When you’re feeling thirsty, which beverage do you typically go for in the kitchen? Juice, soda, a sports drink? Hopefully you decide to grab some water every now and then. It’s well known that water is the healthiest option for beverages, but most people still choose to go for the sugary drinks or higher calorie drinks because of the flavor. There are so many benefits of drinking water, but I will break them down to only five main benefits. Drinking the appropriate amount of water for your body helps with maintaining the proper balance of body fluids, maintaining efficient blood flow, maintaining normal bowel function, protecting our joints, and improving kidney function.
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Reading and understanding the nutrition labels of food is key to understanding the food you are eating! Trying to decipher the numbers on the nutrition label can be challenging here is where we recommend starting! Here is our ATP cheat sheet for understanding nutrition labels.
Start with the Serving Size
Cheat words and their meanings to look for on the labels!
Have you ever heard somebody talking about range of motion? Maybe you have, but what exactly is it? Range of motion (ROM) is the full movement potential of a joint, usually its range of flexion and extension. It is measured in degree of a circle and can be classified as active, passive, or a combination of both. To measure an individuals’ ROM, there are several devices that can be used. A Goniometer and an Inclinometer have a stationary arm, a protractor, fulcrum, and a movement arm to help measure the angle from the axis of the joint. For ROM in other parts of the body, it can be appropriate to use a tape measure.  If not kept, your ROM could potentially become limited which can cause problems down the road. Limited range of motion occurs when a joint has a decrease in its ability to move. This may happen due to a problem within the joint, swelling of the tissue surrounding the joint, stiffness of the muscles, or pain. To keep your ROM, it is important to perform range of motion exercises to improve/maintain the movements of your joints. The motion of moving your joints is determined by the shape of bone surfaces within the joint, the joint capsule, ligaments, tendons, and muscles that are acting on the joint.
The 3 types of ROM exercises include: Passive Active Active assistive What is passive ROM? Passive range of motion is the movement that is applied to a joint by another individual or a passive motion machine. When this range of motion is used, the joint of the individual completing the exercise is relaxed while another force moves the body part through the range. Ex: Lying hamstring stretch with help of another individual What is active ROM? Active range of motion is when the movement of a joint is applied by the individual who is performing the exercise themselves. There is no outside force here to help. Ex: Head tilts, forward and backward while sitting in chair What about active assisted ROM? This occurs when a joint gets only some help or assistance from an outside force. This ROM can result from the majority of motion that is applied by another individual or by the person who is exercising. Ex: Shoulder internal rotation with towel References: Range of Motion. Physiopedia. https://www.physio-pedia.com/Range_of_Motion. Accessed March 8, 2021. Most Americans can identify the benefits of being physically active but a far fewer people can identify the negative risks associated with being sedentary. These are extremely important, but as most of us have been cooped up in the house over the past year, we have been more sedentary than ever. Being sedentary is defined as lying or sitting and completing very minimal strenuous physical activity, in which heart rate is close to true resting measures, and the individual is relaxing their muscles. Sedentary behaviors include the typical behaviors individuals think about when being sedentary such as watching television, reading, or using a computer. Individuals often forget to include other sedentary behaviors such as their occupation if they do a lot of sitting, their commute to work, and even going out to dinner and sitting for a couple hours. As you add all of this total time up throughout the day, the average adult spends more time being sedentary then they will self report.
According to the World Health Organization, 65-75% of adults over the age of 55 do not complete an appropriate amount of physical activity throughout the day. To go along with this scary stat, over 60% of children and adolescents live a sedentary life. The number of adolescents and children being sedentary has risen in the previous 20 years and is projected to continue to increase over the next few decades. One is considered to live a “sedentary life” if they are not completing low to moderate physical activity for over 2 hours per day during their average day. This time can be added up throughout the day and the physical activity can be by design or achieved through activities of daily living. Being sedentary is associated with a vast number of health conditions, especially if an individual already has an existing health condition. To start, Coronary Artery Disease, Congestive Heart Disease, and certain types of cancers are primary health conditions that have been directly related to living a sedentary lifestyle. To go along with this, if an individual already has a health condition that limits their functional abilities, living a sedentary lifestyle have a much greater risk of developing diabetes, becoming oibese, and having some vascular concerns. As levels of physical activity increases, the risk of developing one of these primary or associated health conditions decreases, especially when paired with proper nutrition. Unfortunately, Americans are now more sedentary than ever before. As the COVID-19 pandemic has changed our world, it has also been attributed to decreasing physical activity levels, resulting in even heightened sedentary behaviors. Recent research has stated that level of exercise has decreased but only slightly since the start of the pandemic. Unfortunately, the number of individuals living a sedentary lifestyle has increased by what some researchers believe to be an additional 10% to the already high numbers of 65%75%. These stats are extremely eye opening, especially with how many individuals were sedentary before the pandemic. Trekking Poles |
 |  |
Posture: elbows bent at 90 degrees
- If muscle soreness begins to occur in the upper body, take one of the trekking poles and grab it with both hands shoulder width apart. Raise the pole as high as you can above your head and stretch the low back and shoulders.
