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Thread: core strengthening for person with C5-C6 injury

  1. #1

    core strengthening for person with C5-C6 injury

    If any of you "hard core" exercisers and recoverers can help me with this question it would be much appreciated. My 21 year old son (injured nearly three years ago) has had a slow but encouraging recovery. He has weak triceps and quite good wrist extension/flexion as well as enough finger / palmar function to eat with a large handled fork and drink grasping a small water bottle. One very positive thing is that he has quite a lot of leg function -- more on the left than on the right. Since about one year after injury he has been doing partial weight supported gait training (suspended from a ceiling hoist while in rehab hospital, and using a mobile hoist with a special arm and sling now that he is at home). It was very slow at first -- up until three months ago the most he could do was about five or six independent steps with the left leg in a 30 minute session. Now he does this training four times a week for an hour and "walks" as far as 400 metres, moving the left leg independently and needing assistance with the right. We do this with him at home, and he also goes to physiotherapy at a hospital three times a week. The therapists there emphasise that in order to walk independently he must strengthen his core muscles. We are having him do kneeling exercises as well as reaching from a sitting position. My question: with a C5-C6 injury, which of the "core" muscles can be expected to be still active or recoverable? Any suggestions for other ways to strengthen these? As incomplete injuries are all different, this question may be impossible to answer, but I'd appreciate anything you can tell me about your own experience. Here's a link to a video of David "walking.'

  2. #2
    If you look at the body and how it works, core strength will come from larger muscle groups. Your lats, for example are fairly long and attach at the top of the back (or under the arm) and connect again at the hips. If you (he) can do an independent lift in his chair, getting the butt free from the cushion (like a pressure relief) he can learn to swing his hips using only his lats. Also, putting himself in positions that may feel 'unsafe' and using his body to compensate. Wheelchair sports are awesome for this type of strengthening. Skiing, tennis, rugby (for C 5/6), and anything that will put him in a posture to learn how to maximize what function does remain. One question you have to answer is how functional is the walking, or how practical? The walking is great and he should take advantage of every opportunity to be upright, but perhaps it is more of an exercise than trying to do it as a primary form of mobility. I have known many 'quads' that will walk to load their chair into the car or truck, and lean against the vehicle in order to reach the drivers seat. Recovery of muscles will take place over the first 12-18 months, what function you have after this time is going to be what can be built on. This is obviously not true for every case, but averages of return post-injury tend to occur with in this window of time. Hope this helps. Looking forward to seeing some progress!
    SCI Boot Camp

  3. #3

    It is encouraging to hear about your son's progress. From your description I would encourage you to tackle his core musculature (abdominals, obliques, spinal erectors, etc.) as much as possible. I would disagree with SCI Boot Camp that whatever function you have after 12-18 months is all that can be built on, as I have seen 100s of SCIs in my 13 years at Project Walk regain muscle function they did not have well past the 2 year mark.

    If you go to our YouTube Channel you will see 100s of videos of our clients exercising. Most will have some sort of core strengthening exercises in them. Your son will probably need assistance with many of them. The simplest exercise I could suggest would be to have your son lay on his back with his legs spread in a V. The assistant then sits between his legs facing him with their legs in a V over the top of his. The assistant will then grab your son's hands or wrists and have him try to engage his abdominals and crunch up, the assistant will help him sit up all of the way. It is important here to make sure your son keeps his arms straight and does not perform a "bicep curl" to sit up. Once he is sitting up you can have him do the reverse and resist the assistant pushing him back down toward the floor.

    Hope this helps!

    Eric Harness, CSCS
    Neuro Ex, Inc
    Adaptive Performance and Neuro Recovery

  4. #4
    Thank you both for your suggestions. Eric, David has had the good fortune to work (briefly) with two PW therapists who were in Hong Kong for short periods. One is still here and will be doing a few more sessions with David over the next two weeks. He is very much focusing on David's core muscles. I was wondering if switching from the partially weight supported gait training (where the person is held in a sling from above, as you can see in the video) to more of a weight bearing set-up with a walker (something like the Gait Harness System by Second Step looks like the safest type of walker) might in itself help to recruit and strengthen the core muscles. What do you think?

