Spinal Cord Injuries and IBT
As 2018 progresses, the potential for Integrated Biomechanic Therapy (IBT) to reach the full spectrum of the human experience is becoming realized. Intentionally expanding my field of view to provide the service of IBT to all owners of a human body has revealed promising impact for persons with disabilities, specifically persons with spinal cord injuries (SCI).
According to the National Spinal Cord Injury Statistical Center, an estimated 288,000 individuals are living with an SCI. Annual incidences of spinal cord injury are approximately 17,700 cases each year. Secondary Complications:
In addition to adapting to their lives past the rehabilitation stage, persons with disabilities are susceptible to chronic, secondary conditions involving complications with respiratory, cardiovascular, urinary and bowel, spasticity, chronic pain syndromes, pressure ulcers, osteoporosis, and bone fractures. (World Journal of Orthopedics : Rehabilitation of spinal cord injuries) Chronic Pain:
The International Association of Pain classifies pain related to SCI within two main groups. These two groups are nociceptive (musculoskeletal/visceral) and neuropathic. While neuropathic pain treatment in persons with an SCI can be complex and require varied medications and potential surgical interventions, nociceptive pain from musculoskeletal imbalance presents a relatively simple condition that IBT was specifically invented to address. SCI and Potential IBT Intervention:
For individuals who live their daily lives using a manual wheelchair and who are experiencing this nociceptive pain, orthopedic massage and corrective exercise are not the first to come to mind for meaningful intervention.
Typical treatments reported are use of analgesics, non-steroidal anti-inflammatories, and opioids. These options, however, only serve to mask pain, cause potential organ complications, and can put these individuals at risk for substance abuse and addiction.
These interventions do not remove the noxious stimulus that is causing the nociceptive pain, they do not strengthen the weak musculoskeletal tissue that is the result of imbalances, and they do not educate the individual and any potential caregiver on continuing the care past IBT intervention. What the Research Says:
A 2002 research study evaluating the comparison of massage therapy to exercise in the SCI population was conducted. A group of twenty individuals with a C-5 through a C-7 injury were randomly assigned to receive five weeks of either two 40 minute massage therapy session per week, targeting the arms, neck, shoulders, back, and wrist or instructed range of motion exercises targeting the same areas.
Anxiety, depression, manual muscle testing, and range of motion evaluations were conducted both before and after treatment sessions on the first and last day of the study.
Results showed that anxiety, depression, and manual muscle testing although improved in both groups, massage provided the higher amount of improvement.
Range of motion evaluations indicated statistically significant improvement in both groups, however, in wrist flexion and extension, the massage therapy group showed greater improvement, compared to the exercise group.
The Future of IBT and the SCI Population:
Considering that exercise has shown to improve all of these factors as a stand alone activity, the results indicating that massage bested exercise in comparison is notable. This then presents the question: “What if you did both?”
IBT is looking to answer this question. While I, as an individual IBT practitioner, have witnessed the remarkable results from performing intentional, informed orthopedic massage using IBT’s philosophies and adaptive therapy management system on this nociceptive pain, and individuals with a spinal cord injury are showing more and more how they are capable of exercising, there has yet to be the holistic integration of massage and exercise that IBT has established.
Although the techniques in the study were not what I would consider orthopedic, and the exercises were not corrective in nature, this study’s conclusions are exciting, nonetheless. It indicates the enormous potential of intentional, informed massage care integrated with exercise on the quality of life for the SCI population. Trusting your IBT Practitioner:
Education for licensed massage therapists for this specific population is sparse and inconsistent. IBT provides assurance that all practitioners are trained specifically for clients of this population. Through thorough research, hands on experience, direct feedback from this population, and seeking out (and encouraging) feedback from medical professionals who work within the population, IBT practitioners are prepared for the considerations that are required to serve this part of our community. The curation of this information has been paramount to ensure safety for the client as well as empower the therapist to know both their potential and limitations.