point of this post.  The end result was that, by the end of my gap year, I could maintain my balance better than before, perform better wheelchair transfers, and feel like I could actually live on my own at college.

Accomplishment, right?  Well, when I got to college, I mentioned my gap year to a few people, but there was no way to say, “I improved my balance and now I can transfer from my bed to my chair without falling on my ass!” without getting a blank stare and a delayed, “Sounds great!” from the person I was talking to.  Fine, I get it, talking about recovering my core muscles isn’t as exciting as, “Hey, I moved my leg!”, but dangit, it should be.  Our society may be conditioned to view leg recovery as the only thing that matters when it comes to paralysis (which is ableist as hell, by the way), but there is so much more to recovery than that.  There are other muscles and body functions that matter, and recovery of any of them assists an individual in not only becoming more able, but healthier.

I’m continuing to work on my core, and I’m happy to report that when standing (with a lot of assistance), I don’t get nearly as dizzy as I used to.  My wheelchair transfers are easier (not perfect, but easier).  Oh, and I don’t fall over when I put my bra on, so I think that’s a victory.

Thanks for reading!

Val

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