Ramblings on healthcare, medical education, and life with a spinal cord injury
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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.

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