Spinal cord injuries can cause a bruise, hemorrhage or laceration in the spinal cord. There is often concern about using bodywork under these sorts of circumstances. These damages can result in short- and long-term motor and sensory disability. You certainly want to be clear with the client and with their physician about any contraindications.

The level of symptoms will differ depending on the level of the trauma.

• Above C3. A serious spinal cord injury above C3 means that the client will have a respirator to survive and that the diaphragm has lost its ability to function.
• Above C5. An injury above C5 can result in the lower and upper extremities being paralyzed.
• Below T1. Below T1 the lower extremities may be paralyzed but movement in the upper extremity is retained.

Sensory changes and dramatically increased deep tendon reflex responses also occur as a result of spinal cord injury. Bowel and bladder control may be lost, with an increased susceptibility to bladder stones. Increased blood pressure, heightened perspiration levels and headache. If you are dealing with someone confined to a wheelchair or bed for that matter, decubitus ulcers, thrombosis, osteoporosis from lack of weight-bearing exercise, and swelling of the lower extremities from inactivity are also things to be watchful of. Spinal cord injuries usually cause spastic paralysis, in which the involved muscles have highly exaggerated tone. The flexor muscles tend to be more hypertonic that the extensor muscles, so the client with a spinal cord injury may appear to be in a permanently flexed position throughout the body.

You must always remember when treating a client with a spinal cord injury that the presence of sensory deficits requires caution since a client might not be able to feel when they are experiencing pain. Associated problems such as increased blood pressure, thrombosis, osteoporosis and spastic paralysis should inspire great caution in the therapist because these conditions can contraindicate massage. Decubitus ulcers should not be massaged. Your client will receive spasm relief, edema reduction, range of motion improvement, restoring of motor function, stress reduction, and of course circulation increase.

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