When the spinal cord sustains an injury it can lead to motor and sensory effects such as spasticity (muscle tightness), numbness, or breathing difficulties, just to name a few. When these effects are left untreated, they can progress into more serious spinal cord injury complications.
Thus, it’s important to be aware of the potential complications of spinal cord injury and seek emergency medical attention if new symptoms arise.
This article will discuss what potential spinal cord injury complications can occur and what the underlying causes may be. It will also explore management techniques that can help improve overall health and promote recovery.
What are the Complications of Spinal Cord Injury?
To prevent spinal cord injury complications from worsening, it helps to understand what they are and how they can occur. It’s especially important to note the risk factors that can increase the chances of developing certain complications.
Be sure to seek emergency medical care if you or a loved one experience any new signs or symptoms after spinal cord injury.
Here are some of the most common spinal cord injury complications that may occur:
1. Lack of Blood Circulation
The spinal cord is responsible for transmitting messages that control movement and sensation throughout the body. When a spinal cord injury affects movement, it can result in paraplegia (paralysis of the legs) or quadriplegia (paralysis of the arms and legs), potentially creating the need for a wheelchair. When spinal cord injury survivors rely on wheelchairs and do not participate in regular exercise or therapy, this lack of physical activity can cause blood to pool in the arms and legs.
As a result, this can disrupt blood vessel tone, and when your blood vessels relax too much, there isn’t enough pressure to efficiently push blood back to the heart. Individuals with poor blood circulation may experience low blood pressure, cold feet, lightheadedness, dizziness, or weakness.
2. Pain
Pain is among the most common complications of spinal cord injury. Specifically, untreated secondary effects of spinal cord injury can result in musculoskeletal and/or visceral pain.
Musculoskeletal pain involves pain in the bones, joints, ligaments, tendons, and muscles. It can stem from unmanaged spasticity (tightness of the muscles) or excessive use of muscles and joints. It can also be caused by dependency on the unaffected areas of the body.
For example, a wheelchair-bound individual may rely on their arms and shoulders to move around after a spinal cord injury. However, the arm and shoulder muscles are not designed to carry the weight of the full body, and thus overworking these muscles can result in musculoskeletal pain.
Although less common, spinal cord injury survivors can also experience visceral pain, or internal organ pain. Visceral pain is usually caused by urinary or bowel dysfunction, and individuals generally feel aching or cramping around the abdomen.
A physical therapist is a great resource for treating musculoskeletal pain after spinal cord injury. Alternative remedies such as acupuncture, massage therapy, and rest may also help reduce pain. You can also talk to your doctor about possible medication for pain depending on the severity.
3. Constipation or Incontinence
Proper bowel movement is necessary to remove waste from the body. When the spinal cord cannot transmit signals to the bowel muscles, it can lead to bowel dysfunction. When bowel movement does not improve it can cause more serious complications such as constipation and bowel incontinence. Lack of bowel management can further result in abdominal pain, hemorrhoids, anal fissure, and other diseases.
Fortunately, there are ways to help your body get rid of waste and restore proper bowel movement after a spinal cord injury. This can include lifestyle changes such as increasing your water intake and maintaining a high-fiber diet.
Additionally, medication may be prescribed to help manage complications such as laxatives to promote bowel movement. Be sure to consult with your doctor before taking any medication to see if they are safe for you.
4. Pneumonia
After a spinal cord injury, survivors may not be able to cough strongly enough to get rid of fluids in the airway. This is common after high-level spinal cord injuries, like a C5 (cervical injury), which can result in loss of control over the diaphragm muscle.
When the diaphragm is impaired, it can make it difficult to breathe and cough, which is an important mechanism to clear the airway. Eventually this can lead to respiratory infections such as pneumonia.
Pneumonia occurs when one or both lungs fill with fluid and become infected. Treating pneumonia generally consists of antibiotics, but alternatives may also be recommended by your doctor.
