Reducing High Tone After SCI:
3 Exercises for Long-Term Relief from Tone and Spasticity
We receive numerous questions, from SCI athletes and rehab professionals, in regards to managing high tone - and how we formulate our movement programs for clients with high tone.
Is high tone or spasticity affecting activities of daily life?
Are you/your client feeling tight or stiff after a spinal cord injury?
Is your spasticity management plan ineffective or not as effective as you’d like/need?
Would you like to find ways to manage tone without medication?
using daily movement practices with minimal equipment required?
If you answered ‘yes’ to any of these questions, please read on!
In 2022, we wrote about “Tone & Spasticity in Incomplete Spinal Cord Injury.” In this article, we discuss why tone and spasticity occurs, and the science behind managing tone without relying solely on medications. Before proceeding, I would highly recommend reading the above linked post to understand more of the rationale for our methods.
This article outlines 3 of our favorite floor-based movement exercises for reducing tone, PLUS one bonus breathing exercise!
Note: All exercises can be executed on a bed or large therapy table; a firmer surface tends to provide better input to the body, allowing for a better proprioceptive experience.
Before moving on to the exercises, please note these exercises do not “cure” high tone and spasticity. These movement-based strategies (vs static stretching) support changes in the following systems:
increase your parasympathetic nervous system activity
desensitize the joints in safe ranges of motion
develop proprioception and awareness in your body
Consistency is key!
In order for these exercises to be truly effective, daily practice and consistency are required; the summation of effects will bring lasting results in tone management. These movement practices are all about building nervous system resiliency, so it’s important to do the exercises daily (sometimes twice daily), even if the tone has subsided. Efforts to manage tone and spasticity take time and consistency to see lasting results!
Individuals may experience a decrease in tone almost immediately after doing the exercises listed below. However, the length of time this relief lasts varies from person to person: we recommend you keep track of the relief you experience and the timing of when the tone returns so you can recognize the positive change over time (ie. relief for longer and longer each time exercise routine is implemented).
Typically, our Zebrafish Neuro athletes report relief for 1-8 hours after a single movement session with increasing effects the longer they commit to the program. We see the best results when the program is executed consistently for 3 months.
Interested in starting a high tone coaching program with us? We offer 1:1 and group coaching sessions remotely! Check out our offerings here.
The Exercises
The exercises are presented in the order that we recommend you to perform them. However,
we encourage you assess yourself after each exercise (a quiet moment of ‘feeling’ your body’s current state) to figure out which one has the greatest immediate impact on your tone, pain or general comfort in your body so you can prioritize that specific exercise in your daily SCI exercise routine.
Theo, ZFN co-founder, demonstrates pinwheel. Original image source: From the Ground Up, page 176.
Exercise 1: Pinwheel
Goal:
Smooth and controlled trunk rotation; head and arm movements to create a twist between the hips and ribs. This rotation of the trunk can mimic the type of natural rotation the body experiences during gait an can have a soothing effect on tone and spasticity.
Description:
Start on your side with your hips and shoulders stacked on top of each other.
The top arm reaches out past the opposite hand (try to initiate the reach from your armpit) and the top arm begins to circle up overhead, keeping the hand close to the floor.
Follow your hand with your eyes as you reach overhead and rotate your trunk so that your chest opens up toward the ceiling/sky above you.
Complete the circle by bringing your arm down by your side and then returning to your start point.
Tips for more controlled and successful movement:
Use a wedge, bolster or other prop behind the hips to prevent the hips from rolling back during this movement. This video here on our Instagram explains this process.
If have trouble keeping your elbow straight (limited triceps strength) keep your elbow bent throughout the movement and focus on reaching and making the overhead circle with your elbow.
How to progress this exercise: ADD THE LEGS!
After opening your chest to the ceiling, draw your knees up and over to the other side. Initiate a full pinwheel rotation on the new side with the legs switching back over. Complete one full repetition, alternating sides.
Stephanie, ZFN co-founder and CEO, demonstrates 3D pelvis. Original picture source: Level 1, in-person training course manual.
Exercise 2: Prone 3D Pelvis
Goal:
Goal: Increase mobility at the hips using the squish ball to self-massage the iliopsoas muscle (hip flexor) and lower abdomen.
Description:
Start with the squish ball under your hips while you lay face down on the floor (you may need assistance getting positioned on the ball).
While propped on your elbows, shift your weight in all directions so the ball rolls around under you, prioritizing fluidity and control of the movement.
The ball should be have enough texture so that it is ‘sticky’ but still allows you to move freely (we love to use the official Zebrafish Neuro Squish Ball)
Tips for more controlled and successful movement:
Let some air out of your squish ball so it doesn’t roll as much; it’s easier to control this way
Practice good scapular mechanics and pushing from the armpits to help control trunk during this exercise
Add some ‘bumper rails’ to either side of you (large couch cushions, pillows etc)
How to progress this exercise:
Roll from prone position on the ball into a side-elbow prop position keeping the ball under the opposite hip, then return to prone and switch sides
Watch our tutorial on this exercise here on Instagram.
