Laurance Johnston, Ph.D.
Sponsor: Institute of Spinal Cord Injury, Iceland
1) Body Acupuncture
2) Scalp Acupuncture
Acupuncture: Studies suggest that acupuncture has considerable
potential for treating SCI-associated problems, including, in some
cases, restoring some function. Acupuncture-related therapies stimulate
specific skin points by inserting needles or applying heat, pressure, or
massage. The World Health Organization has listed many disorders
amenable to acupuncture, including those supported by rigorously
designed clinical trials.
Acupuncture evolved from observing that a disorder
was associated with an increased sensitivity in specific skin areas.
These areas were consistently linked to a specific organ and followed a
defined topographical pattern. These patterns or meridians serve as
pathways for a life-force energy called qi.
In his book “Life Force, The Scientific Basis,”
physicist Dr. Claude Swanson (USA) reviews the science that supports
this ancient healing tradition. For example, studies have shown that
acupuncture points and meridians do, indeed, have anatomical and
physiological correlates. For example, acupuncture points correspond to
small (~ 1 mm) skin areas of greatly reduced electrical resistance. The
meridian pathways closely match up to “Bonhan ducts,” which contain an
abundance of biophoton-emitting DNA (perhaps one reflection of qi
energy). Swanson states that a key component contained within these
ducts “may be undifferentiated cells (adult stem cells) which flow to
regions of growth and injury where they specialize into the needed type
of cell, and provide the building blocks for tissue repair.”
Scientists have proposed numerous mediating
physiological mechanisms to help explain acupuncture. The therapy
stimulates neural pathways and neurotransmitter systems. For example, it
stimulates muscle sensory nerves, which send messages to the spinal
cord, midbrain, and pituitary, which, in turn, releases pain-reducing
molecules such as endorphins and cortisol-producing hormones. It has
been shown in rabbits that the effects of acupuncture-induced analgesia
can be transferred to other rabbits through the transfer of
cerebrospinal fluid. In another example, through the release of specific
molecules, acupuncture dilates blood vessels, thereby improving
Under Traditional Chinese Medicine (TCM) theory,
traumatic SCI damages the
Du or Governor meridian, which, in turn, affects qi circulation for the
entire body. The goal of treatment is to clear and activate meridian
channels, reversing qi stagnation.
Evidence suggests that acupuncture has the
potential to restore some function in both acute and chronic SCI.
Virtually all chronic injuries have some intact, but dormant, neurons
running through the injury site. Acupuncture may work by somehow turning
on these dormant neurons. Animal studies suggest that only a small
percentage of turned-on neurons are needed to have significant function.
Several SCI-focused acupuncture studies are
Dr. X. Gao et al (China) treated 261 individuals
with SCI, of which 79% had been injured at least one year. Ninety-five
percent had some improvement, such as improved sensation,
bowel-and-bladder function, spasticity, and walking. The authors
speculate that acupuncture improves regeneration-promoting circulation
around the spinal cord.
Dr. H. J. Wang (China) summarized the treatment of
82 cases of SCI with electroacupuncture of bladder-meridian points
(lateral to the vertebrae). Ninety-three percent accrued functional
benefits, including improved lower-limb and bowel-and-bladder function.
Dr. P. T. Cheng and colleagues (Taiwan) showed that
electroacupuncture-treated patients achieved balanced voiding in fewer
days than controls. Patients starting acupuncture within three weeks of
injury required fewer treatments compared to those treated later.
Dr. A. M. Wong et al., (China) treated acutely
injured patients with electrical and auricular acupuncture starting in
the emergency room and measured functional improvement one-year post
injury with the commonly used ASIA standards. Compared to controls,
treated patients recovered more function.
In eight patients with SCI, Dr. H. Honjo et al.,
(Japan) demonstrated that acupuncture increases bladder capacity,
decreasing urinary incontinence.
Dr. S. Nayak and colleagues (USA) reported that 50%
of acupuncture-treated patients with SCI had chronic pain relief.
Dr. T.A. Dyson-Hudson
et al. (USA) suggested that acupuncture reduced chronic shoulder
pain in wheelchair users with SCI.
Dr. L. M. Rapson
et al. (Canada) treated 36 subjects with below-level central
neuropathic pain characterized by generalized burning with
electroacupuncture. Twenty-four had reduced pain.
Drs. P. T. Dorsher and P.M. McIntosh (USA) reported
a case study of an individual becoming “completely continent of urine
and able to void volitionally after treatment with electroacupuncture.”
