Stretching After Incomplete Spinal Cord Injury: Preparing for Translation
Abstract
The Consortium for Spinal Cord Medicine (2008) prescribes that all spinal cord injured patients receive stretching therapies beginning within the first week post-injury. This kind of therapy is targeted at preventing some serious joint and muscle problems that many spinal cord injured patients develop. These include contractures, where the range of motion of a joint or joints is reduced and any movement of that joint involves increased force (stiffness), muscle shortening (often associated with contractures), and muscle wasting (loss of mass and strength). Maintaining muscle and joint health early after injury is critical to long-term health and function and for participation in any future rehabilitation efforts. Despite the fact that essentially all patients with spinal cord injuries receive significant levels of stretch-based physical therapy, stretching has not been studied systematically in animal models and has been studied very little in the clinical setting. Essentially nothing is known about how stretching might influence the neural circuitry in the spinal cord, which is responsible for controlling the motor and locomotor activities of the legs. Over the past 10 or 12 years, we have been studying activity-based rehabilitation after spinal cord injury in animal models, and over the past 4 or 5 years we extended our studies to include clinically based muscle stretching. We discovered that muscle stretching, applied as recommended clinically, causes significant drops in locomotor and motor function of the hindlimbs. We have further extended those findings to show that this is true after both mild and more severe injuries, and both acutely (early post-injury) and much later. Finally, we have determined that this effect is dependent on the presence of neural structures normally associated with pain. Despite all we now know about stretching, there are several important details that need to be determined before we feel we can design powerful, logical, and ethical studies to examine this powerfully negative effect in humans with spinal cord injury. These details include the anatomical structures and specificity, the relationship with activity and exercise, and the influence of injuries at different anatomical levels. With these questions answered, we will rapidly proceed, if it is justified, to design clinical studies on the impact of stretching.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810705
Entities
People
- David K Magnuson
Organizations
- United States Army
- University of Louisville