In the world of movement methods, there are virtually endless options to choose from when it comes to fitness and wellness. There’s Crossfit for the adrenaline-seekers, yoga for those seeking mindfulness, and dance for those looking to make art of movement itself, just to name a few.

But it's surprising how little the SCI community uses these common movement methods to improve function and wellness after a paralyzing injury.

It seems individuals with SCI gravitate towards limited forms of therapy (no doubt directed by our medical insurance system) without consideration for the movement methods that have a sound reputation for healing, or even the movement programs individuals engaged in before their injury. However, these unpopular-for-SCI-recovery movement methods offer so much towards the development of physical and psychological recovery after SCI and should not be overlooked!

Through our program at Zebrafish Neuro and this blog, we aim to share our story of how Pilates, fascial systems, and other forms of movement have shaped the recovery programs (and lives) of so many individuals living with paralysis.

From here on out, we’ll refer to ‘individuals with SCI’ as ‘SCI athletes’ for simplicity.

“Now what?”

Zebrafish Neuro co-founder, Theo St. Francis (C6 incomplete SCI athlete) found himself in quite the familiar predicament for most individuals with SCI, leaving the hospital thinking: “Now what?” 

Like many, Theo exhausted every ounce of what physical therapy and activity-based programming offered, but still felt a plateau in progress. One day he finally turned to me, his lead ABT trainer at the time, and said: “Now what?”

Up until that point, we had always chalked it up to needing “more reps and more time! Just keep doing the same thing until something changes!”

But after a while, this didn’t sound much different to us than Einstein’s definition of insanity: doing the same thing over and over and expecting different results. Not only that, but it eliminated any control Theo had over his recovery process. 

It was time for Theo, and many other clients who were not responding well to traditional protocols, to try another approach to healing and movement recovery.

So we set out to study all sorts of movement methods and healing modalities including Pilates, Bartenieff Fundamentals/dance studies, Gyrotonics, primal movement, movement based on fascial systems/biotensegrity, and infant development progressions. From our exploration, we pulled what felt like the most relevant parts of each modality and consolidated them into our current approach to SCI recovery: one that offered an analytical and step-wise approach to movement progressions that followed natural human movement - the way we were designed to move.

Four Applied Systems in Zebrafish Neuro

We've incorporated four main movement systems for our SCI recovery approach. We always credit these systems in our resources, making it clear we're not claiming the exercises and concepts as our own. You can't patent movement, after all! 

While we don’t have formal case studies to share specifically how these systems support our SCI athlete’s goals, these movement methods are already widely recognized, studied, and used globally. If they can successfully support healing and wellness in other populations, why not confidently use them for recovery after SCI? 

Let’s take a look at each of these systems and how we have observed them support SCI athletes using them in their recovery programs:

Foundations in motor development progression

Most of us have witnessed (in some capacity) the incredible process of an infant learning to move and coordinate their bodies in their first year or two of life. It’s an incredible journey that they fumble through, without the help of a training manual or coach, yet the process unfolds so beautifully bringing us from helpless bodies on our backs to dynamic beings walking, running, and playing around the house.

The motor development progression (MDP) refers to the specific sequence of movements and positions that infants go through on their way to learning how to walk and run. In a basic review, the positions and movements are:

(Re-) learning movement through the MDP in this sequence ensures that no foundation is left unchecked: the specific development of strength, mobility, and coordination learned at each phase ensures success in the next position. Without the foundations learned in, for example, supine, prone, and side-lying positions, there is just far too much going on in quadruped for us to introduce at once and keep track of.

We’re not naive to the fact that infants have fully intact nervous systems, and learning through the MDP at that age is a little different than using it for learning movement after SCI. However, it does provide insight into what foundational strengths need to be developed to be successful in others. 

A template like the MDP provides a lot of clarity for SCI athletes and neuro rehab clinicians to know what exercises to do and in what order. Our SCI athletes finally have a ‘map’ for their motor development trajectory with standards for when they can ‘graduate’ to the next level - they always know exactly where they are on that continuum and what they need to do to advance. What an empowering piece for SCI recovery plans!

Connectivity brought to us by fascial systems

The MDP lacks some nuance when it comes to body connection after paralysis: again, the MDP assumes a fully functioning nervous system. This is where our fascial chains come into the picture.

A little background on fascia: fascia is a type of connective tissue that surrounds every muscle, organ, bone, nerve, and vessel in our body. I think of it like Seran wrap: holding all of our bits together. Anatomists have known about fascia for a long time, but in the past, it’s been discarded in dissections as the annoying white fuzz that is in the way of the good stuff. Fascia has only recently been recognized and respected for its incredible functions including force transmission, joint stability, nerve conduction, and sensory information. 

What makes fascia interesting for those with reduced muscle tone (due to spinal cord injury and/or muscle loss) is its material properties that offer an alternative source of structure and stability, for example, in our core and trunk. When we move in and leverage our fascia, we can hold our positions and postures with much less effort.

How does this work? You know how when you stretch an elastic tissue (like a muscle or a rubber band), the diameter of that tissue gets smaller? Smaller diameters of tissues (cross-sectional area) are generally weaker. Not ideal for our bodies to rely solely on this kind of tissue for joint structure, which is why we also have fascia surrounding each muscle.

When you stretch the fascia, the tissue expands, rather than getting smaller! This auxetic property allows us to generate tensile strength in our bodies without having to contract muscles. Pretty exciting for SCI athletes who have a hard time contracting muscles in the first place… 

The key to leveraging this very special feature of fascia is understanding how to best create this stretch. And that takes understanding how fascial chains exist in our body.

Thomas Myers popularized fascial chains in his book Anatomy Trains in 2014, describing seven different chains of connective tissue that run from tip to toe. Each has its characteristics and function in joint/body stabilization and movement generation. 