- If muscle soreness begins to occur in the lower body, take a pole and stretch it across your back and shoulders. Keep your legs straight, bending at the hips, moving your chest towards the ground. As you move lower, you will feel a stretch in the back of your legs and through your low back!
Staying Active with MS
Multiple sclerosis (MS) is a chronic disease of the brain and spinal cord, which is also known as the central nervous system. In MS, the immune system attacks the protective sheath that covers your nerve fibers and results in problems with communication between your brain and the rest of your body. This disease can cause permanent damage to your nerves.
For individuals with MS, staying active is one of the most important things you can do. Exercise can help to improve symptoms, as well as improve fitness, endurance, and strength in your arms and legs. Studies have also shown that exercising can improve:
The best exercises for individuals with MS
The best MS exercises to stay active are aerobic exercises, stretching, and progressive strength training. It is also important to warm up before beginning exercise--- this can include something as simple as walking or even cycling on a stationary bike!
https://www.yogajournal.com/practice/5-yoga-poses-for-people-with-multiple-sclerosis/
Tips for a great workout!
References:
Multiple Sclerosis and Exercise: Why MS Patients Should Stay Active. Penn Medicine. https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2017/may/multiple-sclerosis-and-exercise#:~:text=When%20you%20have%20MS%20and,give%20your%20mood%20a%20boost. Published May 1, 2017. Accessed February 15, 2021.
Multiple sclerosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269. Published June 12, 2020. Accessed February 15, 2021.
Exercise. National Multiple Sclerosis Society. https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Exercise. Accessed February 15, 2021.
For individuals with MS, staying active is one of the most important things you can do. Exercise can help to improve symptoms, as well as improve fitness, endurance, and strength in your arms and legs. Studies have also shown that exercising can improve:
- Cardiovascular fitness
- Strength
- Bladder and bowel function
- Decreasing overall fatigue
- Mood
- Cognitive function
- Bone density
- Flexibility
The best exercises for individuals with MS
The best MS exercises to stay active are aerobic exercises, stretching, and progressive strength training. It is also important to warm up before beginning exercise--- this can include something as simple as walking or even cycling on a stationary bike!
- Aerobic exercises:
- Stretching:
https://www.yogajournal.com/practice/5-yoga-poses-for-people-with-multiple-sclerosis/
- Strength Training:
Tips for a great workout!
- Make sure to stay hydrated- this will help to keep your body temperature low!
- Exercise in a space that is cooler and won’t cause you to overheat!
- Stretch after your workout too!
- Start at low intensity/weight, and go slow!
- Talk with your doctor before you start a new exercise program!!
References:
Multiple Sclerosis and Exercise: Why MS Patients Should Stay Active. Penn Medicine. https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2017/may/multiple-sclerosis-and-exercise#:~:text=When%20you%20have%20MS%20and,give%20your%20mood%20a%20boost. Published May 1, 2017. Accessed February 15, 2021.
Multiple sclerosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269. Published June 12, 2020. Accessed February 15, 2021.
Exercise. National Multiple Sclerosis Society. https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Exercise. Accessed February 15, 2021.
Physiology of disability
When thinking about the human body, the spinal cord can be thought of as the control tower of all movements. Without proper spinal cord function, movements can be limited, impaired, or nonexistent. A Spinal Cord Injury (SCI) occurs when a portion or all of the spinal cord or nerve endings of the spinal cord are damaged. The impact of the impairment is dependent on a number of factors including location of damage along the spinal cord, degree of damage done to the spinal cord, and specific nerves that were damaged along the spinal cord.
