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Fresh after injury, all the new things to remember, and habits to build, can be exhausting and daunting.
However, building strong habits is paramount. Unfortunately, small problems can quickly turn into life threatening situations. Being proactive and taking preventative measures against secondary complications is essential to long term health. It may seem like a million things to remember and plan for in the beginning. It also may be physically and mentally exhausting as well. Some days it literally feels like a full time job. Be kind to yourself, and take things one step at a time. It will get easier and more automatic overtime. I promise.
Pease note, I am not a medical professional and this is not intended to replace the advice of qualified health professionals. I just wanted to provide an informative oversight regarding healthy habits when living with a spinal cord injury. Always listen to your body and be mindful, what’s right for one person may not be right for another.
There are many secondary complications that come along with having a spinal cord injury. Thankfully many serious issues can be avoided by being proactive about health. Here is a list of good habits to work into your routine to ensure many happy and healthy years ahead:
Pressure Reliefs- Pressure reliefs help prevent pressure sores, by taking pressure off of contact points in order to promote tissue health and blood-flow. It is essential to stick to a reliable pressure relief schedule. It is recommend you do a 3 minute pressure relief every 30 minutes, or 1min every 10 minutes. This can be done by pushing up on your arm rest or wheels. By leaning forward to take pressure off of the coccyx area. Or alternately, by changing your sitting position (such as crossing a leg or sitting cross legged).
Skin Checks- Skin checks can be done the old-school way with a mirror. Or the modernized way, by using a camera to take a picture of the area. It can be tedious and time consuming. However, it is important to perform at least one skin check per day. Especially on sensitive areas, such as the coccyx, tailbone, hip and sitting bones. Lack of muscle for padding; as well as, increased pressure from sitting all day can cause the skin to weaken in these areas. This in turn can make you more susceptible to forming pressure sores. If caught early with a skin check it can heal on its own. If it is not caught early it may be necessary to have surgery; or be on bed rest for up to a year in order to give it time to heal.
Keeping Skin Dry- When the skin is kept dry and clean, skin breakdown and pressure ulcers are less likely to form. It is important to wear breathable or moisture wicking clothing.
Clean Catheterization Techniques- Usually bacteria in the urinary tract is flushed out during urination. However, when using a catheter bacteria can potentially be pushed into the bladder and cause colonization or lead to infection. It may seen counter-intuitive, but “clean” catheterization (soap and water or baby wipes) is advantageous to sterile catheterization (iodine wipes or alcohol wipes) in a home setting. This is because to allows “good bacteria” to survive and help prevent infection.
Good Personal Hygiene – Frequent showers, fresh clothes and a clean seat cushion go a long way towards both looking good and feeling good.
Exercise/Cardio Routine- Maintaining cardiovascular health is crucial when living with a spinal cord injury. It is more challenging finding appropriate cardio activities versus someone with working legs. Some popular activities include: handcycles or table top hand cycles, weighted cordless skipping ropes, boxing with light weights, going for a stroll around the neighbourhood, or using fitness machines such as the skierg or vitaglide. The key is finding something you enjoy, and switching it up from time to time to cross train your muscles. Always remember to stretch out afterwards and don’t over exert yourself when you are starting out.
Proper Pushing Technique- Proper and mindful pushing can go a long way in maintaining healthy shoulders. Make a conscious effort to always grab the wheel as far back as you can and perform a wide arc all the way forward, allowing yourself to glide and coast between pushes, rather than multiple small quick pushes. It can also be helpful to use objects in your environment to pull or push yourself along. This uses different muscle groups and switches it up from repetitive pushing motions.
Good Transfer Techniques (no muscle strain, proper angle, avoiding wheel) – It can be tempting to just muscle through when performing a transfer. However, improper technique can catch up to you overtime and lead to injury. Take your time and line up your chair properly, and use a sliding board to make your transfer easier. Be extremely mindful not to hit your hips or sit bones on your wheel when transferring, overtime this can lead to skin breakdown and pressure ulcers forming.
Using Helpful Adaptive Devices to Make Your Life Easier- There is nothing wrong or embarrassing about using equipment to make your life easier. Grab rails can provide support and leverage. Sliding boards can make transfers smoother, and adjustable beds can assist you in sitting up. There is no sense sacrificing your long term body integrity by powering through everything just to prove that you can. It is certainly helpful to know you don’t NEED it in an emergency or an unfamiliar situation, but there is no harm in using tools that make your life easier.
Stretching Upper Body- Overuse of the upper body can lead to tension and pain. It is crucial to develop a comprehensive stretching routine that is implemented every day. It is also good to get into the habit of stretching in 2-5 minute intervals when you have spare time throughout the day.
Stretching Lower Body – The lower body can become stiff from prolonged periods sitting. In addition, you may experience tightness due to muscle atrophy and ligament shortening. It is important to stretch out the legs and sit in different positions throughout the day. It can also help relieve spasms and nerve pain for some people.
Laying on Stomach- This is a great stretch for the hip flexors and abs. In addition, it allows pressure relief off of the backside of the body. If comfortable it can be a great position to sleep overnight to give your back and butt a break.
Drinking lots of Water – It can be stressful drinking large quantities of water when dealing with a neurogenic bladder and potential incontinence. But proper fluid intake is essential in diluting and flushing the bladder clean of bacteria. It can be helpful to drink large quantities in the morning to hydrate for the day and nourish the organs with water for optimal function.
