As with any client, massage provides pain relief and an increase in flexibility for the client presenting with permanent spinal cord injury
Spinal cord injury presents as damage to the spinal cord, resulting in a change, either temporary or permanent, in the cord’s normal motor, sensory or autonomic function. Estimates from the National Spinal Cord Injury Statistical Center suggest that the number of Americans with spinal cord injury ranges 236,000 to 316,000 annually. Males suffer from spinal cord injury more than females by a 4-to-1 ratio. The average age for spinal cord injury patient is 40 to 45 years of age.
Clients with spinal cord injury may have permanent and often devastating neurologic deficits and disability. Lesions present will impact spinal nervous tissue adversely.
Just as with any clientele, massage therapy can provide pain relief and an increase in flexibility and relaxation. According to “Pain profiles in a community dwelling population following spinal cord injury: a national survey,” published in The Journal of Spinal Cord Medicine in 2019, up to 60 percent of patients with spinal cord injury develop chronic pain.
Further, 458 out of the 643 patients who completed the study survey, or 71 percent, said they had experienced pain in the previous week. Neuropathic pain was indicated in 37 percent of responses and nociceptive pain in 32 percent of responses. Common treatments for pain included medications (76 percent), massage (29 percent) and heat (25 percent).
[Read “A Firsthand Account from a Disabled Massage Client,” by Mark Beck.]
Degrees of Injury
These are the degrees of spinal cord injury, according to the National Institutes of Health’s National Institute of Child Health and Human Development:
• Tetraplegia (replaces the term quadriplegia)—Injury to the spinal cord in the cervical region with associated loss of muscle strength and functionality in all four extremities.
• Paraplegia—Injury in the spinal cord in the thoracic, lumbar or sacral segments, including the cauda equina and conus medullaris, with associated loss of muscle strength and functionality in the lower extremities.
• Spinal Cord Shock—Occurs in clients with acute spinal injuries. Spinal cord tissue becomes ischemic, causing tissue necrosis. Complications include blood pressure dropping dangerously low, heart rate lessening and possible hypothermia. .
• Concussion—Nervous tissue has been irritated and impacted due to sudden trauma, but no structural damage has occurred. Swelling of spinal cord tissue presents on a scan.
• Incomplete vs. Complete Injury—Incomplete injury represents some but not all spinal column fibers have been damaged at a segment; complete injury represents that all spinal fibers have been damaged at a segment.
The most common neurologic level of injury is at C5, or the fifth cervical vertebrae. This is likely due to less muscular protection around the C5 bone. In paraplegia, T12, or the twelgth thoracic vertebra, and L1, or the first vertebra in the lumbar region, are the most common level. This is likely due to less muscular protection at the thoracolumbar hinge at the T12 to L1 spinal level.
Causes of Injury
According to the National Spinal Cord Injury Database, since 2005, the most common causes of spinal cord injury remain:
1. Motor vehicle accidents (especially seen in individuals 45 years of age and older);
2. Falls (especially seen in elderly females with bone disease);
3. Interpersonal violence (such as firearm injuries and domestic violence);
4. Sports injuries (football, auto racing and diving are the most common sports involved).
Other causes of spinal cord injury include vascular obstructions, tumors such as neuroblastomas, vertebral fractures in conjunction with osteoporosis and infectious conditions such as meningitis.
Spinal cord infarctions are linked directly to spinal cord injury. These infarctions are caused by strokes or other vascular challenges and will obstruct blood flow to the spinal cor ontinence and loss of muscle strength.
Two common complications of spinal cord injury are Central Pain Syndrome and Central Cord Syndrome. Both syndromes witness damage within the central nervous system (CNS), which are comprised of the brain and spinal cord.
Central Pain Syndrome is difficult to diagnose as pain patterns can vary greatly depending on the extent of CNS damage. A common clue of Central Pain Syndrome is distinctive pain in the hands and feet.
Central Cord Syndrome typically affects the upper extremities more than lower extremities and can easily be mistaken for thoracic outlet or carpal tunnel syndromes.
Spinal Injury Complications
There are numerous common complications presenting in spinal column injury patients. Among the most severe to witness will be decubitus ulcers (bedsores). These ulcers occur when too much pressure is placed upon the skin causing necrosis that is quite difficult to heal. Quality of care comes into question, which makes this sign often troubling.
