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  • and now for something completely different...

    I am a 49 year old male 6’2” 170. I incurred a spinal cord injury in 1986 that left me permanently paralyzed (C6/C7 quadriplegia: motor complete, sensory incomplete). Given that I have not been able to stand up under my own power in 32 years, my current dead lift and squat are both zero. I do bench and press, but given the location of my lesion, I have only partial triceps activation. So what. After dabbling with exercise in the many years since rehab, including a brief trial involving an FES-induced stationary bike, I decided to get serious. Since finding some effective adaptive gear, I have lifted consistently for 2 years or so, and incorporated modified BM methods (RPE specifically) for the past 6 months. The results have been excellent and I really enjoy it.

    After presenting with mild tendinopathy, my current primary care doctor is discouraging heavy lifting due to injury concerns. My counter argument is that maximizing my shoulder strength reduces the chance of injury, improves range of motion, and enhances my ability to maintain activities of daily living. In addition, muscle exhaustion is the only method I have found to reliably spike my heart rate as the sympathetic cardiac feedback process is innervated at T6 (below my injury level). My doc recently described the nightmare that shoulder replacement would deliver to my existence. What are your thoughts and how can I convince him that maximizing strength is the best approach?

    My general health is good. I have no other comorbid conditions, no joint contractures, no autonomic dysreflexia issues and I have learned to manage my thermodysregulation. Medications are testosterone gel (daily) and sildenafil (as needed).

    General guidance and thoughts on exercising - and especially lifting heavy – with SCI is appreciated.

    Paralysis sucks every day but this life is still worth living for me (good job, 3 kids, and a wicked hot wife) and besides, what am I going to do, not train?

    -Dave

  • #2
    First of all - this is an incredible story.

    From your description, it sounds very clear to me that training provides you with dramatic improvements in quality of life. So, regarding your situation: if the issue is a mild tendinopathy, why in the hell are we scaring you by talking about the possibility of a shoulder replacement? Unless I'm missing something here, I'm not sure any of this discussion is necessary, and I certainly don't think that tendinopathy provides sufficient ground to recommend against training.

    I'll also tag one of my colleagues who has a bit more experience with SCI folks to see if he has anything to add here.DCP
    IG / YT

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    • #3
      I just want to add kudos to you for finding something you love that’s so beneficial to your health and life.

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      • #4
        And there goes every excuse I've ever had to not train...

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        • #5
          Dr. Baraki,

          Thank you for that reply. The premise, I think, of my PCP's argument is related to shoulder overuse. The hypothesis: my shoulders endue day-to-day stress that they aren't "designed" for, which accrues over time. Almost like the shoulders have an odometer and I'm racking up the mileage. And that mileage is finite.

          I disagree and think more is better as the resulting adaptation is beneficial for future use and wear. I wish there was more data here, as it is easy for my doc to point to a few worst case outcomes and project that on to others.

          Finally, I've interacted with my fair share of doctors over the years and I really appreciate how transparent and accessible you are. Condescending and close-minded is the baseline; you guys are outliers.

          -Dave

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          • #6
            Originally posted by quadfather View Post
            Thank you for that reply. The premise, I think, of my PCP's argument is related to shoulder overuse. The hypothesis: my shoulders endue day-to-day stress that they aren't "designed" for, which accrues over time. Almost like the shoulders have an odometer and I'm racking up the mileage. And that mileage is finite.

            I disagree and think more is better as the resulting adaptation is beneficial for future use and wear. I wish there was more data here, as it is easy for my doc to point to a few worst case outcomes and project that on to others.
            In my opinion, discouraging you from training based on this theoretical concern does far more harm than good.
            IG / YT

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            • #7
              Dave,

              First off I think it's great you are not letting your injury limit you where you can still make difference and gains. In general I am sure you know the SCI population has body habitus changes, increased incidence of metabolic syndrome/diabetes/heart disease that can't just be explained by inactivity and muscle atrophy itself.

              Couple questions which might be useful: Do you have a SCI specialist doctor that follows you as well in addition to your PCP? Also what is your mobility situation? Power assist or manual WC? Any recent modifications? Reason being sometimes getting a power assist on a manual WC can give your shoulders some relative rest that might help.

              Upper extremity and shoulder preservation is something that is really pushed on patients after spinal cord injuries, reason being of course the fear of overuse. As Austin was noting above making the leap from tendinopathy to shoulder replacement is nocebo of the highest order and while probably well intentioned is not an appropriate comment to make. I think you are doing what is right and training what is trainable.

              Ultimately it is up to you to decide the risk versus benefit, and in this scenario I think you have significant potential for benefit not limited to just strength improvement but like you noted as a way to get some cardiovascular conditioning. Let your symptoms be your guide in terms of intensity, volume which I think you are already doing. In general if you haven't had issues with autonomic dysreflexia or orthostatic hypotension yet I doubt exercise would induce it but as always keep an eye out for any symptoms and make a note of it. Most of the younger SCI physicians I have trained under are a bit more "liberal" in the sense that they encourage patients to push the limits of what they can do and try different ways of being active and exercising.

              I hope this is useful, if you have any other specific questions I would be happy to do a little more research on my end to help out.

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