One must crawl before one may walk..
A large part of rehab so far has made me realize that recovering from a spinal cord injury is a lot like being a baby all over again. You have to rediscover your body and how it works. And sometimes how it doesn’t. Parts wake up that you’d gotten used to being asleep, and I certainly know how a baby feels when it sits in place wiggling an appendage just because he or she can. I do that a lot too. I’ve felt since much earlier in rehab that regaining the ability to walk will quite possibly even more make me feel like a baby. When my physical therapist had me get on the ground and start crawling, though, I couldn’t help but laugh.
I’ve never been one for patience. Patients, yes, I want those at some point; after appropriate training would be a good idea. Right now, though, the idea of having to wait a long time before I can walk is very frustrating. There are no certainties as to whether or not I will, in fact, ever walk again. But I try to stay hopeful as much as possible, even knowing that if I am to walk again, it is going to be a long time before it happens. I thought this would be a good time to write about the progress that I’ve made since my post about kicking people.
I still enjoy giving people a good kick. In fact, I was at my cousin’s wedding this weekend and my family all wanted to be kicked. Ahh, the love of family. ”Kick me!” Quite discouraging to me at this point, however, is the fact that my right quadriceps muscle has not woken up yet. Because of this, I’m still only able to kick with the left leg. Now, after my left hip adductors and toes came back, the quadriceps was one of the first muscles to return as well.
At this point, I have a lot of movement in the left leg: I can kick (quadriceps aka knee extensors); I can bend the leg backwards at the knee somewhat – I just bent the knee flexor against gravity while lying on my stomach today for the first time; I can move the whole leg more midline (hip adductors); I think I can move the whole leg away from midline a bit now (hip abductors); I can rotate internally/externally from the hip; I can bend the ankle up and down; I can lift the knee up towards my chest while lying on the ground against gravity – this is something I could not do when I was discharged from Mount Sinai (hip flexors); I can wiggle my toes in both directions; and I can generally evoke movement in most directions at this point. Endurance and strength are another issue altogether, mind you, but the fact that movement is there is excellent. Muscles begin to atrophy after a few weeks of inactivity and with every contraction I’m fighting the atrophy that begin on January 27, 2008.
I have a good portion of these actions in the right leg as well, to a much lesser degree though. The right leg came back significantly later than the left, and although it too is getting stronger, the lag is very frustrating. Especially considering that the quadriceps is still not firing. I’m very nervous about it atrophying. The longer it takes to begin firing, the more muscle is lost and the longer it will take to catch up. I spoke to Dr. Stein about it before being discharged, and he said that it’s quite normal for one side to come back earlier and stronger than the other. This is due to the asymmetrical nature of damage to the cord in real-world spinal cord injuries. Damage is never perfectly symmetrical across the entire cord, much as our minds find beauty in symmetry. When I saw him for a checkup two weeks ago and again expressed my concern about the right quad, he simple said, “Something’s got to come back last.” His confidence did put me at ease a bit, but I’m still nervous about it (or I wouldn’t keep writing about it).
Contracting these muscles takes a lot of effort for me, and the challenge is doubly compounded by my inability to feel when specific muscles are fatigued. I still do not feel pain much below the level of injury, although in some hyper-sensitive regions it does appear to be slowly coming back. As a result, I do not feel the lactic acid buildup in muscles that normally cues us in to our bodies being tired. Instead, I must discern from the suddenly limited movement that results from my neurological directions. Although when considering the years I spent in the gym prior to the accident, not being able to feel lactic acid buildup probably lets me truly push myself to muscle failure.
Quickly move your fingers up and down repeatedly. I bet you can do other things at the same time, as directing your fingers to move does not take much effort. This is good – this is what is supposed to happen. My fingers likewise move without any extra effort on my behalf. Now tap your foot on the ground quickly, then lift the upper part of your leg off your chair. If you’re not spinal cord injured, this should also be just as simple. But for me, not so. While the movement has become far easier to evoke than when it first came back, moving the majority of the muscles below my level of injury requires a concerted effort. Imagine if it took straining as much as when you’re lifting something heavy just to lift your leg off the chair, and even then it only moves a few inches. That’s what it’s like for me to move. But it is getting better over time.
