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Muscle Spasticity and Muscle Strength: Understanding the correlation between the two and why the gym as a method of rehabilitation, seems to be ‘working out’ for individuals with Cerebral Palsy

Jess Silver

September 15, 2013

It has long been known that the more that an individual exercises, the better he or she will feel and the stronger and more resilient the body as a whole will be. A newer insight into the science of exercise shows that the same is true for those that have been diagnosed with neurological conditions like, Cerebral Palsy. In fact research has shown that the more that they participate in physical activity and programs such as those developed by qualified personal trainers, the stronger they are able to get. The strength that is developed through individualized methods of training, allows for the individual to feel less restricted in his or her movement, and more in control of their body.

The National Center on Health, Physical Activity and Disability, defines Cerebral Palsy as a non-progressive brain injury that can occur before, during or after birth. It causes physical impairment and postural and balance problems. Due to the damage to the Cerebrum and Motor Cortex of the brain those impulses that are directed to one’s extremities and allow one to be coordinated in movement and speech, are often impaired. The condition causes muscles to be more rigid because of the difficulty that individuals have with remaining ambulatory. Because they are forced to be more sedentary, either relying on a wheelchair to move around, or because they cannot walk long distances with assistive equipment such as canes, they’re muscles are more spastic (tighter) and are unaccustomed to firing in an active state.

Research found in studies conducted prior to the last decade, showed that the conventional methods of rehabilitation for brain injuries were recognized as more effective to giving individuals with the condition symptomatic relief of the pain felt from the increased muscle tone that causes abnormal movement patterns. It was believed before gyms and fitness studios began to be more widely recognized, that physiotherapy and the repetition of slow, simple movement was what worked best to improve the physical condition of those with Cerebral Palsy. But now with the recent trend of more and more people heading to the gym to improve their well-being and thus gain confidence in themselves, it is recognized that the same is true for those with physical challenges. Even more so than for those that do not have a challenge because they have to increase the activity in their muscles, tissues and joints which are otherwise often neglected and dormant. “I am a firm believer that exercise, when calculated and done efficiently, can increase the overall well being of virtually any human being on this planet. There are many people out there that would not have thought exercise would make such an impact on Jessica`s condition and quality of life, but I did, along with her of course in which she is probably the most determined person I`ve ever met,” says Daniel Cecchino, Certified Kinesiologist and Personal Trainer. Daniel has been working with me for a year and a half, and has realized my potential.

Though it’s important to understand that there exists many variants of the condition, and some individuals are unable to control their movements at all, and or process information due to extensive cognitive impairment to the cerebrum, many others do aspire to be physically active, and are turning to fitness as a means for doing so.

Working out with Daniel, as he thoroughly understands my condition and the fact that it takes my body longer to execute a movement due to muscle spasticity, has allowed me to be in control of my movements and gain strength. Because we have developed a very positive and dynamic relationship, he is not afraid of challenging me outside of my comfort zone. Through resistance training, core and stability exercises and the integration of various types of equipment to use in conjunction with my own body weight, I’ve been able to learn how to isolate muscles that were not active before, and get stronger and more confident. There’s something to be said about the competitive edge, and atmosphere of fighting to get stronger and improve that you feel as a member of a gym. For me it’s different than going to a physiotherapy session or working with an OT at a rehab center where it’ll all of sudden hit you that you’re disabled and different from everyone else. At the gym I feel like I’m part of team of competitive, athletic-minded people like myself, and every time that I do another rep I’m willing to fight through fatigue to get even stronger.

The Department of Allied Health Sciences at UNC Chapel-Hill School of Medicine featured an article and study, entitled “Dr. Debbie Thrope Researches Exercise and Cerebral Palsy,” that looked at different methodologies behind the more conventional, conservative therapeutic methods in contrast to the notion that fitness is in fact an effective mode of rehab for people with CP. Dr. Deborah Thrope, Associate Professor and Physiotherapist, chose to look at the conventional view and compare it to the effectiveness of specially tailored fitness programs. Whereas before it was believed that those individuals with CP had to be treated differently because their bodies were more vulnerable and weaker in muscle function, her research found that engaging in fitness promotes an increase in confidence, strength, mobility and makes them more resilient. “They’re tired; tired of being therapized,” she said. Other research conducted by the National Center on Health, Physical Activity, and Disability supported the findings of Dr. Thorpe and attested to the fact flexibility and resistance training programs that also focus on improving balance, are integral parts of a fitness regiment for individuals with Cerebral Palsy, and other conditions. I believe that there shouldn’t be any apparent distinction when it comes to being concerned of one’s fitness whether you have a condition or not. While a trainer like Daniel, working with someone like myself needs to be more understanding of biomechanics and the way that my body responds during an exercise, the focus should still be on building muscle strength and overall confidence as with anyone else. I believe this is where there still exists a gap in the science of exercise because many professionals still believe in the efficacy of conventional methods for rehab. And it’s this perspective that is contributing to the misconceptions of the public that has a hard time seeing past the wheelchair sometimes if they see me at the gym.

By devoting attention to muscle isolation exercises and stretching, the personal trainer can help the individual improve his or her range of motion, and aid in reducing overall muscle spasticity. Furthermore exercises that target the weaker muscles such as the hip flexors and abductors, which also happen to be very tight depending on which sides of the body are affected, help increase the synchronicity of the neuro-muscular junction that controls the firing of nerves to muscles. The stronger the affected muscles get and those that support the areas that are more severely impaired, the easier it is to counteract the habitual patterns of nerve impulses to combat involuntary muscle spasms. However it is because the muscles have an involuntary tendency to contract, that one needs to be careful not to overexert during training. The relationship of muscle strength and muscle spasticity has both an adverse and reverse effect. Part of the responsibility and difficult task for the trainer is to understand that only through repeating the exercise many times while telling the individual which muscles to focus on contracting and activating, is there chance for spasticity to reduce. At the same time, the professional needs to understand that overexertion in an individual with CP, results in the increased build up of lactic acid in the muscles, which coercively causes greater muscle spasms. The ‘catch 22’ of sorts, makes it all the more challenging for the personal trainer who has to tailor the exercise program as such that it focuses on reducing spasticity and reaching one’s fitness goals, while understanding what factors influence spasticity.

Because the integration of fitness programs is proving effective to both the mind and body of those individuals like myself with Cerebral Palsy, more facilities are developing programs geared towards this type of rehabilitation. For example, The Morley Centre for Sport and Recreation in Australia has a center that was specifically developed for individuals with CP to be able to train. The foundational elements of a gym such as a team approach to health and fitness help make the individual with CP a part of the team working towards achieving improvement and success.  Being in control of the physical goals with the guidance of a personal trainer should the individual be capable, allows them to be assertive and feel stronger. For this reason, training seems to be ‘working out’ for individuals like myself, whose hope it is to break the barriers of conventional thinking.