Most human movements would not be possible without the spinal cord. The brain and the spinal cord are considered part of the Central Nervous System (CNS) and work together to receive sensory information from the Peripheral Nervous System (PNS). The PNS is comprised of nerves that run off of the spinal cord between each vertebrae that receive specific sensory information through muscle spindles within the muscle, the golgi-tendon organs which receives input regarding tension from the body’s tendons, and dermatomes which are nerve endings that receive input regarding pressure from the body’s skin. These components of the PNS work together to relay sensory information to the CNS. With this sensory information from the PNS, the CNS is able to sort the sensory information into purposeful impulses which are relayed down the spinal cord to the PNS. When the PNS receives this impulse form the CNS, muscular contraction (tightening or shortening of the muscle) occurs.
To create a muscular contraction within a motor unit (muscle fibers belonging to a singular motor neuron) the CNS and PNS are needed. The CNS sends an electrical impulse to the PNS, the PNS then transitions the electrical impulse to an action potential (AP). An action potential is the chemical signal that runs through the muscle fiber of the motor unit where the electrical activity changes within a muscle causing contraction. Without the impulse successfully passing between the CNS and PNS, muscular contraction would not occur. This is called the All-Or-None principle in which a muscle fiber contracts at full strength, or does not contract at all. When damage is done along the spinal cord, the PNS is unable to receive information from the CNS and therefore muscular contraction at and below the level of injury is unlikely to occur. However, the location of injury and severity of injury determine how well the PNS and CNS communicate.
Location and severity are two critical factors when assessing an individual with a spinal cord injury and their functional ability levels. The location of the injury determines where the break in CNS and PNS communication will occur along their spinal cord. The signal from the CNS is unable to continue to travel down the CNS at the point of injury. Therefore the PNS will receive no impulse from the CNS. Without this input from the CNS, the PNS is unable to create muscular contraction. In complete spinal cord injuries 90% or more is damaged at the site of injury. If less than 90% of the spinal cord is damaged it is considered to be an incomplete spinal cord injury. Generally speaking, if an individual obtained an upper level spinal cord injury (Cervical, and upper Thoracic region), then all muscle fibers from that point of injury and below are damaged. When injuries occur to the spinal cord below the level of T2 then the individual is considered to be a paraplegic (having full arm function). When the injury to the spinal cord is at or above T2 then the individual is classified as a quadriplegic (decreased function ability of arms, trunk, and legs).
Some key locations of spinal cord injuries include the following:
● C1-C4 location: may require a ventilator, have paralysis of arms, hands, legs, and trunk
● C5 location: individual has control of shoulders and biceps, but not hand or wrist
● C6 level: wrist control but no hand function, wrist extension is easier than wrist flexion
● C7 & T1 location : may have some control of hands, no thermoregulation homeostasis (inability to regulate body temperature)loss of bladder and bowel control
● T-2 location: full function of arms and hands, with mild trunk control
● T2-T5 location: have use of Quadratus Lumborum (can be used to aid in hip flexion)
● T6-T12 location: more use of back extensors and abdominal control, good balance in unsupported stated position, and may have ability to stand with adaptive equipment
● C1-T12 locations: loss of bladder and bowel control
● L1-L5 location: impairment in hip and knee flexion and extension, very limited impairment in trunk control
● S1-S5 location: less impairment in hip and knee flexion and extension, can typically stand with adaptive equipment, little to no impairment in trunk stability
Physiology of intervention
The location of spinal cord injury directly impacts if a muscle fiber is able to contract. To create preferred movements, multiple muscles have to work together (coordinated flexion and elongation). For any specific movement, the body will use muscles as agonists, which contract to complete a majority of the desired movement. The antagonist muscles elongate in opposition to the agonist muscle during a
desired movement. If the coordination of the agonist and antagonist muscles does not occur, the desired movement will not be completed or will be completed poorly. The synergist muscles help to stabilize and assist the agonist during a desired movement. With proper spinal cord function, the agonist and synergists muscles contract while the antagonist muscles elongate to create the desired movements. It is crucial to work the synergistic muscles in individuals with SCI to increase their stabilizing strength.
