The Effects of Exercise and Activity-Based Physical Therapy on Bone after Spinal Cord Injury

International Journal of Molecular Sciences, 2022 · DOI: 10.3390/ijms23020608 · Published: January 6, 2022

Spinal Cord Injury Rehabilitation Musculoskeletal Medicine

Simple Explanation

Spinal cord injury leads to paralysis and bone loss, especially in the legs, increasing fracture risk. This happens because bone breaks down faster than it rebuilds. Scientists are looking at how exercise and activity-based therapies can help reload the legs and encourage bone growth, but the evidence is limited and inconsistent. This review discusses what causes bone loss after SCI, studies on exercise and bone health, factors affecting bone response to therapy, and recommendations for improving bone recovery through activity-based therapies.

Study Duration

Not specified

Participants

Persons with spinal cord injury

Evidence Level

Review

Key Findings

1
Bone loss after SCI is distinct from other disuse conditions in both severity and mechanism.
2
Only sparse and relatively inconsistent evidence supports the ability of these physical rehabilitation regimens to inﬂuence bone metabolism or to increase bone mineral density (BMD) at the most fracture-prone sites in persons with severe SCI.
3
FES modalities reported attenuated BMD loss at the distal femur and/or proximal tibia in persons with acute to subacute SCI and increased BMD in those with chronic SCI, suggesting such regimens hold promise.

Research Summary

Spinal cord injury (SCI) leads to paralysis and a unique form of neurogenic disuse osteoporosis, heightening fracture risk at the distal femur and proximal tibia. The review identifies factors impacting bone responses to ABPT and provides recommendations to optimize ABPTs for bone recovery. Despite the potential benefits of ABPTs, evidence supporting their effectiveness in improving BMD is sparse and the existing evidence is contradictory.

Practical Implications

Optimize FES Parameters

Determine the best stimulation frequency, amplitude, pulse width, power output, and pedaling cadence to effectively stimulate and/or maintain bone improvements.

Determine Optimal Training Regimen

Establish the ideal training frequency (sessions per day/week) and duration (time per session and intervention length) needed to improve bone parameters.

Assess Fracture Risk Reduction

Evaluate if BMD gains and microstructural changes from FES are sufficient to enhance bone strength, improve mechanical characteristics, and ultimately reduce fracture risk in the distal femur and proximal tibia post-SCI.

Study Limitations

1
Limited and inconsistent evidence on the skeletal benefits of ABPTs in persons with SCI.
2
Few studies have evaluated whether ABPTs improve trabecular or cortical bone microstructure at the distal femur or proximal tibia
3
Lack of assessment on whether BMD gains or bone microstructural changes mitigate fracture risk.

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