Sports for Individuals with Spinal Cord Injury

Original Editor - Naomi O'Reilly

Top Contributors - Naomi O'Reilly  

Introduction

Individuals with a spinal cord injury can get involved in most sports following their injury, with modifcations to the sport and / or with adaptive equipment to allow participation in these sports if needed. Athletes with disabilities are able to compete in sports at elite levels. These levels can be only fractions behind athletes without disabilities.

History of Sport for Spinal Cord Injury

The demand for sport for people with a spinal cord injury traces its roots back to World War II. Large numbers of young veterans with spinal cord injury and amputations returned from the war; the desire to pursue sports undiminished by these veterans' impairments. 

Sir Ludwig Guttmann founded the National Spinal Injuries Unit at the Stoke Mandeville Hospital in Aylesbury, England at the request of the British Government in 1944 to address the needs of the large numbers of civilians and soldiers injured during World War II [1][2][3], accepting the post only on the condition that he was free to implement his own theories on how best to treat patients, with no interference. Treatment for individuals with a spinal cord injury at the time was still rudimentary and Guttmann was dismayed by what he found, with terminal progonosis and palliative treatment the main stay of treatment as a result of complications such as bed sore and urinary tract infections.

Guttman was a strong believer in ‘purposeful, dynamic physical management’ [4], the role that sport could play in the physical and mental rehabilitation of people with a spinal cord injury. So sport was introduced to the programme at Stoke Mandeville Hospital and became a vital element in the treatment of all patients. [1][2] Wheelchair Polo was the first competitive team sport developed at Stoke Mandeville but it was on the 28 July 1948, ‘by chance more than by design’, that the foundation of the first annual sports day, known as the ‘Stoke Mandeville Games’, coincided with the Opening Ceremony of the Olympic Games in London.[1]

Sport should become a driving force for the disabled to seek or restore his contact with the world around him and thus his recognition as an equal and respected citizen” Sir Ludwig Guttman [5]

The role of sport in the medical rehabilitation and treatment of people with a spinal cord injury, continued to grow throughout the late 1940’s and early 1950’s. [3] Many medical and administrative personnel from around the world visited Stoke Mandeville Hospital to observe the work of Guttmann in order to develop and shape procedures back in their home countries. [1] It was partly through this cooperation that the first International Stoke Mandeville Games were established in 1952, when a team of Dutch ex-servicemen from the Aardenburg Rehabilitation Centre in the Netherlands travelled to Stoke Mandeville to compete in the Games. [1] This was the first step towards Guttmann’s vision for a ‘truly international’ Games that would be the equivalent of the Olympic Games for men and women with a spinal cord injury. [1][2] The International Stoke Mandeville Games continued annually in Aylesbury, with increasing numbers of countries and participants each year but was still only catering for athletes with a spinal cord injury. With this increase in international sports competition for people with a spinal cord injury there grew a need for a common and consistent approach to sports rules and regulations. This was discussed at a ‘Meeting of Experts on Sports for the Disabled’ convened by the World Veterans Federation in Paris, 1957 who agreed that ‘international sporting regulations for ‘able-bodied sport be applied as closely as possible’ [1], with standardisation of modifications made through regular communication between technical experts.

Following the 1957 International Stoke Mandeville Games, the first technical meeting elected an appeals tribunal and agreed a central role for the Stoke Mandeville Committee in relation to rules and technical matters of competition. [1] It was 1960, in Rome, that saw the next step in the development of international sport competition for people with a disability when, for the first time, the International Stoke Mandeville Games were staged in an ‘Olympic Year in connection with the Olympic Games’ . [1] Four hundred competitors, all with spinal cord injury, from 23 different countries competed in the Olympic Stadium. These games have since become recognised historically as the ‘First Summer Paralympic Games’. [2]

The growth of the Paralympic Movement continued with a gradual expansion of sport events, countries and other disabilities competing at the annual International Stoke Mandeville Games which were held in Aylesbury three years out of four; and in the Olympic Year held in conjunction with the Olympic Games in the fourth year of the cycle. The Paralympic Games continue to be held, with few exceptions, in the same city and, since 1988 Seoul Summer Games and 1992 Tignes-Albertville Winter Games, at the same venue as the Olympic Games every four years.

Participation in Sport for Spinal Cord Injury

Despite the many barriers faced by individuals with a spinal cord injury to participate in sport, there are many benefits which can be targeted that may in many ways outweight these barriers, remembering the key point that sport participation for individuals with a spinal cord injury has been shown to significantly improve quality of life, and provide the opportunity to build social contacts and socialize with people in similar situations.

Barriers

A wide range of barriers have been identified, which may have implications for the rehabilitation of individuals with a spinal cord information including;[6][7]

  • financial constraints,
  • lack of information regarding medical complications
  • lack of information regarding sporting opportunities
  • need for able-bodied support.

Benefits

A variety of benefits from participating in sport were identified, including; [6][7]

  • socialization
  • acquisition of knowledge from others
  • development of greater awareness of health and well-being issues
  • higher perceived quality of life
  • weight maintenance
  • less pain, musculoskeletal and neuropathic
  • improved mood
  • increased strength
  • increased endurance
  • increased ability for activities of daily living
  • increased independence

Medical Considerations

Upper Extremity Overuse Injuries

This can often be improved with appropriate regular exercise. If you already have significant pain or a known upper extremity overuse condition, you should begin your program under the guidance of a physiotherapist or health care professional.

