We’ve all heard the lecture: stay active or risk losing strength. Keep moving and stretching or risk tightening up. Be sure your food intake matches your activity level or risk adding unneeded weight.

Many meet the activity challenge through exercise and working out, but for a lot of quads that seems a bridge too far. Here’s how six Denver quads, relative newbies and oldtimers alike, have found routines and exercises that work for them. Besides being quads, they have one thing in common. They all work out at Craig’s PEAK (Performance, Exercise, Attitude, Knowledge) exercise facility. Some use a number of fairly inexpensive alternatives to high cost machines.

Ben Hernandez, 34, a C5-7 quad injured in a car accident in ’98, speaks enthusiastically about what exercise has done for him. “I’ve been working out regularly for about a year. In that time I’ve gone from a power chair to a manual chair (with Wigits), learned to do transfers more or less independently, lost weight and have much more energy. What’s not to like?”

When asked about the specific exercises he finds most valuable, he quickly points to the Uppertone and Rickshaw machines housed in PEAK. “Using the Rickshaw has given me the strength to be able to do my own transfers,” he says. “I use the Uppertone to do curls, rows and presses. I think they’ve all helped strengthen my core, which has helped me with transfers, picking stuff up from the floor and then getting back to an upright position. The medicine ball is great for the core as well. The Nustep gives me a full body cardio workout.”

Hernandez is also into low cost, DIY solutions: “I do a lot of core (torso) strengthening using 2 to 3-inch diameter PVC pipe filled with cement. They weigh about 10 pounds. An old basketball filled with sand is my medicine ball. Basically I’ll use anything heavy that I can pick up to work on balance by holding it out to one side, or to strengthen my back by bending forward and sitting back up while holding it.”

James Nall, a 32-year-old quite incomplete C5-6 from a fall down a flight of stairs in 2010, was a runner prior to injury. “I was a workaholic general manager of a restaurant, working ungodly hours,” he says. Now he’s about to graduate from a local college and begin grad school. He says he’ll continue with his exercise routine he’s come to value and respect.

“I do about 250 sit-ups in bed every morning. With minimal sensation there’s little pain to stop me,” he says with a smile. “I work a lot on balance, at the edge of the bed or a couch. I’ll hold a small amount of weight out to one side and go side to side or lean forward and backward.”

He frequents the PEAK several times a week and goes to his local YMCA for a couple of the Nautilus machines and the pool. In all, Nall estimates he spends about 20 hours a week working out.

“I’ve been doing it for about two and a half years — it’s very important. The biggest thing I’ve gained has been my independence. I’ve got much more mobility and strength and I’m definitely less stressed. Strengthening my core has helped so much with transfers, cleaning, reaching, posture, general mobility, overall stamina and pain relief.”

Josh Stapen has been working out for eight or nine of the 10 years he’s lived with a C6-7 injury. “A few years ago I stopped working out. Not long after that I began experiencing quite a bit more pain. I got back to working out and the pain decreased.”

Stapen uses PEAK’s Equalizer multi-station machine for pull downs, rows, overhead presses and a variety of exercises that work the rotator cuff. He finishes his routine, which takes about an hour, with a few minutes of forward and backward windmills to keep his shoulders loose and flexible.

“Working out has helped me improve my overall rugby game, especially with pushing. I just turned 40, and if I want to maintain the skills I have at the present level, I have to stay fit. When I work out regularly I have less pain, less stress, I sleep better and maintain my bed mobility.”

Staying healthy, maintaining transfer skills and sustaining independence are Stapen’s long term exercise goals. He plans to keep doing what he’s doing.

Use Light or Moderate Weights and Bands
Erik Hjeltnes, a C6-7 with the upper body of a linebacker, is the resident exercise guru at Craig’s PEAK. He’s available to answer questions, coach technique and lead weekly classes — one for general performance and another for moderate to intense cardio work. When asked if people can duplicate high tech state-of-the-art machine-type exercises at home, his short answer is “Yes.”

“A person can work every major muscle group — chest, biceps, triceps, shoulder and back — using kettle bells, resistance bands (colored elastic tubing with handles on each end), Thera-Bands, medicine balls or free weights, all of which are fairly inexpensive. Personally I like the resistance bands and kettle bells. Both have handles that are quad-friendly and both are quite versatile.”

Hjeltnes also says people don’t need to use heavy weights to achieve significant gains. In fact, using modest weights can provide significant results in both strength and flexibility while ensuring proper technique. When people use too much weight, he claims, they use muscles other than the ones those specific exercises are intended to work, and they can hurt themselves in the process, often due to poor posture or improper technique. He stresses the importance of maintaining good posture while lifting to reduce straining the lower back.

He also emphasizes strengthening the back and posterior shoulder muscles as well as the chest, shoulders and triceps. “You’ll notice shoulders rounding forward, especially with cervical injuries — that’s often caused by overuse and tightening of the pectoral and anterior deltoid muscles. I urge tetras (quads) to work on all the back muscles, which will stretch and open up the chest. Strengthening the back, scapula and rotator cuff will maintain range of motion and help prevent shoulder injuries down the road.”

“The kettle bell is good for trunk stability. While sitting in your chair and holding the kettle bell with both hands,” Hjeltnes suggests, “move it across the body from one side to the other. If that’s too easy, hold it away from the body and do the same motion, or take it by the handle and do shoulder presses, which work the muscles used for wheeling,” he continues, adding to use caution when going overhead, as it’s easy to flip your chair.

“Work the rotator cuff by pulling the band straight across the body at waist level with the elbow tight against body,” he says. “Concentrate on posture, staying as square and upright in the chair as possible.” He also suggests anchoring the elastic bands to a hook in the wall or a door handle or something at an appropriate height, positioning the chair to do a desired exercise. Choose different bands for desired difficulty and proceed.