So back to the crawling. A few weeks ago, one of my therapists said that we’re going to crawl. After I stopped laughing, I got onto the floor, into quadruped (hands and knees on the ground), and tried to crawl. Quadruped is a challenging position, because it doesn’t just work the hip flexors used to move the knees forward, it works the core, the shoulders, the triceps, and the chest. It also forces me to keep my hips balanced above my legs, which is probably at least moderately necessary for walking. Probably. Of course, it does work the hip flexors significantly, and when I first started crawling, a significant amount of effort netted me very short, choppy knee strides, and roughly three feet of movement.
Today, my strides were much longer and I was almost jabbing my knee upward. I moved roughly twelve to fifteen feet very quickly, and was not completely fatigued when I made it as far as I could go. The hip flexors are of primary importance to running and walking. I guess those physical therapists know what they’re doing when they say to get on your knees and crawl like a baby. So I’ll be more than happy to continue crawling.
When a friend of mine who’s fianceé is expecting asked me how I’m doing with the crawling, I told him “Pretty good, but I think your unborn baby could still beat me.” Now he wants us to race sometime. Maybe before I continue on the path to medical school, I’ll stop and race a few babies on the way. I mean, most incoming medical students will be entering from college or fairly significant research positions. Me? Baby racing.
Oh, I’ve been standing too. Not fully self-sufficiently, mind you, but with my hands using the kitchen counter top for support and the cabinets below to keep my knees from buckling. A lot of the weight goes through my arms, but every day I try to put more through my legs. I try to do this from five to six times each day, for roughly a minute each time. The challenge has been getting my hamstrings to not spasm while the quadriceps straightens out the leg completely. I’ve upped the amount of stretching that I do daily, and this appears to be helping. In my most recent kitchen standing events, I’ve been able to get the left leg completely straight and bearing a good amount of weight. Additionally, I can force the right leg to straighten through some creative weight shifting, which then allows me to put weight on the leg. I can’t let go of the counter top or I will go toppling forward, but with every day of standing I get closer to standing with a walker and trying to start moving the legs forward.
But for now, I’m content to crawl around (both forward and backward now) and get those hip flexors and extensors strengthened.
18 comments
STANDING (assisted) and CRAWLING 10 FEET????
You animal! You go! I had no idea! Here I’ve been sitting in this radio silence for weeks imagining despair and hopelessness as the cause of no messages.
Look, buster, if you won’t think like a human, think like a monitor: emit status beeps every now and then, will ya??
YOU GO! And drop us a line now and then, willya?
Your writing gives others a glimpse of what a TBI survivor goes through on the road to recovery. Thank you for your honest accounts and exercises in understanding. And way to go!
Thank you very much! While at Sinai, the SCI and TBI floors would occasionally have recreational activities together. It was challenging to try to understand what they were going through, and I am humbled to think I may help provide others with some insight.
Dave – hahaha.. Yes, I realized it had been a bit since I posted a real progress report. The first few weeks out from the hospital really left me in a fog, and I wasn’t in much of a state to be thinking about the positive things that were going on. But that’s changed quite a bit. Things are on the up-and-up, and I’ll be posting more details soon pursuant to a recent visit to the neurosurgeon who saved my spine. Literally.
So I’ve pretty much caught up on the majority of your posts…I cannot believe how much I’ve been oblivious to! And I refer to the general stuff involved with SCIs as well as what has been going on with you. I wish I had the chance to read all this before my visit, instead of just being flabbergasted and all.
It seems I caught you at a good time though, things have obviously improved tremendously since the beginning of the year, and I have no doubt that it will just keep getting better. Never quite understood how you managed to hold down a job, school, and squeeze out dj gigs without going insane, but it’s obvious that determination is definitely something you aren’t short of.
Keep it up, and hopefully I’ll see you sooner rather than later.
You’re going to make a superb doc, no doubt about it. Your command of the written word, your empathy, and sense of humor will get you through all of the trials of medical school!
Have fun with the baby races….
Hi Chris!
From a future classmate at Case (we got an email from Christian Essman today with your blog link on it) I just wanted to say welcome! I’m really enjoying reading your blog. It is courageous, and my thoughts and prayers are with you. I’m sure you’ll be a fantastic addition to our school. I included my blog link on the website box… though it’s still fairly new and I’m not entirely sure what I’m doing with it. But feel free to peruse if you want.
I look forward to continue reading about your successes. Keep up the good crawling!