Theo, ZFN co-founder and athlete, demonstrates Z-sit. Original image source: From the Ground Up, page 183.
Exercise 3: Z-sit Femur Rolls
Goal: Hip mobility with an upright posture to emphasize internal & external rotation of the hips.The mobility of the hips plays a large role in tone and spasticity patterns as the hips are the connection between between the legs and trunk. With prolonged sitting, the hips often become tight or stiff. As hip mobility is challenged during functional movements, such as a transfer, the body can perceive the lengthening/shortening of these muscles as a threat, initiating a spasm or high tone response.
Description:
Start with legs positioned as shown in the image below. One hip starts in external rotation (with the thigh rotated outward) while the other is internally rotated (with the thigh rotated inward).
Prop up with your hands to support your torso in an upright position
Leading with the hip of the internally rotated leg, push the front of that hip to the crease of the opposite leg, maintaining an upright posture throughout.
The hands/arms can be used to help guide the hip forward by pulling on the ground in front, or on the knee/shin of the front leg.
Repeat for 30-60 secs, or as comfortable, and then switch sides.
Tips for more controlled and successful movement:
Coming into and out of the position can be enough of a movement challenge to start with. If this is the case, get into position using some of the adaptations listed below (or shown in this video) and hold for 20-60 seconds at a time, or whatever feels comfortable for you.
To reduce the intensity of the stretch in the hips, we have listed a few options to try:
Place a pillow, yoga block or ball under the knees.
sit on top of a secure pad to raise the hips off the floor
add a block or stable surface under each hand to provide more leverage in the arms for maintaining upright posture.
How to progress this exercise:
Bring the hands behind you to enter a back prop position with straight arms to increase the stretch in the hands. Work into and out of this position by going forwards backwards with the hands.
In back prop, swing the legs over so that they face the opposite direction, using your hips to control the legs and manage them smoothly.
More Instagram videos on Z-Sit:
Vanessa, a ZFN athlete, demonstrates posterior rib breathing. Original picture source: Level 1, in-person training course manual.
BONUS EXERCISE: Prone Drape - Posterior Rib Breathing
Goal: Increase flexion of T-spine while expanding the lungs posteriorly to engage the posterior intercostal muscles (which are often limited due to back supports in wheelchairs, laying on your back etc.)
Description:
Start with the squish ball under your chest while you lay face down on the floor.
Allow yourself to drape over the ball as much as is comfortable for you. Initially, this may feel slightly difficult as it limits your ability to breathe into your stomach and chest… but the goal of the exercise is to change the direction of the breath as you inhale toward your posterior ribs. Know your needs, and adjust accordingly.
Inhale through your nose.
Send the breath towards your upper back, expanding your posterior ribs.
Imagine your upper back rounding and lifting from the air entering that area of your body.
Take 10-20 deep breaths here, expanding the ribs a little farther every time.
Note: The sympathetic nervous system is the driving force behind tone and spasticity, increasing flexion of the T-spine can help reduce sympathetic activity and help create a more parasympathetic state within your central nervous system.
We hope these exercises are beneficial in your SCI program for managing tone and spasticity. We would love to hear from you and what changes you see or feel afterwards. Send us an email or tag us on Instagram, and if you want more information or personalized options, we’d be happy to help you find a program that suits your needs.
Tone and spasticity can be a frustrating by-product of spinal cord injury, and until our clients get a hold of their tone, it feels like nothing else comes easy. Because of this, tone mitigation and management is one of our top priorities (next to pain!) in our client’s programs!
Most individuals with high tone find that stretching, supportive standing and medication offer just temporary relief from the relentless rigidity.
In this program, participants will learn a more holistic approach to reduce rigidity for the long term with our movement “recipe” for high tone management after spinal cord injury.
HIGH TONE PROGRAM:
Mondays & Thursdays @4pm PDT
Starts the week of August 5, 2024
Program includes:
30-minute 1:1 intake call to learn about your specific goals and needs so we can be ready with modifications and challenges for you within the group setting
12 Group Classes (6 “movement flow” classes + 6 coaching calls - see below for more information)
10 page resource guide, outlining the WHY behind our program & exercise list
Weekly journal prompts (if you want!)
Access to class recordings throughout the duration of the program
Texting access to your coach and other ZN coaching clients through the ZN Community on WhatsApp
That’s all for now! Cheers,
Interested in group coaching?
About the Author of this Blog:
Barry Moore has worked with adaptive athletes in various settings since 2014. He blends his experience in adaptive sports, recreation, rehab and holistic wellness, with his formal education (MSc in Kinesiology) to offer well-rounded recovery programs for individuals of various types of neurological injuries and conditions. He fully believes in the phrase “Movement is Medicine” and enjoys finding new ways for his clients to experience movement.