Phase III

Strength: Eccentric/Concentric Muscle Contractions

Moving into Phase III doesn’t mean that your body has stopped relearning. It hasn’t. Your body will continue going through Phases I and II throughout the entire recovery process. You don’t just graduate from one phase to another, it is more like a gradual change that happens over months and sometime years. We have clients that are walking but still have paralyzed areas of their bodies in Phases I and II. By having different Phases, you can see where you are during your recovery which helps to educate you on what lies ahead. It also gives milestones to achieve and reasons to celebrate a success.

Phase III is where the future of recovery really starts to separate away from traditional occupational practices. Symptoms like tone and spasms are welcome because they help us with training the nervous system. Ask yourself what is causing the tone and spasms; you are through your nervous system. Our theory is that your nervous system is trying to connect the way it did before your accident but without external stimulation to re-teach it, all you get is static in the form of tone and spasms. These are symptoms of a dysfunctional nervous system, but a nervous system that can be re-trained. By learning how to manipulate a nervous system, a skilled Specialist can take you from tone and spasms to controlled movement. Because you will enter Phase III with stable joints, the Specialist will be able to create a desired movement by manipulating your body and then applying resistance thus creating stronger contractions. You will graduate Phase III when you can create that controlled movement without any assistance from a Specialist.

Let’s take a look at today’s mindset:

Traditional Approach to SCI

• No hope for recovery
• Medicate the symptoms (pain, burning, pins and needles, spasms, etc.)
• Your improvement is determined by your level of injury
• Most insurance companies do not provide for a standing frame
• Though your instincts tell you that spasms are good, you are otherwise educated that your spasms need to be eliminated

Results

• Many people who have tone and spasms are so heavily medicated that they can’t think or function. We have clients that have been on anti-spasm medication for over five years and still have all the symptoms that they had on day one.
• Withdrawal from medications can take months and in some extreme cases, a year
• No improvement in function
• The body becomes tighter with more spasms
• Anger and frustration

Project Walk’s Idea of the future:

• Hope of recovery. In the center at any given time there are several people (your peers) that have been where you are right now with tone and spasms. They can give you an understanding of their progress and you can watch them control their legs. One question we are frequently asked at this point is, “So these clients are controlling their spasms?” We find this disturbing because it means you have been incorrectly educated. You can’t control spasms because they are uncontrolled muscle contractions. What our clients are doing when they move their legs is simple, they are controlling them.
  
• By eliminating anti-spasms and pain medications (under a doctor’s supervision) and replacing them with exercise that stimulates the nervous system, we reduce tone and spasms, create a mature nervous system, and boost your overall health.
  
• The Dardzinski Method™ creates a strong, mature nervous system that results in controlled movement and at the same time reduces or eliminates tone and spasms.

Phase III is where muscle contractions begin. When you contract a muscle thousands of times with the right stimulation, the nerves and muscles will gain continued strength but more importantly, coordination. This is why our clients start with simple exercises to stabilize their joints in the earlier phases of training. In time, the muscles are performing isometric contractions. With the right skills, a Specialist can take these contractions and teach the client how to turn them on and off on command. Controlled muscle contractions are one giant step closer to walking. During this phase of the program, you will continue putting on muscle mass (some clients have bigger leg muscles now than before their injury) and as you move out of this phase, you will be able to control some movements in certain positions.

Results of Phase III Strength: Eccentric/Concentric Muscle Contractions

• Increased function
• Increased muscle control
• Increased daily activities
• Increased ability to think
• Increased bone density and circulation
• Increased sensation
• Increased control of your life

A side affect of Phase III is an increase in occupational abilities. Each client comes to us with a goal of walking, but amazing things happen along the way in the form of occupational milestones. In phase III, most clients are now driving, can transfer using their legs for support, can stand without a standing frame, and all have gained back their independence.

Since your body has changed, its time to change your workout prescription.

Training Guidelines

Appointments

During this phase workout days and hours are determined by the clients tone and spasms, with the majority of our clients’ working three days a week. An exception to the rule would be someone that is over one year post injury whose nervous system is out of control, meaning, they have tremendous tone and are controlled by their spasms. We would see this person everyday because we need to continuously break down their nervous system. We have found our clients with these characteristics feel better on Saturday after a hard week than they do with a rest day. One thing that we have learned is that every nervous system is different and we have to be able to adapt to the continual changes. As your body changes, we will adapt to it and determine how long your sessions should be.

Workout Prescription for Phase III

Phase III workouts are about creating contractions. The SCI Recovery Specialist you are working with should not be doing all the movements, just helping you to create movement.

Most clients will spend the majority of their time one-on-one with a Specialist working the nervous system to create muscles contractions. Nothing in the world can react to your nervous system or be as beneficial to you as a certified SCI Recovery Specialist. Your workouts will involve a Specialist creating contractions and having your muscles resist.

• Positional Movement
  This is where we start. It is simple---we move your leg around looking for your nervous system. As we elicit a response, we put your leg in a position that enables you to perform a muscle contraction. Repetition after repetition will be performed to increase strength and endurance while creating voluntary contractions. Weights will be added and you will perform movement in all planes of motion to recruit more muscles to respond and contract.

The goal of positional movement is to get all of the muscles that move a particular joint involved in eccentric contractions. As you now know, this will not happen all at once. Some muscles will receive nervous signals while others will respond more slowly. Our goal is to continue to promote nerve activation in all the muscles and not ignore those that are slower to respond.

