Return of the Heel Strike

17 11 2010

I’ve had a couple of new physical breakthroughs.  First, I got my heel strike back.  “What’s that?” you may ask.  Well, when we take a step we typically land with our heel first then continue through the step and finally push off with our toes.  My left leg has been stubborn due to spasticity and inflexibility brought on by years in a chair.  When I took a step, my left calf would spasm causing my toes to point so my foot would strike the floor with my toes landing first.  Not good for momentum or balance.

Last week at physiotherapy I was able to concentrate on landing my step heel first and make it happen. They were kind of wonky, over-exaggerated looking steps. I was concentrating hard and using all of my effort so my leg lifted higher than expected and I was almost marching. I was able to work out most of the kinks this week as I settled into the technique and better understand how much effort to expend. So now my foot moves smoothly through a relatively normal looking stride.

I’m actually not sure what the reason for the improvement is yet because my physio and I have been trying many things at the same time.  For those interested, here are the things that altered:

1. Reduction in spasms/spasticity. I cut back on the drug I use to relax spastic muscles (baclofen) after learning from folks on the SCI web forum that it weakens muscles.  This provided increased strength in my legs, particularly my hipflexor which is key to pulling my leg straight through a stride.  Oddly enough, for people with paralysis who don’t or won’t progress due to the nature of their injury, baclofen is an incredible drug to help settle spasm and tightness.  For those who need more strength and move more, it just inhibits muscle function.  Ultimately my spasms have decreased anyway due to more walking & exercise, stretching my calf muscles/tendons, and using muscle stimulation to activate dorsiflexion in my foot.  Yesterday, for the first time, my calf was actually relaxed while I walked.  This was so enjoyable and made walking a piece of cake – at least while using a walker.

2. Gait training. After posting a video of me walking on the SCI web forum I received tips on how my gait was hampered: swinging my leg to the side so my foot would clear, foot inversion etc.  My physio and I applied the tips on proper mechanics.

3. Extensive exercise.  I committed myself to working out really hard to improve as much and as fast as possible. I’m up to 3 days spinning a week.  It is incredible exercise for the arms, but, more importantly it is great for my core stomach and back muscles which I use when I walk.  I notice my pants are tighter so I suspect (or at least hope) this is because I’m bulking up with muscle. I also continue with physio twice a week and beyond that perform specific exercises targeting my quad, hip flexor, hamstring and glute.

4. Recovery. The signal from my brain is reaching the correct muscles.  I’m not sure if this is new or if my muscles are now strong enough to perform what my brain is asking of them.

My second new breakthrough is achieving a better sense of balance.  In my last post I wrote about walking independently and how difficult that is without balance.  I continued working on this at physio and it seems that I’m regaining my sense of balance.  My brain forgets in between each stroll how to balance, so the first steps of each session are off kilter. Finally, my brain says, “oh, I recognise this orientation. It’s not right. I’ll send a signal to the appropriate muscle to correct it.”  Then I’m good to go.  With each walk, balance kicks in a little quicker.  The most challenging part remains the strength of my muscles (or the ability of nerve signals to reach those muscles) because having a sense of when you’re leaning too far or falling and actually being able to do something about it are two very different accomplishments.

The coolest thing about this process now is seeing steady, often exponential, progress.  The one thing that remains constant: quarter squats are the bane of my existence!

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