A good workout can
make many of us feel pretty good. Not only does it stimulate the release
of feel-good molecules called endorphins, assuaging life’s trials and
tribulations, but it promotes physical health in so many different ways,
especially for individuals with spinal cord injury (SCI).
Foremost, it helps to
maintain a healthy weight with a better fat-muscle ratio. Given
post-injury muscle atrophy, this is an important issue. Our body-fat
composition greatly influences our physiology and the development of
disorders such as diabetes common in individuals with SCI. For
diabetics, good old-fashion weightlifting is especially effective in
pulling excessive sugar out of the blood where it is not needed into
muscle tissue where it can fuel activity.
In addition, exercise
profoundly influences the nervous system itself. For example, it
stimulates the production of regeneration-stimulating nerve-growth
factors and the differentiation of neuronal stem cells into mature nerve
cells, replacing ones lost by injury and the entropy of aging, nurturing
those that have survived. Due in part to these nervous-system
influences, aggressive exercise programs have been shown to enhance
functional recovery, even long after injury.
Finally, the focus of
this update, studies suggest exercise can lessen SCI-associated pain,
including not only the shoulder pain common to wheelchair living but
also the more insidious neuropathic pain resulting from nervous-tissue
da
mage.
A summary of key studies are included below:
Studies
In 1999, Dr.
Kathleen Curtis et al (California) examined the impact of a
six-month, home-based, stretching and strengthening program on shoulder
pain in 42 wheelchair users (35 with SCI). After study completion,
subjects reported a 40% reduction in pain compared with 2% for controls.
In 2003, Dr Audrey
Hicks and colleagues (Ontario) evaluated the influence of a
nine-month exercise program on a variety of factors, including pain, in
34 individuals with SCI. Subjects were randomized either into a group
participating in a twice weekly exercise program that involved both arm
ergometry (i.e., cranking) and resistance training (i.e.,
weightlifting), or a control group offering bimonthly education session
on topics like exercise physiology, osteoporosis, and relaxation
techniques. Upon study completion, exercisers reported a modest
reduction in pain while controls reported an increase.
In 2006, Dr.
Deborah Nawoczenki and colleagues (New York) evaluated the benefits
of an eight-week strengthening and stretching exercise program on
existing shoulder pain in 21 manual wheelchair users with mostly SCI.
Shoulder pain was significantly reduced after completion of the program.
In 2007, Dr. Mark
Nash et al (Florida) examined the effects of circuit-resistance
training on muscle strength, endurance, and shoulder
pain in seven men with paraplegia. The program consisted of training
three times weekly for 16 weeks with resistance and endurance
(arm-cranking) training. Shoulder pain decreased substantially by the
end of the study.
In 2011, Dr. Sara
Mulroy’s team (California) evaluated the effectiveness of an
exercise intervention on shoulder pain in 80 manual wheelchair users
with SCI. Subjects were randomized to either a 12-week home-based
program of shoulder strengthening and stretching exercises together with
strategies on how to optimize transfers, raises, and wheelchair
propulsion; or a control group, which saw an instructional video
reviewing shoulder anatomy, mechanisms of injury, and concepts in
managing shoulder pain.
As with the other studies, pain decreased substantially in the
exercisers after finishing the program, a decline that persisted four
weeks later. No change was noted in controls.
In 2012, Dr.
Cecilia Norbrink and associates (Sweden) measured the benefits of an
exercise program on both musculoskeletal and neuropathic pain in
eight subjects with SCI. Subjects exercised with a double-poling
ergometer adapted for persons with lower extremity impairments three
times a week for 10 weeks. For the subjects with neuropathic pain,
average pain decreased 40%. For those
with musculoskeletal pain, pain virtually dissipated; all but one had no
musculoskeletal pain at the end of the study; and the number of days per
week with pain declined from an average of 5.5 to 0.7 days.
It is not especially
surprising that exercise has the potential to reduce musculoskeletal
pain through, for example, the strengthening and balancing of key
muscles. However, because neuropathic pain is physiologically a totally
different ballgame, the results are quite significant. The investigators
noted that the impact of the exercise program on neuropathic pain is
comparable to many of the drugs studied for treating neuropathic pain.
Conclusion
There are no magic
bullets when it comes to SCI pain. Commonly prescribed pain-killing
drugs often have only marginal long-term effectiveness and are laden
with adverse side effects, but, nevertheless, seem relatively innocuous
compared to some of the nerve-destroying surgeries that have been used
in the past. Exercise is also no magic bullet, but studies suggest it,
indeed, helps and without significant side effects. For individuals with
SCI, perhaps the workout maxim “no pain, no gain” is less apropos than
“you gain no pain” by exercising.
Adapted from article
appearing in April 2013 Paraplegia News (For subscriptions, call
602-224-0500) or go to
www.pn-magazine.com.
TOP