5. Atelectasis
High level spinal cord injuries can also result in other lung complications such as atelectasis, the complete or partial collapse of the lungs due to blocked airways. Atelectasis is often asymptomatic until it affects larger portions of the lungs. When it occurs, survivors may experience shortness of breath, coughing, and chest pain.
Deep breathing exercises may help increase lung volume as well as using a ventilator or CPAP machine. Additionally, coughing exercises can help provide strength to effectively remove mucus from the lungs and help prevent pneumonia.
6. Bloated Stomach
When bowel and bladder dysfunction or an impaired diaphragm are not treated properly, it can cause a bloated stomach. Stomach bloating after spinal cord injury occurs due to gas or water retention in the body. This is an uncomfortable sensation that can make you feel heavy and even be painful.
To reduce gas and water retention and promote a healthy digestion you can try adjusting your diet, drinking more water, and increasing physical activity when possible. You can also try a bowel program for spinal cord injury to help manage and keep track of stomach bloatedness.
7. Scoliosis
Another spinal cord injury complication that may occur is scoliosis, a condition in which the spine curves to the side. Although scoliosis typically occurs during adolescence, adults can develop it after traumatic events like a spinal cord injury.
Particularly when a spinal cord injury impairs control over the core muscles, it can become difficult to maintain good posture while sitting or walking. Individuals who continuously compromise their posture and slouch or lean to the side can develop neuromuscular scoliosis if left untreated.
8. Pressure Sores
When you sit or lay in the same position for an extended period and start to feel pressure in certain areas of your body, you can adjust and shift positions. However, after a spinal cord injury, survivors may not feel the excess pressure due to impaired sensation and remain in the same position for long periods of time.
Too much pressure for long periods of time can disrupt adequate blood flow and deprive tissues of oxygen, making the skin susceptible to pressure sores. When treatment is neglected, it increases the risk of additional complications including pain and serious infections. Fortunately, the earlier pressure ulcers are identified, the easier they are to treat.
Additionally, there are ways to minimize the progression of pressure sores. This includes inspecting your skin daily, especially at bony points such as the tailbone, sit bones, ankles, knees, and hips.
You can also ask your caregiver or loved one to provide “pressure reliefs” to reposition your body every two hours when lying in bed or every 30 minutes when sitting up in your wheelchair.
9. Osteoporosis
As previously mentioned, when a spinal cord injury impairs motor control survivors may become less physically active. Lack of physical activity can increase the chances of developing more serious complications, such as osteoporosis.
Osteoporosis occurs when your bones break down faster than the rate at which they are reforming. This causes your bones to become weaker, less dense, and more likely to fracture. Without regular weight-bearing on the affected areas, bone density can decrease, reducing bone strength.
To help lower the risk of osteoporosis after spinal cord injury, you can make sure you have sufficient calcium and vitamin D into your diet. These nutrients are essential for building and maintaining bone strength.
Another way to reduce the risk of osteoporosis is to gradually add more weight-bearing exercises into your routine to help build bone density. You can also ask your doctor about medications that can help slow down bone breakdown.
10. Heterotopic Ossification
While osteoporosis involves too much breakdown of bone, some complications can occur from the opposite direction, excess bone tissue. Heterotopic ossification, for instance, is an abnormal bone growth in your soft tissues below the level of injury. Nearly 20% of spinal cord injury survivors, typically with more severe injuries, experience heterotopic ossification.
For this spinal cord injury complication, survivors may need prescribed medication. Additionally, if the bone growth prevents joint motion or other bodily functions, it will need to be surgically removed. Other options such as medication or radiation therapy can be explored too.
11. Weight Gain/Weight Loss
Both weight gain and weight loss are common complications of spinal cord injury.
Survivors may lose weight shortly after spinal cord injury due to the decreased levels of physical activity that result in loss of muscle mass (muscle atrophy) and decreased bone density. To help lower the risk of weight gain, it’s important to participate in weight-bearing exercises when possible.
On the other hand, less physical activity also means your body is not using as much energy as it did pre-injury. In order to avoid the complication of weight gain, it’s important to be mindful of your diet post-injury. Be sure to eat balanced meals and avoid crash dieting. You need plenty of vitamins and minerals, like calcium, to promote recovery and prevent further complications.