  5. #5
    Snow, I understand you cannot discount anything, but lets not lose sight of the realities of the injury. If David can stand and move freely, independently and safely in an upright position, then yes, do it. Would never discount what is possible or what I have seen. I cannot and would never assume to know or understand someone else's situation or down play the desire to get back what has gone missing due to a compromised cord. PW has done some good for a lot of people, but for how long must the therapy continue and to what end? 100% return is a fleeting dream and still a long way off in both science and therapy. Get back and use what is available to you, and live your life, today, while its still here.
    I am not a CSCS or a CSRS, I do not work in research and development. But after 21 years of living the life, I can say that there is no substitute for being content in all things, being grateful for all things. Build bridges for canyons to come rather than rebuilding the ones that are in the rear view.
    SCI Boot Camp

  6. #6
    try to incorporate compound strength training to his regimen. all compound exercises will build core muscles (over head press, bench press, squat, dead lift). have him start with a weighted bar until he feels comfortable doing these movements then slowly add resistance.

    Personally, these types of exercises have helped me far more than any aerobic/cardiovascular exercise in terms of improved circulation, sensation, mood, and overall health.

  7. #7
    Thanks Exumer. Can you tell me where I can go to find out how to make these exercises possible for someone with a C5/C6 injury? What kinds of aids / accessories are needed? Anything on YouTube showing these exercises being done by someone with a spinal injury?

  8. #8
    how strong are his core muscles now? can he sit up unassisted? does he have standing braces? If he can at least sit up, he can do an over head press movement. this will engage the shoulders and the core for stabilization. have the bar rest at shoulder height then press upwards til the arms are fully extended. focus on having him squeeze his ab muscles as he performs the exercise. if resistance is fairly light, he can repeat this for 10-12 repetitions then take a 60 second break and repeat for no more than 3 sets.

    he can also try performing a pull up. this is a very simple movement where he pulls himself up until his nose or chin is in level with the bar. this movement forces your core muscles to contract to keep the body stable throughout the movement. this is very taxing on your abs if you do not use them regularly so he might be sore the next day.

    of course this is just my personal opinion/experience on how to improve core strength. you might want to run this by his PT before actually starting anything new.

  9. #9
    SCI Boot Camp
    I am not discounting your experience living with SCI at all and I would agree with most of your last post, especially:
    "But after 21 years of living the life, I can say that there is no substitute for being content in all things, being grateful for all things. Build bridges for canyons to come rather than rebuilding the ones that are in the rear view."

    But as for:
    "How long must the therapy last and to what end? 100% return is a fleeting dream..."
    I would say it is a life long journey to recover or maintain function. If you stop exercising as an able body you begin to lose function, gain weight, lose bone density, etc. To what end? Staying healthy, maintaining or gaining function are to great ends IMO.We never guarantee return, but if you don't try it will never happen. 100% return is very rare, even the people we have been able to help run and jump again still have some deficits. However, if someone is able to get his core function back, even a tiny bit, think of the benefits. He will have better posture, reducing the risk of shoulder injury from pushing. He will be able to reach for things without having to worry about falling out of his chair. He will be able to transfer better...etc. These core strengthening exercises can be done at home and really do not require any specialized equipment, other than someone to assist you.

    As a C5/6 injury those compound exercises may be too advanced for him, especially considering his stated lack of core strength. His mother did say his upper body was more affected than his lower, so that probably means he has limited arm movement which would further reduce the probability of performing compound exercises successfully. With these two probable deficits, compund exercises would greatly increase the risk of injury due to poor technique and posture. Peforming exercises strictly focusing on the core musculature would greatly enhance his ability to actually contract these muscles in the proper position without increased risk of injury.

    Eric Harness, CSCS
    Neuro Ex, Inc
    Adaptive Performance and Neuro Recovery

  10. #10

    After watching the video and not really having the ability here to determine his leg strength etc, walking that way is probably the best option. It looks like his left leg may hyperextend if loaded further. I would suggest trying to strengthen the hamstring on that side. If you are looking to increase load bearing while standing/walking he may need a knee brace on that side.

    Eric Harness, CSCS
    Neuro Ex, Inc
    Adaptive Performance and Neuro Recovery

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