A quick check web search finds a set of three kettle bells (5, 10, 15 pounds) for $45 with shipping. A set of three resistance bands, ranging from 5 to 30 pounds, can be had for $42 with shipping.  Need to get a grip? Most DME websites sell adaptive gloves.

Individual Routines and Researched Benefits  
Ben Robles, a C5 quad, began working out at the PEAK about 18 months ago. He usually does two-hour sessions three or four times a week. “When my helper began coming to coach me a few months ago, I began to see big improvements.

“My goal is to be able to transfer independently. I like the Rickshaw, which works the muscles I need for transfers, and pull-downs the most. I also do curls. When I’m strapped in to do pull-downs, I work on flexibility and range of motion for my shoulders. I’m much more flexible now.”

Robles, 55, fell about two stories from scaffolding while learning the drywall trade 15 years ago. In addition to improved flexibility, he’s sleeping better and noticing much less shoulder pain. Exercise has also helped with his Type 2 diabetes. “My circulation has improved and I’m taking less medication.” When I ask if his confidence in achieving his goal of transfers reflects a different attitude, he smiles and says. “I’m viewing things differently. I’m more optimistic and have more patience.”

Jo Donlin, a C5 quad for 23 years, was very active in organized sports —basketball, softball and more — in high school and exercised every day while in college until a diving accident paralyzed her. But a membership and some personal training session at the PEAK,  a Christmas present from her mom,  changed her life again.

“I’m stronger, have more stamina and less fatigue. I’m getting through my morning routine faster because I’m helping my attendant with transfers. I feel stronger while driving, at work, doing presentations, teaching, training and typing. I’ve lost weight and am maintaining my level of function and independence. I wish I could do more, but I have to work nearly full-time.”

She’s at the PEAK three times a week for 45-60 minutes to do a routine of crank cycling, vita-glide, Thera-Bands to simulate rowing, pull downs, pull ups, curls and some pec work (some while in a standing frame) and sparring with a heavy bag for cardio and stamina.

“Regular exercise has helped me physically, mentally, socially and spiritually. I could do some of this at home but value the social aspect too much. I’m much more positive and see exercise as my hedge against depression. I ride my handcycle several times a month and have even done a 10K race. I just love having athletics as part of my life again.”

Julie Waldie, who holds a doctorate in physical therapy and is PEAK’s director, cites researched benefits: “Exercise is linked to better overall health and wellness. It decreases the risk of cardiovascular disease, hypertension, stroke, obesity, diabetes, UTI’s, respiratory infections and osteoporosis. People who exercise usually experience less anxiety, pain and depression.”

Waldie says the types of exercises people do should depend on their individual goals. “If you’re looking to do transfers, use the Rickshaw, though repeatedly practicing transfers or any other specific task is still the most effective way of mastering it rather than strengthening specific muscles.” However, each individual has a unique level of innervation, she says, so it’s difficult to generalize for quadriplegics.

“Shoulder integrity, especially the scapular area (shoulder blades) is critical for quadriplegics,” she says. “If the scapular area is unstable, people will be in pain and hurt themselves,” she cautions, reiterating Hjeltnes’ warning. “Squeezing the shoulder blades together and down will strengthen them, as will prone elbow work.” she says.

Waldie also cautions that too much weight leads to bad form and often results in injury. She says a primary goal of strength training for chair users should be to stretch anterior (front) muscles and strengthen posterior (back) muscles of shoulders, which will counteract the tendency toward rounded shoulders and help with upright posture. “Regular stretching is also important for the same reason,” she says.

For cardio health Waldie suggests 20 minutes of moderate to vigorous intensity aerobic exercise and strength training workouts, consisting of three sets of eight to 10 repetitions working each major muscle group, twice a week. “Exercise should be intense enough to cause labored breathing, while still being able to talk some without stopping.”

This article was funded by the U. S. Department of Education’s National Institute on Disability and Rehabilitation Research, Grant # H133N0110006. The opinions expressed in this article do not necessarily reflect the opinions of NIDRR.

Resources:
• 16 Exercises for Quads: www.newmobility.com/2014/09/16-exercises-quads
• Reeve Health Minute fitness video: goo.gl/q8jqGU
• Online fitness class: scitotalfitness.com

Stay Safe While Exercising

While working out, be vigilant in avoiding the following:
• autonomic dysreflexia
• hyperthermia/hypothermia
• skin breakdown
• overuse and injury
• postural hypotension (drop in blood pressure due to a change in body position, usually from sitting to standing, or from lying down to sitting or standing, leading to lightheadedness and sometimes loss of consciousness).

Options for C4 injuries

Despite having only some scapulae, upper traps and neck muscles to work with, PEAK’s director, Julie Waldie, offers an array of passive muscle work, extensive range of motion work and a variety of FES-assisted technologies to keep the joints sufficiently limber and serve as protective factors against numerous secondary conditions.

“Range of motion is so important to prevent abnormal tightening of certain muscles, preventing spinal abnormalities and chronic pain issues. At the C4 level, people are using their upper traps and neck muscles to breathe, so any strengthening or ROM work will maintain those abilities, as will breathing exercises. We use a number of passive motion and FES technologies to maintain decent ROM and address posture problems.”

Problems associated with poor posture range from skin issues to spinal deformities, which can quickly lead to compromised breathing and/or serious respiratory complications, such as upper respiratory infections, pneumonia or worse.

“In addition to mat work, standing frames, and pool therapy, The PEAK uses a tilt table equipped with passive lower extremity motion, FES bikes (if appropriate), and sometimes even body weight-supported treadmill walking.

She also mentions that should some new technology/intervention offer the possibility for further recovery, the main disqualifier would be compromised range of motion.