In our programs, we ‘access’ these different fascial lines through specific positions of the head and shoulder blades. For example, the Spiral Line is best accessed through the serratus anterior muscle (what we like to call the ‘armpit muscle’) and through upward rotation of the scapula. This position of the shoulder blade increases (good) tone in the oblique abdominals and supports symmetrical seated postures. We find a lot of our SCI athletes have asymmetrical seated posture due to decreased muscle tone on one side of their trunk. The activation of the Spiral Line helps bring their posture back to their midline.

Our SCI athletes find that these specific stretch strategies leveraging facial tension give them enough joint integrity for decreased low back pain, more integration for smoother transfers, the ability to sit up taller, and efficiency in gait. Fascial connections give a sense of “body wholeness,” a perception of self that can be challenging when 50%+ of the body has lost sensation or function after SCI. 

Safe exploration & kinesthetic feedback from Pilates [equipment]

My very first exposure to anything Pilates was watching a teacher work with a neuro client on a piece of Pilates equipment called a Trapeze Table: springs suspended from a canopy, supporting the weight of the client’s legs while they moved them with such ease in a relatively gravity-free environment. My mind was blown: I no longer had to bear the weight of my client’s limbs during their “range of motion” hip mobility warm-up!? And that was just the beginning.

The Pilates method is more than the equipment: it originated as a rich repertoire of exercises designed to work and integrate the entire body on a mat. The equipment came later as a way to refine (and support) bodies in their journey to learning complex calisthenics. And that’s exactly how we use Pilates equipment for our SCI clients: the equipment offers the perfect balance of support and resistance to allow SCI athletes with limited movement, to move. 

Many of our SCI athletes feel that Pilates equipment provides a similar experience to being in the water. In both environments, individuals can explore movement and build strength in positions that otherwise feel too “heavy” in real life.

Pilates uses springs as its primary form of resistance, and in our program, support. Any changes in the client’s position, weight shift, or effort are reflected in the springs (this is called dynamic support) - for better or worse! Instead of a rigid piece of equipment or a trainer/therapist holding up the body, the individual must work to keep in balance with the spring’s support. This kinesthetic feedback quickly helps individuals understand their own alignment, weight shifting tendencies, and level of effort through feeling - a much faster way to learn movement concepts vs. verbal cueing from our coaches.

While we understand not everyone can afford pilates equipment in their homes, we have been able to recreate pilates equipment and the exercises we do on them, at home. For example, this common seated posture exercise in Pilates can be practiced at home using resistance bands anchored to a point on the wall! Pilates-inspired exercises make at-home recovery programs much more accessible and sustainable for the long term.

Full body integration and expression from Bartenieff Fundamentals

Where the prior three movement systems focus on physiology and movement science, our last system provides an alternative way to discuss and experience movement for those less anatomy-inclined. 

Bartenieff Fundamentals is commonly studied in the dance world where form, shape, emotion, expression, and effort drive movement (vs. your glute muscles or spiral fascial line in other systems). 

There are a lot of layers to Bartenieff Fundamentals, but the verbal cueing used in the method is most helpful for getting clients out of their heads and into their bodies: moving from feeling and expression vs. direction. For example, instead of asking someone to “roll onto their back,” I might say “pour onto your back.”

For those with high tone and tendencies to co-contract everything in their body when asked to move, the imagery of ‘pouring’ generally promotes relaxation and suppleness, allowing our clients to move more fluidly. What a relief to move freely in a body that’s usually so rigid!

In addition, Bartenieff Fundamentals is always done on the floor - a place where full-body movement is safe and unlimited. Clients usually share how expressively limited they feel in their wheelchairs, while this movement system as a whole allows for the full expansion of their bodies and personalities. This outlet not only supports physical growth but psychosocial development as well.

A curated approach for every body

We can all agree that there is no one protocol for how to reconnect a paralyzed body: everybody is much too different from the next to have a singular system. But with an approach that draws from several systems and methods, we can emphasize one or two systems within a program to cater to the individual in front of us. We tend to ask the following questions when curating this approach:

1. How far out is this person out from their initial injury?

2. What is their mindset towards healing and recovery?

3. How much tone does this person have on a day-to-day basis?

4. Are/were they an athlete before their injury?

5. What kind of learning style do they have? How do they absorb information?

6. What kind of depth are they looking for in their recovery?

7. How does their body respond to stimuli X, Y, and Z?

Our results

The exercises we use are simple, building foundational strength and stability from the ground up ensuring that no box is left unchecked. While our approach does not guarantee individuals with SCI will walk, it does prepare the body for all kinds of complex movements, walking and standing being some of them. We recently had a client tell us that our approach helped them find the ‘missing link’ in her standing and walking stability, while we did very little of those specific positions in her program. 

With the strategic implementation of exercises in appropriate progressions, our SCI athletes gain confidence in their bodies which inevitably carries into confidence in their lives: school, work, families, and relationships. This element of the recovery process, a return to life, is an important outcome measure to consider when evaluating the success of a program. 

Movement heals

While the frontiers of SCI recovery research are exciting, we encourage all SCI athletes and neuro rehab professionals to stay grounded (literally and figuratively) with a foundational important part of the equation. We encourage SCI athletes to find what movement methods feel best for now and be open to other options as the body and priorities change over time. The best form of therapy for you at this time might be right under your nose.

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About the Author of this Blog:

Stephanie Comella has been working with individuals with spinal cord injuries since 2011. She blends her formal education in movement science, Pilates, and other mindful movement modalities with neurological science to provide an intuitive, hands-on style of teaching focused on body re-connection. Stephanie aims to empower both individuals with SCI and their trainers using a human-powered healing approach.

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.