Challenges of the cardiovascular system may arise with the development of thrombi. If blood clots form in the crus region, deep vein thrombosis is likely. Skin color will change, heat may be felt, the leg affected will swell and clients will report a deep, dull “on-the-bone” sensation with DVT.
A major danger of clot development is the potential for these clots to break free and travel throughout the blood stream. The thrombus is now called an embolus when this occurs. The most common area for an embolus to settle will be the lungs, resulting in a pulmonary embolism.
Other complications that may result include infections within the respiratory, urinary and reproductive pathways, as well as musculoskeletal challenges such as spasticity, contractures, paresthesia, numbness and weakness of the limbs.
Spinal cord injuries have major functional, medical and financial effects on the injured person, as well as the individual’s psychosocial well-being.
Fluid replacement with isotonic crystalloid solution may be administered if a spinal cord injury patient experiences neurogenic spinal shock. This form of shock may deprive the spinal column of oxygen and witness increased perfusion within the injured portions of the spinal cord.
Treating hypotension and occluded airways may become essential. Computerized tomography (CT) scans to examine potential intracranial injury and bleeding may be prudent. Antiemetic drugs and a nasogastric tube may be administered if any digestive obstruction is witnessed.
Pulmonary management is a treatment of pulmonary complications or injury in patients with spinal cord injury. It includes supplementary oxygen for all patients and chest tube thoracostomy for those with pneumothorax and/or hemothorax.
Surgical decompression involves decompression of the spinal cord as suggested in the setting of acute spinal cord injury with: progressive neurologic deterioration, facet damage, need for progressive radiculopathy, in patients with epidural hematomas or abscesses and with cauda equina syndrome.
There are numerous considerations for the massage therapist to understand in the care of spinal cord injury patients. Swedish massage is generally considered safe; however, be aware of contraindications such as blood clots, pressure sores and skin infections. Incorporating mild stretching will create space along the spinal column. Encouraging fascial unwinding, especially within a cranial sacral therapy session, will further facilitate efforts to maintain spinal column length.
If torso mobility is limited significantly, light touch modalities are indicated. Gentle touch therapies such as acupressure, Therapeutic Touch and Trager method can softly induce relaxation within a rigid, immobile client. Gentle, rhythmic movements provided by Shiatsu massage can combine the relaxation of light touch therapies with enough muscle manipulation to provide extra relief.
Myofascial release can also accomplish the same relaxation goal. There are numerous manners to administer myofascial release. Long, slow, medium-to-deep strokes can create lengthening of spinal column tissues. Softer, layer-by-layer approaches designed to slowly progress into the body with light touch can free fascial restrictions.
Holding statically upon the skin until a change in skin tonicity is felt, then inducing a rocking motion may further free myofascial restrictions. Including a mechanical device or tool to induce a piezoelectric effect can further augment efforts to free spinal column tightening of tissue.
Massage may be focused on pain management, especially for developing tendonitis in the hands, wrists, feet and ankles. Remember that many spinal cord injury patients retain sensory feeling, therefore checking in about levels of pain is always imperative. Never assume your spinal cord injury patient cannot feel your touch. Even if a client has a faint perception of touch, manual application upon muscles will nourish them properly.
An important question to consider is, “How can I make you most comfortable?” The use of various sizes of bolsters may take pressure off body regions feeling compression. The therapist may also consider if performing the session in a chair or upon a table will provide more comfort.
Does the therapist need to accommodate time and space if a client possesses a urinary catheter or colostomy bag? Investing in a hydraulic table to easily lower the table to aid the spinal cord injury patient will be helpful.
A Client’s Perspective
Massage client Chelsey Godel of Phoenix, Arizona, who has scoliosis in conjunction with an injured spine, shares a sentiment commonly expressed by many spinal cord injury patients:
“Massage helps tremendously with my scoliosis, as it soothes the pain that my deviated spine causes me,” she says. “I believe massage helps to bring balance back to my body and [that] regular, frequent massage prevents the scoliosis progression from worsening.”
About the Author:
Jimmy Gialelis, L.M.T., B.C.T.M.B., is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches many CE classes, including “Working with Pathologies—Autoimmune Disease.” Gialelis’s mission with massage therapy is to integrate allopathic and homeopathic ideals with both clientele and classes.His many articles for this publication include “Massage Improves Quality of Life for the Cerebral Palsy Patient” and “Autoimmune Disease: A Breakdown of Self-Tolerance.”