Skin Breakdown

Pressure sores or abrasions can be caused by improper positioning during the exercise activity or by lack of cushioning. It’s important to do a complete skin check when you first start a new activity and make adjustments as needed.

Autonomic Dysreflexia

This problem arises when you have a sudden and very large increase in blood pressure which is often accompanied by severe headaches. Moreover, if an activity causes skin irritation or if your bowel and bladder are not empty, you could be at risk of experiencing autonomic dysreflexia. 

Orthostatic Hypotension

Orthostatic hypotension is a condition commonly experienced by individuals with a spinal cord injury, often associated with unpredictable increases or decreases in blood pressure. Orthostatic hypotension is defined as a drop in systolic blood pressure of 20mmHg or more, or a decrease in diastolic blood pressure of 10mmHg or more in the presence or absence of symptoms (e.g., lightheadedness, dizziness, nauseas, fatigue, etc.) when the individual progresses from lying down to to an upright posture (e.g., sitting or standing). Individuals with tetraplegia are at an increased risk of experiencing orthostatic hypotension because of their higher lesion level and can experience a larger drop in blood pressure than individuals with paraplegia.

Thermal Dysregulation

In many cases, people with a spinal cord injury experience thermal dysregulation, or trouble with regulating control of body temperature. This is caused by the loss of blood vessel control and sweating responses below the level of the injury. To avoid complications, it is suggested that exercise should be limited in extreme hot or cold temperatures. Moreover, attention should be placed on hydration, clothing, and signs and symptoms of heat stress or hypothermia.

Spasticity

For those who struggle with spasticity, some exercises might exacerbate this problem. This can be remedied by stretching spastic muscle groups before exercise. If the spasticity continually is worsened, avoid the problematic exercise.

Spinal Rods or Fusion

Those with spinal hardware or a spinal fusion should be cleared by their spinal surgeon before participating in exercise, especially if recently injured or after recent surgery.

Medications

Medications can change how your body responds to exercise. Most common medications taken by individuals with a spinal cord injury (e.g. spasticity medications, bladder and bowel medications) are not usually associated with health issues in response to exercise. Those prescribed medication for high blood pressure or breathing problems should check with their healthcare provider before starting an exercise program.

Fracture

One study has shown that people with spinal cord injury can lose ⅓ - ½ of their bone mineral density in their affected limbs, thus making them more susceptible to fractures. Those who experience severe muscle spasms and have osteoporosis should take precautions during exercise activity to prevent fractures from occurring.

Sport Oppounities

Sports Paraplegia Tetraplegia
Paralympic Summer Sports
Archery
Athletics
Badminton
Basketball
Boccia
Canoe
Cycling
Equestrian
Fencing
Powerlifting
Rowing
Rugby
Shooting
Swimming
Table Tennis
Tennis
Triathlon
Volleyball
Paralympic Winter Sports
Alpine Skiing
Nordic Skiing - Biathlon
Nordic Skiing - Cross Country
Curling
Ice Hockey
Snowboard
Non-Paralympic Sports
Rock Climbing

Resources

International Paralympic Committee

Founded on 22 September 1989 as an international non-profit organisation, the IPC is an athlete-centred organisation composed of an elected Governing Board, a management team and various Standing Committees and Councils. The IPC’s primary responsibilities are to support our 200 plus members develop Para sport and advocate social inclusion, ensure the successful delivery and organisation of the Paralympic Games and act as the international federation for 10 Para sports. They can provide information on the disability sport organisations responsible for paralympic sport within each of their 200 plus member countries.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Bailey S. Athlete First: A History of the Paralympic Movement. John Wiley & Sons; 2008 Feb 28.
  2. 2.0 2.1 2.2 2.3 International Paralympic Committee. (2008d) ‘History of Sports for Persons with Disabilities’ [online], available: http://www.paralympic.org/release/Main_Sections_Menu/IPC/About_the_ IPC/History_of_Sport_for_Persons_with_a_Disability/ [accessed 12/11/2019]
  3. 3.0 3.1 DePauw KP, Gavron SJ. Disability sport. Human Kinetics; 2005.
  4. Bailey S. Athlete First: A History of the Paralympic Movement. John Wiley & Sons; 2008 Feb 28.
  5. Ludwig Gutmann In Council of Europe, European Charter for Sport for All: Disabled Persons, Strasbourg, Council of Europe, 1987, pp.11
  6. 6.0 6.1 Kljajić D, Eminović F, Dopsaj M, Pavlović D, Arsić S, Otašević J. The impact of sports activities on quality of life of persons with a spinal cord injury. Slovenian Journal of Public Health. 2016 Jun 1;55(2):104-11.
  7. 7.0 7.1 Stephens C, Neil R, Smith P. The perceived benefits and barriers of sport in spinal cord injured individuals: a qualitative study. Disability and rehabilitation. 2012 Dec 1;34(24):2061-70.