Alex
Hi,
I am a future classmate. I will be a MS-4 when you get here so feel free to email me with questions about the school and city. You have a lot to look forward to in medical school: great friends/colleagues, exceptional professors, uncanny experiences on the wards and great/funny stories for a lifetime. Oh yeah, and the whole medicine part of it is great as well. I did not grow up wanting to be a doctor like you but I have definitely fallen for it in my time here. So I am guessing you will be more than ecstatic. Also, its not just a pitch, you do really start seeing patients almost on day one…so come ready for that… judging by your sense of humor and comm skills you will be more than ready. Good Luck and see you soon.
Chris, in case you weren’t aware, the director of admissions sent out an email to all current medical students at Case to introduce us to you and your story through this website. I’ve never met you but I am looking forward to meeting you. Your candid writing detailing your journey – medical, emotional, and intellectual – and your aspirations has been a timely and poignant reminder in the midst of the rigors of medical school of what I’m doing this for. Good luck and I would be absolutely thrilled if you accomplished your dream of becoming a surgeon. Best, MD
Hi Chris! Mr. Essman just notified our class that you will be joining us next year as a result of your accident. I am very sorry that you have to endure such trials before even beginning the challenges of medical school! I would bet, however, that you’ll be an exceptional doctor because of it. I wish you the very best with your rehabilitation, and if you have any questions about med school or Case, as the year goes on I may be able to answer them! Keep up the good work!
Pankit -
Thanks, and I will definitely be sure to keep in touch with you. Particularly since you’ll be completing the dreaded MS3 when I’m rolling into town.
No pun intended. I’m glad to hear you’ve got such high regards for Case after you’ve been there for a few years.
MD -
Thank you! Fortunately, Christian was kind enough to ask me if I was ok with him sharing the blog with the current student body before he sent it out. I’m flattered to read the comments and e-mails from students that I’ve received since then, and I’m very enthused about getting out to Cleveland and really becoming a part of the community next year. And I’m humbled that I’ve been able to serve as a reminder to you during the challenges of medical school.
Megan -
Thanks for the well wishes, and I look forwarding to seeing you out there in Cleveland next year!
Hi Chris,
I, too, suffered a SCI at the end of last year and was also at Mt. Sinai for rehab – maybe we were even there at the same time! (small world, huh?)
I just want you to know that I can really relate to what you wrote, and I wanted to say thanks for being so honest and forthcoming with your comments. It helps to know that there are others out there who know what I am going through.
I suffered an incomplete SCI with a T12 fracture. The Mt. Sinai rehab was tough, but I think that it was the best possible place for me to begin the long process back to being “somewhat normal” again. (whatever that means:) I had Dr. Klein, and 8 plus months out, he is a real motivator. At my last visit at the end of June, he told me that he was glad to see that I’m using the walker and has encouraged me to start working with crutches in my outpatient pt. He said that next summer I should be walking in flip flops again – YEAH!
Anyway, thanks again for your thoughts – they are most appreciated from a fellow Mt. Sinai Rehab “graduate”…
Kelly -
Thanks, I’m glad you’re able to relate. I feel like I’m not entirely forthcoming with certain thoughts, but I think in the future I’ll go back and revise things to be more complete. Some things I think I’m just not ready to share as of yet…
It’s a long road, and congrats to you on the walker and crutches! That’s awesome! Mount Sinai is an amazing place to do rehab, and I didn’t fully appreciate it until I started evaluating and discussing treatment options with people from elsewhere afterward.
[...] expressed surprise at how much less support she had to provide to the right knee than expected. I’ve been worried about the right quadriceps for a while, and over the past couple weeks I’ve started to notice [...]
[...] moved up in the world from merely crawling on the ground or standing on the parallel bars. As I’ve said before, recovering from a spinal cord injury can be a lot like being a baby again. I’ve been [...]
Hey there Chris; i had been doing some research on spinal cord injuries and the effects it has on the body as well as the mind and i came across your story. See, I’m dating someone who had a spinal cord injury almost a year ago and he’s now learning how to walk again with the bars. I don’t want him to feel obligated to learn to walk so quickly being that everything happens in good time; but i feel as if he’s rushing to keep up with me. I want to encourage him to appreciate this second chance and realize that i’m there for him, but i don’t know how to go about it. Could you help me to understand what I might be doing wrong in this situation, please. Thanks in advance, Teresa
Teresa -
Sent you an e-mail.
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