In addition to working on muscular strength and muscular endurance stabilizing strength is important to incorporate in exercise prescriptions (ExRx) of a person with a SCI. This is due largely to the fact that these individuals have a decreased ability level within their stabilizing muscles, therefore it is important to attempt to work as many stabilizing exercises into their prescription as possible. People with SCI are often in wheelchairs that provide them with stabilization through the back, arms, and foot plates of their wheelchair. Some activities of daily living (ADLs) can be completed from this position however, others require that an individual has more degrees of freedom to complete the ADL. For example, reaching forward to open a drawer to get out a utensil requires additional stabilizing strength. A person who has worked on their stabilizer muscles in an exercise setting will be more successful in completing these ADLs outside of the exercise setting. To incorporate stabilizer muscles into the exercises of a person with a SCI they can complete exercises from a mat table that does not provide them with the known stability of their wheelchair, thus causing their stabilizing muscles to engage and work harder during exercises (even if these exercises are not stabilizer focused). Engagement of the stabilizer muscles can also be achieved through body weight exercises and the use of adaptive equipment. Purposefully targeting core stabilizers can be achieved through crawling movement patterns. When crawling, one must use stabilization strength in order to transfer weight onto one side of the body while attempting to recruit additional muscles to flex at the hip allowing forward movement on the no weight bearing leg. When one hip moves forward, the body must regain balance with a change in the center of gravity; actions completed by core stabilizing muscles. In addition to the benefits of core stabilization that occurs during exercise, the individual is working to prevent further loss of bone density and creating purposeful compensatory mechanisms.
Physiology of our program
A worthwhile exercise program for this population group applies principles and concepts of exercise to individuals with SCIs in a safe, effective, and meaningful way. Through modification and adaptation to exercises one can challenge an individual with a SCI consequently improving their quality of life.
A successful way to challenge the body and modify an exercise is to change the leverage angle (LA) at which the exercise is performed. This will change the difficulty or ease at which the exercise is completed. By changing the LA, the agonist is able to remain the targeted muscle due to the fact that a decreased force is needed to complete the desired movement. For example, changing the LA of a pushup for an individual with a mid to lower level SCI they will be able to complete the exercise with proper form and full range of motion (ROM). Once an individual can complete several pushups at a specific LA, it is appropriate to decrease the LA of the pushup. The lower the LA, the greater force required to complete the pushup. The goal of changing LA is to continue to challenge an individual in a safe and effective manner, working towards the completion of a push up with proper form and full ROM at the lowest LA achievable for the individual’s location of injury.
A specific principle needed when working with an individual with a spinal cord injury is the use of the stretch-shortening cycle. The stretch-shortening cycle (SSC) occurs when a muscle is stretched / elongated, the receptors in the attached tendons send a reflex to the attached muscle to contract, in order to prevent injury. SSC is used in all ballistic movements. The body of someone with a SCI still possesses reflexes, making the use of incorporating exercises that utilize the SSC critical in their ExRx. Applying the SSC to an individual's ExRx can be achieved through exercises that force muscles to stretch/elongate in order to promote muscular contraction. A successful application of this principle is through bounce squats. *Please note that these need to be conducted in a safe manner for the individual with a SCI, meaning a variety of modifications may be necessary (ie. harness, resistance bands, personal lifts, hand support, etc.).* When completing a bounce squat, the quadriceps muscles are elongated/ stretched. Due to this stretching, receptors in the Patella Tendon send a reflex to the quadricep muscle causing contraction. Progression in this exercise is achieved by decreasing the resistance (unloading force) support needed. When working with an individual with a SCI, it is necessary to decrease the amount of assistance during a weight bearing exercise, rather than increasing the output required to complete the exercise. This is largely due to the fact that the CNS and PNS are still not communicating, instead we are focusing on the use of reflexes present in the body to complete the desired movement.
Compensatory mechanisms can be a beneficial concept to understand the application of when writing an ExRx for someone with a SCI. This concept states that the body will overachieve in one area to compensate for failures in another. For example, the Quadratus Lumborum is typically used as a back extensor muscle, however someone with a SCI is able to use it to aid in hip flexion. The ability to engage in assisted ‘hip flexion’ can be utilized in crawling or walking with assistive devices.