Healthy Balanced Diet- When dealing with muscle atrophy and loss of motor function caloric requirements are generally lower. Many people experience a decreased appetite as a response. It is important to eat a healthy diet with plenty of fiber for good digestive health. Eating a lot of processed foods and sugar can increase instances of nerve pain and can lead to more frequent UTIs. It can also be more difficult to perform transfers and may cause upper body injury with increased weight to move around.
Wheelchair Maintenance – Your wheelchair becomes your legs and sense of mobility. Without a proper functioning wheelchair you are essentially bed bound. It is important to keep your wheelchair tuned up, not only will it allow you to get out and about, if your chair happens to break while you are in it could lead to serious injuries. It is also helpful to have a tire repair kit on-hand in the event of a punctured tire, you won’t be stranded.
Standing Therapy (with leg braces or standing frame) – Standing can help stretch out the leg muscles and hip flexors. It is also important to provide weight bearing through the legs and the feet to help maintain bone density. As well as, taking pressure off of the butt and hip area from sitting for prolonged periods. Standing is also important to help improve digestion and circulation.
Proper Seating/Cushion- A proper seating assessment is critical for long-term skin health and posture. If possible it is best to arrange a pressure mapping appointment with a physiotherapist. This provides a visual representation of areas that may be prone to pressure sores overtime and it allows you to see any hot spots. A proper cushion gives you extra insurance against pressure ulcers, but it is still important to get into the habit of performing pressure reliefs.
Prioritizing Your Mental Health- There always seems like there are a million things to plan for and consider while living with a spinal cord injury. It can be easy to spiral into anxious though patterns when worrying about the future, and feeling regret or remorse about the past. It is important to make space for any emotions that come up. Make space to grieve your old life. Focus on what self-care looks like for you. Whether it be spending some time with friend or in nature, a spa day, or doing some arts and crafts. Give yourself to refresh and recharge. Focus on activities you can do and enjoy rather than reminiscing about things you used to do.
Support System (aka your wheelie peeps) – Spinal cord injuries can be devastating and isolating, physically and mentally. It can be extremely beneficial to join spinal cord injury peer groups either in person or online. It is great to have a network of people who really “get it” and allow you to vent with a sense of solidarity. There are often local groups such as Spinal Cord Injury Alberta, for example. There are also many Facebook groups online that allow people to connect all over the world. Popular groups include: Spinal Cord Injury Rehabilitation & Recovery and Virtual Peers for Paras and Quads.
Annual Checkups – Nobody loves going to the doctors, especially after living in the hospital for a period of a few months. But it is important to stay on top of your annual checkups and address any small concerns before they snowball into major problems.
Massage- Massage is great for relieving stress from over worked upper body muscles. It is also beneficial for promoting circulation, lowering blood pressure and promoting relaxation.
Acupuncture – Acupuncture uses extremely thin needles positioned along the energy lines of the body. It can be beneficial for relieving nerve pain for some. As well as, increasing energy levels and promoting a sense of balance within the body.
FES/TENS Treatments – These treatments use electrostimulation in order to engage and relax muscles. There are portable TENS units that can be used at home or on the go. While, FES or functional electrostimulation combines the stim with functional movement, such as cycling in order to strengthen muscles and retrain the nervous system.
Compression Socks and Elevation for Swollen Legs and Feet – Fluid builds up in the lower extremities over the day thanks to gravity. Without the leg muscles contracting and helping to pump the blood back to the heart, feet and ankles tend to swell up throughout the day. To help counteract the swelling it can be helpful to wear compression socks or leggings. As well as, elevating your feet periodically throughout the day.
Rehabilitation and Physical Therapy – Recovery is a slow process with spinal cord injuries. There are plateaus and backtracks, but it is important to put in the work and see what the body is capable of. Consistency and repetition is key.
Breathing Exercises for Healthy Lungs- The diaphragm muscle regulates breathing and can be affected by higher level spinal cord injuries. This can lead to difficulties breathing or coughing, and a ventilator may be required in some cases. Performing daily deep breathing exercises can help strengthen these muscles, as well as provide a calming stimuli for the parasympathetic nervous system, to relax.
Mindfulness/Listening to Your Body- Your body is still trying to communicate with you, but the signals get lost along the way if the pathway along the spinal cord is damaged. Pay attention to auxiliary signals that arise and learn to decode these new more subtle signals your body is sending. Making sure your body temperature isn’t too hot or cold. As well as, making sure your body is in a comfortable position and that your bladder isn’t uncomfortably full.
Mediation/Rest– It is important to give your body time to rest and readjust. You have limited energy stores that need to be replenished. Life can feel like it’s go go go all of the time. There is just as much benefit to slowing down as there is in being perpetually busy. Your body and mind need time to recoup. Meditation is a great practice to just learn how to “be.”
The best thing you can do when living with a spinal cord injury is form good habits and routines to maintain your health long-term. Not letting complications snowball over time and addressing small problems before they become potentially fatal conditions.
That being said you cannot control everything or avoid complications completely… such is the joy of living with a spinal cord injury. Just do the best you can, with what you can, and try not to waste precious energy worrying about something until you have to deal with it.