A number of potential mechanisms by which
acupuncture could exert beneficial effects after SCI have been
suggested. These include 1) reducing the levels of proteins and cells
(e.g., astrocytes) fostering injury-site scar formation, 2) reducing the
creation of damage-perpetuating free-radicals, 3) lessening spinal cord
atrophy after injury, 4) decreasing stress as measured by the production
of cortisol, 5) raising the levels of various regeneration-enhancing
molecules, 6) increasing blood flow to the area of injury, and 7)
releasing neuroprotective, opioid-mimicking molecules (e.g.,
Acupuncture and Stem Cells:
As discussed above, a key regenerative
component within acupunctural meridians maybe stem or progenitor cells.
In addition, as
discussed earlier, scientists have shown that acupuncture influences
stem-cell expression in several animal models of neurological disorders,
Based on studies in rats with completely transected spinal
cord, Dr Y. Ding and colleagues (China) concluded that
electroacupuncture may promote the survival and differentiation of
transplanted stem cells. Stem-cell transplantation combined with
electroacupuncture “could promote axonal regeneration and partial
locomotor recovery in the transected spinal cord in rats and indicate a
promising avenue of spinal cord injury.”
In another article, the same investigators concluded that
1) electroacupuncture can promote the differentiation of stem cells and
regeneration of nerve fibers in the injured spinal cord through the
induction of neural growth factors, and 2) the combination of
electroacupuncture and stem-cell transplantation can improve partial
function of paralyzed hind limbs.
In another rat study, Dr. Z. Sun et al (China)
demonstrated that treatment with electroacupuncture combined with
bone-marrow-derived stem-cell transplantation restored more function
than either treatment by itself. They attributed this improved outcome
to the enhanced differentiation of the transplanted bone-marrow-derived
stem-cells into neuronal stem cells.
Because of such suggestive studies, as well as the
aforementioned studies indicating that acupuncture can restore some
function in both acute and chronic human SCI, acupuncture has been
incorporated into a number of SCI stem-cell programs.
According to Harvard University’s Dr. Charles
Shang, the acupuncture system and stem cells are closely linked
through an “organizing center network” composed of under-differentiated,
electromagnetically sensitive cells. Confirmed by published studies,
this network is created early in embryogenesis before the formation of
other body systems (e.g., spinal cord) and has the potential to
influence these later-formed systems throughout life. Under this model,
acupuncture has extensive growth-control effects and can trigger network
stem cells into action. As a crude analogy, view the
acupuncture-sensitive “organizing center network” as a behind-the-lines’
general ready to send in green reserve troops (i.e., stem cells) who
will evolve into the front-line combatants replacing those who have
fallen from the attacks of disease, trauma, and aging. In the case of
transplanted stem cells, Shang speculates that they can be recruited
into a new network for repair and regeneration.
“I am a Vietnam veteran. Due to depression
resulting from post-traumatic stress combined with overmedication, I
attempted suicide. I stuck a gun to my chest and shot myself. The
bullet missed my heart and deflected off my sternum into my spine. My
discharge summary reads T-12 SCI, permanent paralysis.”
“After attending a wedding in Bolivia, I hooked
up with a South Korean acupuncturist. I ended up having 30 days of
inexpensive treatment and continued it back home. The speed at which I
am rehabilitating is overpowering. Two weeks ago, I walked on a
treadmill for almost two minutes (kafo on left leg and plastic afo on
right leg). Presently, I can walk 45 feet with the kafo unlocked
assisted by a rolling walker. The improvement I have gained is a
direct result of my acupuncture treatments.”
Scalp Acupuncture is a specialized
form of acupuncture that has helped many people with nervous-system
disorders, including spinal cord dysfunction.
traditional body acupuncture, specific areas, such as the ear, foot, hand,
and scalp represent acupunctural microsystems for the entire body. Through
treating a localized microsystem, health-enhancing energy flow or qi can
be stimulated in virtually any body part.
scalp-acupuncture microsystem can treat most of the same disorders as
traditional acupuncture, it is especially effective in treating
nervous-system disorders and pain. For example, studies have shown that
scalp acupuncture has helped thousands of Chinese stroke patients,
apparently through altering blood hormone levels that influence
stroke-inducing platelet clumping.
numerous people with multiple sclerosis, SCI, ALS, and head injury have
also benefited from scalp acupuncture.
individuals with SCI have been treated by Professor Ming Qing Zhu (CA,
USA), a leading scalp acupuncture proponent and author. Many of his
patients with SCI have accrued significant quality-of-life-enhancing
health benefits, even though treatment was usually initiated long after
acute injury, the most optimal therapeutic window.
Very fine needles are painlessly
inserted at a 15–30 degree angle into the thin layer of scalp tissue in
treatment zones associated with specific body functions
and regions (click on illustration). To stimulate qi flow, the needles are
element of scalp acupuncture is Daoyin, physical and mental activities
simultaneously carried out to direct the qi energy to affected body areas.