The intersection of all of these concepts is through walking with the support of assistive devices. For example, an individual with SCI would be able to stand from their chair (SSC), then utilize their triceps to decrease the weight through their lower body (changing LA), then incorporate stabilizing strength to stand in the assistive device, then must incorporate other supporting muscles such as the Quadratus Lumborum to use during hip flexion, and once progress is made, the amount of support from an assistive device can be decreased.
Client progress
When incorporating all of this information, great client success can be achieved with a lot of hard work, determination, and skilled exercise physiologists to create and modify the ExRx. One individual with a lower level SCI that has been following an ExRx that hits all of the components of this article has been able to dramatically improve his quality of life. When starting this ExRx, this individual did not have the ability to walk. Through applying the concept of changing LA he increased his tricep strength. This tricep strength was achieved through completing pushups on his knees with his hands on a 12 inch plyometric box. Then progressed to being able to stand and complete push ups with his hand on a 36 inch plyometric box. After the physiological adaptations occurred and the LA of the box was decreased accordingly, the individual was able to successfully complete over 20 pushups with full range of motion with his feet on the ground and hands also on the ground. Through the focus of proper pushup form and progression, the individual with a SCI was working to improve his stabilization strength as well. By way of improved tricep and stabilizer strength he was able to stand upright inside of an assistive walking device (walker). He recruited other muscles in order to flex at the hip but also increased his quad strength through SSC by completing bounce squats consistently. Due to all of the hard work and physical adaptations, this same individual is now walking over 30 feet with no assistive devices other than an ankle brace.
Written by ATP's Jess Johnson & Matt Costa
When thinking about the human body, the spinal cord can be thought of as the control tower of all movements. Without proper spinal cord function, movements can be limited, impaired, or nonexistent. A Spinal Cord Injury (SCI) occurs when a portion or all of the spinal cord or nerve endings of the spinal cord are damaged. The impact of the impairment is dependent on a number of factors including location of damage along the spinal cord, degree of damage done to the spinal cord, and specific nerves that were damaged along the spinal cord.
Most human movements would not be possible without the spinal cord. The brain and the spinal cord are considered part of the Central Nervous System (CNS) and work together to receive sensory information from the Peripheral Nervous System (PNS). The PNS is comprised of nerves that run off of the spinal cord between each vertebrae that receive specific sensory information through muscle spindles within the muscle, the golgi-tendon organs which receives input regarding tension from the body’s tendons, and dermatomes which are nerve endings that receive input regarding pressure from the body’s skin. These components of the PNS work together to relay sensory information to the CNS. With this sensory information from the PNS, the CNS is able to sort the sensory information into purposeful impulses which are relayed down the spinal cord to the PNS. When the PNS receives this impulse form the CNS, muscular contraction (tightening or shortening of the muscle) occurs.
To create a muscular contraction within a motor unit (muscle fibers belonging to a singular motor neuron) the CNS and PNS are needed. The CNS sends an electrical impulse to the PNS, the PNS then transitions the electrical impulse to an action potential (AP). An action potential is the chemical signal that runs through the muscle fiber of the motor unit where the electrical activity changes within a muscle causing contraction. Without the impulse successfully passing between the CNS and PNS, muscular contraction would not occur. This is called the All-Or-None principle in which a muscle fiber contracts at full strength, or does not contract at all. When damage is done along the spinal cord, the PNS is unable to receive information from the CNS and therefore muscular contraction at and below the level of injury is unlikely to occur. However, the location of injury and severity of injury determine how well the PNS and CNS communicate.
Location and severity are two critical factors when assessing an individual with a spinal cord injury and their functional ability levels. The location of the injury determines where the break in CNS and PNS communication will occur along their spinal cord. The signal from the CNS is unable to continue to travel down the CNS at the point of injury. Therefore the PNS will receive no impulse from the CNS. Without this input from the CNS, the PNS is unable to create muscular contraction. In complete spinal cord injuries 90% or more is damaged at the site of injury. If less than 90% of the spinal cord is damaged it is considered to be an incomplete spinal cord injury. Generally speaking, if an individual obtained an upper level spinal cord injury (Cervical, and upper Thoracic region), then all muscle fibers from that point of injury and below are damaged. When injuries occur to the spinal cord below the level of T2 then the individual is considered to be a paraplegic (having full arm function). When the injury to the spinal cord is at or above T2 then the individual is classified as a quadriplegic (decreased function ability of arms, trunk, and legs).
