Exercise Does More Than Make You Fit

Reprinted from PN/Paraplegia News April 2013

Working out promotes mental as well as physical health and may help alleviate pain in people with spinal cord injury.

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Most of us have heard about the benefits of exercise since we were children, but plenty of research shows a good workout can do much more than get you into shape.

Exercise stimulates the release of feel-good molecules called endorphins, assuaging life’s trials and tribulations. Working out also promotes physical health in so many different ways, especially for people with spinal-cord injury (SCI).

Foremost, it helps to maintain a healthy weight with a better fat-muscle ratio. Given post-injury muscle atrophy, this is an important issue.

Our body-fat composition greatly influences our physiology and the development of disorders such as diabetes common in people with SCI.

For diabetics, good old-fashioned weightlifting is especially effective in pulling excessive sugar out of the blood, where it is not needed, into muscle tissue, where it can fuel activity.

Nerve Growth

In addition, exercise profoundly influences the nervous system itself.

For example, it stimulates the production of regeneration-stimulating nerve-growth factors and the differentiation of neuronal stem cells into mature nerve cells, replacing ones lost by injury and the entropy of aging, nurturing those that have survived.

Due in part to these nervous-system influences, aggressive exercise programs have been shown to enhance functional recovery, even long after injury.

Studies suggest exercise can also lessen SCI-associated pain — not only the shoulder pain common to wheelchair living but also the more insidious neuropathic pain resulting from nervous-tissue damage.

Stay Home

Exercise doesn’t have to involve going to a gym, as a 1999 study at Fresno State University found.

Kathleen Curtis, PhD, helped lead the study that examined the impact of a six-month, home-based, stretching and strengthening program on shoulder pain in 42 wheelchair users (35 with SCI).

After the study was completed, subjects reported a 39.9% reduction in pain compared with 2.5% for those who didn’t take part in the physical activity.

Workout or Education?

Another study discovered that whether at home or at a gym, doing exercise is better at reducing pain than gaining some knowledge.

In 2003, Audrey Hicks, PhD, at McMaster University in Canada, led a group that evaluated the influence of a nine-month exercise program on a variety of factors, including pain.

The study involved 34 individuals with SCI. They were randomly put into one of two groups. One was a twice weekly exercise program that involved both arm ergometry (i.e., cranking) and resistance training. The other was a control group offering bimonthly education sessions on topics like exercise physiology, osteoporosis, and relaxation techniques.

The results found exercisers reporting a modest reduction in pain while controls reported an increase.

Better Results by Doing


Exercise and education were also looked at in 2001 by a team led by Sara Mulroy, PhD, director of the pathokinesiology laboratory at Rancho Los Amigos National Rehabilitation Center in California.

Her group looked at the effectiveness of an exercise intervention on shoulder pain in 80 manual-wheelchair users with SCI.

Subjects were randomized into two groups. One was a 12-week home-based program of shoulder strengthening and stretching exercises combined with strategies on how to optimize transfers, raises, and wheelchair propulsion. The other was a control group, which saw an instructional video reviewing shoulder anatomy, mechanisms of injury, and concepts in managing shoulder pain.

As with the other studies, pain decreased substantially in the exercisers after finishing the program, a decline that persisted four weeks later. No change was noted in the control group.

Mind & Body

The benefits of working out also do more than just help with muscle pain.

A study in Sweden last year measured the benefits of an exercise program on musculoskeletal and neuropathic pain in eight subjects with SCI.

Subjects exercised with a double-poling ergometer adapted for people with lower-extremity impairments three times a week for ten weeks. For the subjects with neuropathic pain, average pain decreased 40%. Those with musculoskeletal pain saw it virtually dissipated.

All but one had no musculoskeletal pain at the end of the study; and the number of days per week with pain declined from an average of 5.5 to 0.7 days.

It is not surprising that exercise has the potential to reduce musculoskeletal pain by strengthening and balancing key muscles.

However, because neuropathic pain is physiologically a different ballgame, the results are quite significant. The investigators noted that the exercise program’s impact on neuropathic pain is comparable to many of the drugs studied for treating this pain.

You Gain No Pain

There are no magic bullets when it comes to SCI pain.

Commonly prescribed pain-killing drugs often have only marginal long-term effectiveness and are laden with adverse side effects. But, they seem relatively harmless compared to some of the nerve-destroying surgeries that have been used in the past.

Exercise is also no magic bullet, but studies suggest it helps — and without significant side effects. For people with SCI, perhaps the workout maxim “no pain, no gain” is less apropos than “you gain no pain” by exercising.



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