Spinal rehabilitation in sport
As well as joy and fun, sporting activities sometimes lead to serious physical injuries. In the heat of competition, through clumsiness or by unfortunate accident, serious consequences for the body sometimes occur – and a spinal injury is certainly one of them. As a structure of the body, the spine has neurological and vascular components as well as a bony one.
Bone injuries have a somewhat more favourable prognosis, although their rehabilitation is still demanding, whereas combined injuries of bone and nerve structures very often have permanent consequences with significant disability.
Early recognition, right there on the sports field, reduces the development of permanent consequences and of secondary damage caused by unskilled handling or inappropriate transport. Loss of consciousness, pain in the spine, sensory or motor deficits, bowel and bladder problems and sudden changes in blood pressure are just some of the signs of injury to the neural and bony structures of the spine and spinal cord. During the medical examination it is important to establish the level of the injury, that is, which vertebra is affected and at what level the spinal cord is damaged. It is precisely the level of the injury that will produce a clinically detectable deficit below that level. The anatomy and the mechanism of injury are important during early recovery and rehabilitation in specialist physical medicine and rehabilitation services. The spinal stability mechanisms need to be further reinforced by immobilisation with orthoses and by appropriate rehabilitation that will promote the healing of bone and neural structures, with reinnervation and what is known as neuroplasticity. An injury at the level of the neck (cervical) segment causes tetraplegia, with paralysis of all four limbs, while an injury to the thoracic spine causes paraplegia; both can be complete or incomplete. In the prehospital phase, early recognition and appropriate transport are important, while in the hospital phase – the phase of active treatment and rehabilitation – surgical and drug treatment measures are taken.
The functional outcome covers a number of dimensions, such as breathing, digestion (problems with emptying the bowels), bladder problems, mobility and positioning in bed, transfers (bed to wheelchair, wheelchair to toilet, wheelchair to car) and active wheelchair use. Pressure sores, standing and walking with or without aids, eating, dressing, personal hygiene and washing, as well as communication and transport, are important components of rehabilitation. The rehabilitation phase requires a coordinated team of a specialist physiatrist and other medical specialists, with the help of healthcare staff. It is important to involve the person early in all self-care skills and in wheelchair skills. Through an institutional approach, patients with such injuries also meet other people with similar injuries at every stage, who encourage and guide them towards a quicker recovery. Vocational training is training that returns the person to a working and productive environment, so that they can also be financially independent. Functional electrical stimulation, robotic training, treadmills with body-weight support, biofeedback training, exoskeletons and epidural electrical stimulation are part of the modern rehabilitation techniques used in physiatric practice. Movement rehabilitation, neurorehabilitation, and pulmonary and vascular rehabilitation are components of such rehabilitation.
Complications such as falls and infections are expected and possible, and they need to be prevented. Adequate nutrition, with an appropriate intake in terms of both quality and content, makes for better rehabilitation. Rehabilitation also involves the cardiometabolic system: regular activity and aerobic training reduce cardiovascular risk. The rehabilitation of patients with a spinal cord injury is complex and, to put it mildly, challenging; even in the hands of an experienced physiatrist and an experienced team of other medical specialists and healthcare staff, such as occupational therapists and physiotherapists, it is a very complex and demanding process. Complications are frequent and almost unavoidable – or rather, they are part of the natural course of the post-traumatic condition, which medicine tries to prevent, yet they occur regularly and almost inevitably. For example, dysregulation of the autonomic nervous system leads to autonomic dysreflexia. Orthostatic hypotension, bradycardia and impaired thermoregulation are particular problems. In patients with a spinal cord injury, a particular metabolic phenomenon is osteoporosis and changes in bone metabolism. When gastrointestinal and urogenital problems and all the other difficulties the person has are added to this, multidisciplinary and ongoing care is needed.
Pressure sores in people who spend long periods lying or sitting are an ongoing medical concern, and in these patients the concern is especially pronounced. The medicines we use in people with spinal injuries are not only metabolised differently but also have a different effect on the body's structures. Pain relief for musculoskeletal complaints and for visceral, non-visceral, nociceptive and neuropathic pain is a problem in treatment that is further complicated by spasticity (involuntary muscle contractions); such involuntary contractions can cause further injuries and require careful titration of medicines. Joints that are not moved voluntarily, and are not adequately rehabilitated and positioned, gradually lose their range of motion and a contracture develops, which must certainly be prevented.
Heterotopic ossification around the joints and within the joint capsules and muscles affects up to 30% of people with a spinal cord injury. Faktor Zdravlje Polyclinic provides rehabilitation care for these patients, and we can offer you expert and appropriate medical treatment and comprehensive rehabilitation.