Some key locations of spinal cord injuries include the following:
● C1-C4 location: may require a ventilator, have paralysis of arms, hands, legs, and trunk
● C5 location: individual has control of shoulders and biceps, but not hand or wrist
● C6 level: wrist control but no hand function, wrist extension is easier than wrist flexion
● C7 & T1 location : may have some control of hands, no thermoregulation homeostasis (inability to regulate body temperature)loss of bladder and bowel control
● T-2 location: full function of arms and hands, with mild trunk control
● T2-T5 location: have use of Quadratus Lumborum (can be used to aid in hip flexion)
● T6-T12 location: more use of back extensors and abdominal control, good balance in unsupported stated position, and may have ability to stand with adaptive equipment
● C1-T12 locations: loss of bladder and bowel control
● L1-L5 location: impairment in hip and knee flexion and extension, very limited impairment in trunk control
● S1-S5 location: less impairment in hip and knee flexion and extension, can typically stand with adaptive equipment, little to no impairment in trunk stability
Physiology of intervention
The location of spinal cord injury directly impacts if a muscle fiber is able to contract. To create preferred movements, multiple muscles have to work together (coordinated flexion and elongation). For any specific movement, the body will use muscles as agonists, which contract to complete a majority of the desired movement. The antagonist muscles elongate in opposition to the agonist muscle during a
desired movement. If the coordination of the agonist and antagonist muscles does not occur, the desired movement will not be completed or will be completed poorly. The synergist muscles help to stabilize and assist the agonist during a desired movement. With proper spinal cord function, the agonist and synergists muscles contract while the antagonist muscles elongate to create the desired movements. It is crucial to work the synergistic muscles in individuals with SCI to increase their stabilizing strength.
In addition to working on muscular strength and muscular endurance stabilizing strength is important to incorporate in exercise prescriptions (ExRx) of a person with a SCI. This is due largely to the fact that these individuals have a decreased ability level within their stabilizing muscles, therefore it is important to attempt to work as many stabilizing exercises into their prescription as possible. People with SCI are often in wheelchairs that provide them with stabilization through the back, arms, and foot plates of their wheelchair. Some activities of daily living (ADLs) can be completed from this position however, others require that an individual has more degrees of freedom to complete the ADL. For example, reaching forward to open a drawer to get out a utensil requires additional stabilizing strength. A person who has worked on their stabilizer muscles in an exercise setting will be more successful in completing these ADLs outside of the exercise setting. To incorporate stabilizer muscles into the exercises of a person with a SCI they can complete exercises from a mat table that does not provide them with the known stability of their wheelchair, thus causing their stabilizing muscles to engage and work harder during exercises (even if these exercises are not stabilizer focused). Engagement of the stabilizer muscles can also be achieved through body weight exercises and the use of adaptive equipment. Purposefully targeting core stabilizers can be achieved through crawling movement patterns. When crawling, one must use stabilization strength in order to transfer weight onto one side of the body while attempting to recruit additional muscles to flex at the hip allowing forward movement on the no weight bearing leg. When one hip moves forward, the body must regain balance with a change in the center of gravity; actions completed by core stabilizing muscles. In addition to the benefits of core stabilization that occurs during exercise, the individual is working to prevent further loss of bone density and creating purposeful compensatory mechanisms.
Physiology of our program
A worthwhile exercise program for this population group applies principles and concepts of exercise to individuals with SCIs in a safe, effective, and meaningful way. Through modification and adaptation to exercises one can challenge an individual with a SCI consequently improving their quality of life.
A successful way to challenge the body and modify an exercise is to change the leverage angle (LA) at which the exercise is performed. This will change the difficulty or ease at which the exercise is completed. By changing the LA, the agonist is able to remain the targeted muscle due to the fact that a decreased force is needed to complete the desired movement. For example, changing the LA of a pushup for an individual with a mid to lower level SCI they will be able to complete the exercise with proper form and full range of motion (ROM). Once an individual can complete several pushups at a specific LA, it is appropriate to decrease the LA of the pushup. The lower the LA, the greater force required to complete the pushup. The goal of changing LA is to continue to challenge an individual in a safe and effective manner, working towards the completion of a push up with proper form and full ROM at the lowest LA achievable for the individual’s location of injury.