• Developmental Movement Patterns
  Developmental movement patterns are how we learn general movement pattern skills which eventually become specific skills. When training for any sport you practice skills over and over until you don’t need to think about it, it just comes naturally. At Project Walk® developmental movement patterns are practiced from day one up until you leave. Your improved function allows us to do more advanced movements necessary to increase the stimulation to your developing nervous system. Because you now have joint stability we can create demand on your joints by performing load bearing exercises. We have developed specialized sequences using weight equipment, combined with floor and table work that excites your nervous system in all planes of motion. This stimulation affects all of the postural skeletal muscles forcing your nervous system to respond. Being sedentary doesn’t allow for any improvements.
  
  
• Load Bearing Exercises with Movement
  The human nervous system needs to load bear to improve; a standing frame is great for a passive workout and teaching your body the proper resting length of your muscles. But standing while being supported is passive. We need action! During this phase you will start to eccentrically load your muscles. Achieving this milestone is one of the biggest changes in your body since your injury.
  
  
• Controlled Positional Movement
  We move your legs into a position and you control the desired movement. Some might say you are controlling a spasm; but what is a spasm—it’s an uncontrolled muscle contraction. So, if you are controlling an uncontrolled muscle contraction…get my point? Through positional stimulation and repetition we create controlled contractions, and in time, as the nervous system matures, movement increases.
  
  
• Cheating to Create Movement
  This is where the client creates the movement by cheating. An example would be a client who has learned that if they arch their back, they can control a movement in their legs. Eventually, through repetitions, the client can perform the desired movement without cheating. This is called coordination.
  

Symptoms of Phase III

• Plateaus
  As you continue to heal and gain function, you will hit a plateau. A plateau is where you heal internally, where your nervous system is adapting to the new stresses that your increased function places on it. Once your nervous system has caught up to the stresses, your body moves forward. This cycle happens over and over throughout the course of recovery. This training cycle is no different for someone without SCI. As the body adapts to the training stimulation you hit a wall—it’s only when you challenge the body with something new again does it adapt. Then you see a gain in fitness or skills. The only difference with SCI is the time frame of the gains.
  
  
• Night time
  You will find that your night time symptoms may get crazy! The movements that you are working on and creating during the day will come back and haunt you at night. If we are working your hip flexors during the day, you might be doing hip flexors lifts all night long. This is because we are stimulating your nervous system and pushing it to its limits. At night it is healing, and because you are dealing with an electric system, as it heals, it causes movement. Our clients tolerate these night movements and the lack of sleep because their peers that have already been through it explain how it is part of the healing and recovery process. And, like most symptoms associated with SCI, as you improve, the night time symptoms slowly start to disappear. You will find that the more you move your legs during the day, the less they move at night.
  
  
• Crazy Legs
  At one time or another, all of our long-term clients have had crazy legs. We love crazy legs because it shows us that our clients are recovering. Training crazy legs is easy, but very hard on the individual Specialist. Through The Dardzinski Method™ we have learned with practice to create controlled movement out of crazy legs. It is determined in this stage of healing whether you will go on to walk or just get tighter. We are the best at this stage. Those who rely on Botox and anti-spasm medication don’t under stand how a person with SCI recovers. You can mix and match recovery training with occupational medication but you should check out the research on the medications that you have been prescribed.

Additional Modalities

• Standing Frame
  The importance of a standing frame during this Phase is critical because your muscles are getting tighter and stronger. Since you spend most of your time in your wheelchair, the seated position becomes your natural posture. What this means is that your hamstrings become shorter; your hip flexors are short - in a sense, your body is healing into the wheelchair posture, which is flexion. To stand you need extension. This is why the standing frame now becomes a passive postural recovery tool. By using it at home you are teaching your body to rest at its natural resting length. Using the standing frame on your own allows us to spend more time each workout training your nervous system to move muscles. Without the standing frame, you come into the center tight and with short flexors. When this happens, we spend the first part of a workout opening up tight flexors. We’ve seen clients who use the standing frame improve faster, while those that don’t struggle to improve. Why make it harder than it already is. Every day, get in the standing frame and watch TV or read.
  
  
• External Electric Stimulation
  FES bikes or any other type of external electric stimulation should not be used during this stage of development. You don’t need it---your body is producing its own internal electric stimulation. Adding an external source will only confuse your nervous system.
  


• Pool Therapy
  We still do not recommend pool therapy for your legs. Your nervous system is still developing and needs a closed chain connection. Only when you can move your legs controlling the muscles should you hit the pool.
  
  Pool therapy is only recommended for C level injuries to work only on developmental movement patterns of their upper extremities.
  
  
• Cardiovascular Conditioning
  We recommend cardiovascular training in this stage of recovery. One of the best ways to do this is by swimming laps. You can use a pull buoy to support your legs and some clients have used a snorkeling mask and tube for breathing. Other good cardiovascular tools are a hand cycle (sitting tall--not in your wheelchair), versa climber, or a hand cycle on the road.
  
  
• Real World Outside Activities
  We encourage all of our clients to get outside and participate in life. Many go to school or work. Our clients go horseback riding, sports fishing, scuba diving, skiing, and kayak surfing to name a few of the sports available locally.

Graduation from Phase III

You can now move your legs and have controlled movement but you are not very coordinated; you may even be able to stand on your own. What you are lacking now is coordination of the nervous system consistently in all planes of movement. In Phase IV, Function and Coordination, your workouts will become more dynamic and we will teach you how to control all of this new movement in all planes of motion.