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The spinal cord is a complex part of the body which is integral in allowing people to move around properly, but it is also very sensitive to injury if it occurs. A lot of people know this already to some degree, even if they’ve never personally experienced issues with their own spinal cord before. That’s probably due to what has been observed in media coverage that touches on the matter, including news reports and depictions in TV shows and films. Frankly, the outlook is usually rather scary-looking.
One particular example which has received extensive global media coverage since last year is the ongoing experience of race car driver Robert Wickens (seen in the image below). Following a huge crash during a race last year, Wickens has been on an extensive programme to recover from a spinal cord injury. The process has proven a reminder of how debilitating such an injury can be, but has also delivered some inspirational moments that show the injury is not necessarily as undefeatable as some may assume.
For those that don’t know, Wickens competed last year in the IndyCar Series, one of America’s quickest motorsport championships with the cars capable of reaching speeds in excess of 230mph.
During a race in Pennsylvania on August 19th 2018, Wickens collided with another car at high speed, prompting a violent, high-speed crash which sent Robert’s vehicle airborne into the nearby catch fencing.
Over the following couple of months after the crash, details were released to the public on the extent of the injuries for Wickens while he was still recovering in hospital. In addition to getting fractures in the neck, both hands, the right forearm, one of the elbows, four ribs, the tibia and fibula of both legs and a pulmonary contusion, Wickens also suffered injuries to his spinal cord. A thoracic spinal fracture occurred, meaning bones in the upper back to the mid-back of the spine were damaged and surgery is usually required in response (which Wickens successfully went through). The harm to the spinal cord itself also made Wickens paraplegic, leaving him paralysed from the chest down.
However, as bad as things sounded, there was some hope provided when Wickens publicly confirmed the spinal cord was considered ‘incomplete’.
What makes a spinal cord injury complete or incomplete?
Whether someone can or cannot make a recovery from a spinal cord injury (SCI) mainly depends on if the injury is complete or incomplete. If the injury is considered complete, that means there is a total loss of sensation and muscle function in the body below the level of the injury. If the injury is incomplete, then some function remains below the level of injury.
If the spinal cord is injured enough to be partially or completely severed, then it’s more likely to cause life-long disabilities. However, injuries of this kind rarely mean the spinal cord is severed. What’s most likely to have happened is that there are fractures and compressions in one or several bones that form the spinal column and this damage may have destroyed a few, many or all of the axons in this area. The axons are extensions of the nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body.
Even when a complete spinal cord injury occurs, there may remain some intact axons, or nerves crossing the site of the injury. It’s just that they are not responding correctly due to the physical trauma.
Each case involving a spinal cord injury is different and the future outcome can range from one extreme or another - almost complete recovery to complete paralysis. As long as some nerve function remains in injured areas of the body though, there is potential that the patient can restore more function to the affected areas in the future. To have a shot at this, early treatment followed by an aggressive rehabilitation with assistive devices are all crucial.
Recovering from incomplete injuries
The rehabilitation programme sees patients use what feeling remains in affected limbs to conduct exercise routines. Several hours per week may be put into what exercise can be achieved and numerous supportive aids (equipment and personnel) are involved. The ultimate goal with these routines is to maximise function through affected limbs until more feeling is restored to them over time.
Other benefits of this exercise include improving symptoms of chronic pain and reducing the chance of other illnesses such as depression, anxiety, diabetes and osteoporosis.
When patients, including those in the UK, require therapy for a spinal cord injury there are basically three main types. One is physiotherapy, which covers a broad range of physical routines. Another is hydrotherapy, which involves exercises in warm, shallow water which can help relax the muscles and joints, while also providing resistance to help you gradually get stronger. There is also osteopathy, which is essentially a way of improving the condition of muscles and joints through moving, stretching and massaging techniques.
In the UK, physiotherapy and hydrotherapy are available through the NHS but osteopathy is not, so most people who get that pay for it privately. Besides therapy, UK patients can also get prescriptions for medications that treat neuropathic pain (nerve damage) such as Gabapentin, Pregabalin and Amitriptyline. As of 1st April 2019, Gabapentin and Pregabalin are no longer available from UK online pharmacies, but Amitriptyline can still be ordered from official stores including Doctor4U.
The majority of recovery that can occur takes place within the first six months after injury. Any remaining loss of function present when it’s 12 months after the injury is much more likely to be permanent (but further recovery is not impossible). It’s easier said than done, but maintaining a positive and determined attitude in the face of a gruelling recovery programme with little guarantees is key.
In the case of Wickens, his progress in recovery has been undoubtedly impressive, even for someone who kept himself fit as an athlete competing in a sport. The Canadian has posted numerous updates on social media over the past nine months showing the routines he’s undertaken and progress in recovery, which has included being able to cycle, to swim and even stand without assistance for short spells of time.
Wickens has the ambitious aim of returning to racing, though it remains unclear for now whether he’ll recover enough for that to be possible. But regardless, stories such as these provide inspiring and informative insight into how much people can potentially regain even after experiencing such a nasty injury.
If you’re interested in more insight into how spinal cords work and how they can get injured and treated following an injury, you can check out our blog on Spinal Cord Injury Awareness Day.