A specific principle needed when working with an individual with a spinal cord injury is the use of the stretch-shortening cycle. The stretch-shortening cycle (SSC) occurs when a muscle is stretched / elongated, the receptors in the attached tendons send a reflex to the attached muscle to contract, in order to prevent injury. SSC is used in all ballistic movements. The body of someone with a SCI still possesses reflexes, making the use of incorporating exercises that utilize the SSC critical in their ExRx. Applying the SSC to an individual's ExRx can be achieved through exercises that force muscles to stretch/elongate in order to promote muscular contraction. A successful application of this principle is through bounce squats. *Please note that these need to be conducted in a safe manner for the individual with a SCI, meaning a variety of modifications may be necessary (ie. harness, resistance bands, personal lifts, hand support, etc.).* When completing a bounce squat, the quadriceps muscles are elongated/ stretched. Due to this stretching, receptors in the Patella Tendon send a reflex to the quadricep muscle causing contraction. Progression in this exercise is achieved by decreasing the resistance (unloading force) support needed. When working with an individual with a SCI, it is necessary to decrease the amount of assistance during a weight bearing exercise, rather than increasing the output required to complete the exercise. This is largely due to the fact that the CNS and PNS are still not communicating, instead we are focusing on the use of reflexes present in the body to complete the desired movement.
Compensatory mechanisms can be a beneficial concept to understand the application of when writing an ExRx for someone with a SCI. This concept states that the body will overachieve in one area to compensate for failures in another. For example, the Quadratus Lumborum is typically used as a back extensor muscle, however someone with a SCI is able to use it to aid in hip flexion. The ability to engage in assisted ‘hip flexion’ can be utilized in crawling or walking with assistive devices.
The intersection of all of these concepts is through walking with the support of assistive devices. For example, an individual with SCI would be able to stand from their chair (SSC), then utilize their triceps to decrease the weight through their lower body (changing LA), then incorporate stabilizing strength to stand in the assistive device, then must incorporate other supporting muscles such as the Quadratus Lumborum to use during hip flexion, and once progress is made, the amount of support from an assistive device can be decreased.
Client progress
When incorporating all of this information, great client success can be achieved with a lot of hard work, determination, and skilled exercise physiologists to create and modify the ExRx. One individual with a lower level SCI that has been following an ExRx that hits all of the components of this article has been able to dramatically improve his quality of life. When starting this ExRx, this individual did not have the ability to walk. Through applying the concept of changing LA he increased his tricep strength. This tricep strength was achieved through completing pushups on his knees with his hands on a 12 inch plyometric box. Then progressed to being able to stand and complete push ups with his hand on a 36 inch plyometric box. After the physiological adaptations occurred and the LA of the box was decreased accordingly, the individual was able to successfully complete over 20 pushups with full range of motion with his feet on the ground and hands also on the ground. Through the focus of proper pushup form and progression, the individual with a SCI was working to improve his stabilization strength as well. By way of improved tricep and stabilizer strength he was able to stand upright inside of an assistive walking device (walker). He recruited other muscles in order to flex at the hip but also increased his quad strength through SSC by completing bounce squats consistently. Due to all of the hard work and physical adaptations, this same individual is now walking over 30 feet with no assistive devices other than an ankle brace.
Written by ATP's Jess Johnson & Matt Costa
Do you ever feel like you just can’t get anything done today, or that you just want to do nothing except binge your favorite show on Netflix and eat? Yeah, me too. Sometimes our motivation just isn’t there, especially when it comes to exercising. Whether you need to find the motivation to start exercising, or you just need that extra push to get you off the couch, there are multiple ways to get yourself back on track to a better, healthier you!
First, let’s discuss the different types of motivation that exist; extrinsic motivation and intrinsic motivation. Extrinsic motivation is the motivation that you find from external factors or outside sources, leading to an external gain or reward. For example, you may be motivated to exercise to look better in a bikini for the summer, to be able to fit into a dress or a tux for your loved one’s wedding, or to be able to carry your grandkids again. All of these examples create a sense of reward or gain from outside factors. Intrinsic motivation, on the other hand, is the motivation that you find within yourself. For example, you may be motivated to exercise because it makes you feel better, it helps relieve some stress, or because you simply enjoy doing it.