12. Leg Swelling
Edema, or swelling, is another spinal cord injury complication caused by the buildup of excess fluid in the body. Leg swelling after spinal cord injury is particularly common in individuals with paraplegia or quadriplegia. Limited mobility decreases blood flow, resulting in excess fluid gathering in the tissues.
Leg exercises, such as elevating your legs, can help reduce leg swelling and help the blood circulate again. Resistance bands or leg lifters can provide extra assistance and help you move your legs more swiftly. To help manage leg swelling with paralysis you can also try wearing compression stockings, massaging your legs, and managing sodium intake.
13. Sleep Problems
Sleeping after a spinal cord injury is essential to allow the body to heal. However, sleep disturbances after a spinal cord injury may occur due to a variety of contributing factors.
For example, after a spinal cord injury the body may struggle to regulate its body temperature resulting in body temperature dysregulation. Individuals may then feel too hot or cold while sleeping causing them to wake up throughout the night. Sleep disturbances may also be increased by pain, obesity, stress levels, and medication side effects.
There are some management interventions that can help improve your quality of sleep. This can include cognitive-behavioral therapy to help identify and reduce anxiety or stress levels, medication for pain, and managing your weight.
14. Depression & Anxiety
A spinal cord injury can bring about sudden changes in daily activities and quality of life, which can be difficult to cope with. Without proper support, survivors may struggle with anxiety or depression after spinal cord injury.
If you or a loved one struggle with depression or anxiety it’s important to reach out to friends, family members, or support groups. You can also speak to your doctor about medication if you are interested. Psychotherapists in particular are another great resource and can provide more insight on psychological care.
How to Treat Spinal Cord Injury Complications
Every spinal cord injury is unique, and the complications that may arise also vary for every survivor. Fortunately, rehabilitation therapy and compensation techniques can help you manage spinal cord injury complications.
For example, to help reduce musculoskeletal pain due to spasticity, you can try physical therapy. With physical therapy exercises, you can improve mobility by activating neuroplasticity (the central nervous system’s ability to rewire itself). As the central nervous system begins to rewire itself and improve communication between the muscles and central nervous system, spasticity may reduce.
While some physical therapy exercises can be challenging depending on your ability level, there are other types of exercises that do not require you to exert too much energy, such as passive range of motion exercises.
Instead, a therapist or caregiver can assist in moving your body for you during these exercises. Passive range of motion exercises encourage you to move your joints through their full range of motion and help minimize tightness in the joints and prevent stiffness.
Occupational therapy focuses on helping survivors maximize independence after spinal cord injury. Exercises mimic daily activities such as eating and dressing. Occupational therapists may also encourage survivors to use adaptive equipment to make tasks easier.
Speech therapy can also be helpful, especially for high-level injuries that cause respiratory complications. Speech-Language Pathologists can provide guidance and exercises focused on increasing diaphragmatic strength and managing secretions.
Other methods such as medication can help provide temporary relief from musculoskeletal and visceral pain, as well as respiratory infections. Consult with your doctor before taking medication because some can cause adverse side effects and may not be ideal for long-term use.
Creating new lifestyle habits after spinal cord injury can help lower the risk of developing complications and be beneficial to your overall health such as adapting a healthy diet.
To maintain a well-balanced diet try to consume nutrient-dense foods that are rich in fiber. This can help increase bulk to your stool and regulate bowel movements. Staying hydrated and drinking plenty of water can soften the stool to help prevent constipation and temperature dysregulation.
Overview of Spinal Cord Injury Complications
Learning how to cope with spinal cord injury complications such as osteoporosis, constipation, pain, and weight loss can require time and patience. Fortunately, you can reduce the chances of developing certain complications by seeking timely treatment.
Thus, it’s important to take note of any new or recurrent symptoms and seek emergency medical attention if you are experiencing new spinal cord injury complications. We hope this article has helped you understand the potential complications that may arise after a spinal cord injury and how to take the proper precautions.
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