November 10, 2011

Two Sets of Ten Don't Undo 12 Hours of Disuse

I had back spasms after my stroke.  It was terrifying to be frozen in standing hoping I wouldn't drop my cane or fall down.  So I was highly motivated when my PT gave me exercises to strengthen weak abdominals that allow my back to arch when I lift my hemiplegic leg.  I do exercises before I get out of bed in the morning. However, doing a few exercises doesn't undo the effects of 12 hours of disuse.  Therapists and stroke survivors who pin all their hopes on exercises are doomed to fail.  If exercise was enough coaches would stop after they made football players run laps around the field and throw and catch footballs.  Exercise conditions the body, but the mind has to learn to use new skills when we are distracted.  I'm not against exercising.  I think exercises are a good way to learn how movement should feel.  Since I've been doing abdominal exercises I can feel when my pelvis flops forward as I lift my hemiplegic leg to walk.  This gives me an opportunity to stop and concentrate briefly on sucking in my gut.  But it's the 3,000 steps my pedometer says I take on the boardwalk at Point Pleasant Beach that strengthen my muscles and retrain my brain.

Success at transferring what I've learned to my daily routine is mixed.  I consistently lift my hemiplegic leg higher than is necessary to walk up the steps at my front door.  I'm pleased that I no longer make scuff marks on top on my shoe as I drag the shoe over the edge of step.  I want to stop arching my back to lean my stomach against a counter for support, but I'm failing two-thirds of the time.  I put a beige piece of non-slip shelf liner at the kitchen sink to remind me to lean on my hand instead of leaning on my stomach.  I rarely used this strategy so I added a another memory aid.  A blue piece of non-slip shelf liner reminds me to first put my sound hand on the counter so it's easier to lift my hemiplegic hand to counter top height.  I've seen improvement so I know I can stop this bad habit.

November 3, 2011

Back Pain + Stroke = Disaster

I herniated a disc in my back and had sciatica 20 years ago so I've been stretching my back for years.  After my stroke I was worried my back pain would come back.  It did.  A recent bout of back spasms taught me stretching my back every morning is not enough.  Freezing in place when a back spasm hits and hoping I can walk slowly to sit down without dropping my cane is scary. 

My PT showed me I arch my back because my abdominal muscles on my paralyzed side are weak (bottom half of red line on left).  To stop myself from falling forwards while standing I lean back (top half of red line).  I also arch my back every time I lift my leg to walk.  Leg muscles (small arrow pointing upwards) need a stable base to pull on.  Abdominal muscles (arrows pointing downwards) are suppose to hold the pelvis and spine still when my leg moves.  

It gets worse.  I discovered I arch my back when I lean down to pick up an object, like when I reach down to get a pot from a bottom cabinet, get milk from the bottom shelf of the refrigerator, or pick up something from the floor.  I arch my back when I wash a dish because I am leaning my stomach on the edge of the counter for support.  

My PT taught me to do leg lifts with bent rather than straight knees.  I decided to intensify the workout.  I clasp my hands together, lift both arms over head, and lift my head while twisting to the left until my right shoulder blade lifts off the bed.  Before I start doing a leg lift I press my low back against the mattress and take a deep breath.  When I move I slowly let my breath out through pursed lips.  Holding my breath would increase my blood pressure.  I was dismayed that my NDT certification course did not teach that hand function comes from my gut.

Bottom Line: It takes both stretching my tight back and strengthening my weak abdominals to keep back spasms away.