From these examples of both extrinsic and intrinsic motivation, it is clear to see that extrinsic motivators typically create a timeline, as they are set toward a specific goal (e.g., fitting into a dress for a wedding). However, intrinsic motivators are derived more from self-reflection and emotions. This is why intrinsic motivators tend to play a larger role at helping you achieve your goals and promote long-term success. Therefore, if you have more intrinsic motivators than extrinsic motivators, you are more likely at being successful in achieving your goals.
To ignite your motivation and determine which of your motivators are extrinsic and intrinsic, try journaling or jotting down all of your motivators for exercising. Once you’ve dug deep into your mind and found all of your motivators, make a table of extrinsic motivators vs. intrinsic motivators to see how many of each that you have. Writing these motivators down is a great visual tool not only to see if you should create more intrinsic motivators, but to burn in the back of your head for when you need that reminder of why.
So, how do you create intrinsic motivators? There are a few ways to do this:
Need that extra push to get you off the couch? Sometimes we feel lazy or unmotivated and just need a little extra help to get us into a better mood. Use your external resources!
Written by ATP's Natalie Gates
First, let’s discuss the different types of motivation that exist; extrinsic motivation and intrinsic motivation. Extrinsic motivation is the motivation that you find from external factors or outside sources, leading to an external gain or reward. For example, you may be motivated to exercise to look better in a bikini for the summer, to be able to fit into a dress or a tux for your loved one’s wedding, or to be able to carry your grandkids again. All of these examples create a sense of reward or gain from outside factors. Intrinsic motivation, on the other hand, is the motivation that you find within yourself. For example, you may be motivated to exercise because it makes you feel better, it helps relieve some stress, or because you simply enjoy doing it.
From these examples of both extrinsic and intrinsic motivation, it is clear to see that extrinsic motivators typically create a timeline, as they are set toward a specific goal (e.g., fitting into a dress for a wedding). However, intrinsic motivators are derived more from self-reflection and emotions. This is why intrinsic motivators tend to play a larger role at helping you achieve your goals and promote long-term success. Therefore, if you have more intrinsic motivators than extrinsic motivators, you are more likely at being successful in achieving your goals.
To ignite your motivation and determine which of your motivators are extrinsic and intrinsic, try journaling or jotting down all of your motivators for exercising. Once you’ve dug deep into your mind and found all of your motivators, make a table of extrinsic motivators vs. intrinsic motivators to see how many of each that you have. Writing these motivators down is a great visual tool not only to see if you should create more intrinsic motivators, but to burn in the back of your head for when you need that reminder of why.
So, how do you create intrinsic motivators? There are a few ways to do this:
- Find exercises that you actually enjoy doing, and don’t be afraid to try new things!
- Ex.) hiking, biking, dancing, swimming, boxing, etc.
- Ex.) hiking, biking, dancing, swimming, boxing, etc.
- Try a fun exercise and jot down how you feel afterwards – pay attention to the positive feelings that you recognize and try to keep them in mind
Need that extra push to get you off the couch? Sometimes we feel lazy or unmotivated and just need a little extra help to get us into a better mood. Use your external resources!
- Motivational quotes – you can find these on Google, Pinterest, or basically anywhere on the internet. Find one that sticks with you and put a picture of it as your wallpaper on your phone, write it on your calendar, or add a sticky note of it on your mirror, so you can be reminded every day.
- Motivational videos – simply type in “fitness motivation” on Google or YouTube and you’ll find lots of videos with motivational speakers to amp you up. These will make you want to climb Mt. Kilimanjaro with ATP in July. (For more information on the Mt. Kilimanjaro trip, click on the “MORE...” tab and then the “KILIMANJARO” tab on the home page.)
- Scripture – what’s more comforting and inspirational than the Word of God? Leaf through your Bible at home or Google some motivational scriptures and treat it like the motivational quotes that were mentioned above to add faith into your motivation.
- Journal – when you’re feeling low, jot down your motivations to remind yourself why you want to start moving. Once these positive thoughts and goals get back into your head, you’ll want to make them happen.
- Listen to music – turn on some pump-up music or your favorite songs that make you feel happy and confident. Get yourself in a good mood and get on your feet!
Written by ATP's Natalie Gates
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