A physical therapy post! Huzzah! I did a post a couple of years ago called “Standing with Context” in which I explained what it looks like, and then what is actually happening, when I do standing exercises. I also did one on the importance of core strength. Go read them if you haven’t yet.
This is going to be part of my “Physical Therapy with Context” series, because I love context. I love when there are specific details that explain what I’m doing, so that you understand how mundane everything is – because it is mundane. Staying active requires hours upon hours of repetitive exercise, and most improvements that are made are done gradually. You’ll find no peppy three-minute montages here of me making dramatic leaps and bounds on the way to completely unassisted walking, even though I’d probably love to find a song for such a montage. Context takes the glamour out of physical therapy, and that is exactly the point.
With that disclaimer out of the way, I’m going to talk a bit more about standing exercises. Last time, I focused on standing, in general, with the assistance of a trainer and a standing bar.
Now, we’re talking squats. There are generally two types of squatting exercises I do at Push to Walk (PTW) – the first involves a machine called the Total Gym (an adjustable workout machine that looks like this, and, side note that has no bearing on my opinion of the machine, is Chuck Norris approved), and the other involves the standing bar or anything where I can go from sitting to standing. In both cases, I am trying to straighten my legs, which are placed into a bent position, and stand upright.
On the Total Gym (video from August 2014):
What it looks like: Holy moly, Val can move her legs! Confetti! Confetti everywhere!
What I’m actually doing: I cannot bend my legs on my own, hence the assist by my awesome trainer (who is now PhDing it up and learning more about SCIs than I will ever know). He has the Total Gym at about the lowest level possible, which means I am pretty much on my back and thus barely fighting gravity. I’m not sure which muscles are kicking in, but I’m definitely imagining that I’m using my quadriceps. The movement that you see to straighten my legs is done independently, which shows that I have some trace movement. The purpose here is to get me to use whatever muscles I already have some connection with (e.g. back/trunk and shoulders, hence my weird arm movements), which may facilitate the aforementioned trace leg movement.
What’s the point: Activity Based Therapy (ABT) is used to restore function or provide health maintenance for people with SCI and other mobility impairments. Exercises such as these squats (or, heck, anything else I do at PTW, or at home with my FES Cycle or standing frame) reduce my leg spasticity (and oh, do they spasm), strengthen whatever trace movement I have, and also provide all the benefits that an able bodied person would get from a similar workout.
Another way I do squats involves starting out in a sitting or standing position, squatting down, and then getting back up.
On the Platform Walker (video from March 2016):
What it looks like: Val’s trainer is pushing her knees to get her to stand as she grips onto the handles for dear life.
What I’m actually doing: These are mini squats. My trainer has his hands on my knees for stability and also assistance (to some degree, because I’m not sure how much he’s helping me here). I’m gripping the handles tightly, but I’m not dragging myself upright. Some of the standing is coming from my aforementioned quads, some is coming from my core, and some, yes, is coming from my arms and shoulders.
There are two things to note: 1. If my trainer was just helping me lock my knees, I would not look upright at all. I need my upper body, core, and hips to kick in, otherwise I’ll look like I have straight legs, and my ass will be sticking out. Not a good look, and not good for posture in any regard. 2. I know that I’m using my core and my hips because my arms are not strong enough to pull myself up into standing. I have never been able to do a pull-up. Having the fabulous arms that I currently have does not magically give me super pull-up abilities. That said, I would not be able to do this exercise without my upper body, because it’s helping to stabilize the top half of my body. I am also not yet at the point where I can do squats and lock my knees on my own. Remember that because I am vertical here, gravity is bearing down on me, which makes knee-locking particularly difficult. Hence, the trainer.
The now PhD-ing former trainer, Tommy Sutor, who was kind enough to look over this post before it went on the interwebs, also wanted to note that being vertical means that the sensory receptors in my feet are getting more information than they do when sitting or lying down. To quote, “This actually creates sensory input to your spinal cord, which helps your nervous system to get into a state of higher excitability – that’s why it’s worth performing squats on the [Total Gym] or with the walker, rather than just sit in your chair and have a trainer move your legs!” Even the location of the trainer’s hands and position of his fingers helps with that specific sensory input. In other words, I’m not just doing squatting exercises – I’m also getting my nervous system more excited overall.
Why am I doing this?: Again, ABT. Exercise is good for regaining function, and even when function is not regained, maintenance is achieved. And that’s not a bad thing at all. Indeed, I think maintenance isn’t given nearly enough credit. For all the horror stories about pressure sores, atrophy, and other types of deterioration that are often associated with having paralysis, maintenance is a wonderful thing. Sure, popular culture would have you think that walking is the endgame of SCI physical therapy and exercise, but staying healthy and active enough to go about my daily life is a much larger priority.
But sometimes, after much effort, function is regained! One time during a PTW workout (I want to say around 2010? 2011?), my hips literally came back to life during an exercise. They were shaky and all that, and I was shocked, of course, but they were back. And maybe it’s a story for another day – my hips and butt have been on quite a journey – but I think the reason they reactivated had a lot to do with having them subjected to exercises that forced me to attempt movement as I worked other nearby muscles (i.e. my core).
Which isn’t to say that my hip movement is perfect now. It’s a work in progress, much like the rest of my body below my C7 vertebra. I’m capable of doing assisted squats now, and am working on whatever trace movement there is, while also exercising the parts of my body that have developed a bit of a stronger connection with the rest of my nerves. And, as always, I am continuing to get amazing arms and shoulders.
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