Daoyin activities include chest and abdominal breathing, mental
relaxation, massage, joint movements, pushing, pulling, rolling, standing,
While the needles
are inserted, patients are encouraged to move the affected body parts or,
at minimum, visualize the movement accompanied with qigong-based breathing
practices that help direct the qi flow to the intended area. It is
believed that such treatment-associated movement is critical in improving
connections between the central and peripheral nervous system. Even with
paralysis, these movements are encouraged, using, as necessary, assistive
devices or the help of others.
SCALP ACUPUNCTURE CASES
1) In 1997
Alessandro sustained an injury when “A small two-foot wave became an
eight-foot face that took my 6’2, 215 pound body over the falls and
dropped me headlong into the sand below…I immediately heard a crack
…and knew under no uncertain terms that I was paralyzed.”
started scalp acupuncture only 12-days post injury. “My initial
treatment with Zhu in the hospital was not only incredibly and
literally electrifying, but it really made me feel more at ease with
my situation, physically, psychologically, and emotionally,” he says.
“Moreover, Zhu’s therapy significantly aided in getting me off the
pain pills I was taking as well as other drugs.”
In spite of an
original prognosis limiting his future activity to a “sip and puff”
wheelchair, Alessandro has regained considerable function, which he
attributes to scalp acupuncture combined with his rigorous
physical-therapy regimen. Alessandro has regained arm strength, some
wrist control, and hand sensation, enabling him to use a phone handset
and feed himself without a splint. Because he has also regained
abdominal, lower back, and paraspinal muscles, he is almost at the
point of doing unassisted weight shifts and lifting his torso upright
in his standing frame. This additional torso strength has enabled him
to sit for a long time while exercising on his mat table. For example,
he can swing his arms back and forth in an exaggerated walking motion
without assistance or falling over.
2) Tom, 21, sustained T-11-compression and
T-12-burst fractures and was classified as an ASIA-A complete injury.
Seven months after initiating scalp acupuncture, Tom started walking
with a walker and regained considerable bowel-and-bladder function. He
progressed from ASIA A to C in less than a year.
3) Nancy, 23, sustained a C5-7 incomplete
injury due to an auto accident. A few weeks after her injury, she
started scalp and body acupuncture in combination with aggressive
physical rehabilitation. About a half year after injury, she started
to walk with a walker.
Unfortunately, in people with a physical disability,
such as SCI, qi can stagnate and become unbalanced, increasing the
likelihood of illness. Therefore, it is especially important for them to
stimulate qi flow.
Qigong encompasses gentle movements, breathing, and
meditative practices. It is a holistic, mind-body-spirit system of
self-healing, which is one of the world’s most popular healing exercises
in terms of total practitioners.
Qigong & SCI: With slight adjustments,
most exercises are
possible from standing, seated or prone positions, and, in the case of SCI
with or without arm movement.
QIGONG MEDITATIONS & VISUALIZATIONS FOR SCI
4) Ayurveda: Over 5,000
years old, Ayurvedic medicine is one of mankind’s most ancient healing
traditions. It is a mind-body-and-spirit healing approach that attempts to
keep people healthy and disease-free. Ayurveda’s focus is the prevention
of disease, including the sort of chronic health problems that frequently
afflict individuals with SCI.
According to Ayurvedic theory, all individuals are
made up of three basic energies or doshas called vata, pitta,
and kapha. These are present in unique proportions defined at
birth. Like a fingerprint, your characteristic mix, called prakruti,
will distinguish you for life with respect to physical, mental, and
emotional predispositions. It reflects your true, essential self.
Although your prakruti or energetic imprint may be set for life, your
day–to-day mix of vata, pitta, and kapha may vary greatly depending how
well you interact with your environment (e.g., stress, diet, exercise, and
Your current mix is called your vikruti. If
your vikruti is identical to your prakruti (your born-with Ayurvedic
energetic imprint), your health should be excellent. Simply stated, if you
can remain true to who you are from an Ayurvedic perspective, you will be
healthy; if you cannot, you will invite disease.
People with spinal cord dysfunction often have an
increased incidence of chronic health problems, which are aggravated by
the considerable physiological and metabolic shifts that occur after
paralysis. From an Ayurvedic perspective, these shifts increase the
divergence between your vikruti (your current mix of vata, pitta, and
kapha) and your prakruti (your born-with vata-pitta-kapha ideal).
For example, SCI promotes a vata imbalance. If this
is not corrected, ama (toxins) will accumulate, clogging your body’s
channels and, in turn, causing disease. Hence, people with SCI need to be
vigilant in their efforts to regain a good doshic balance, especially with
respect to foods and behaviors.
Toxic impurities that remain
after improper digestion, which is the root cause of many
The three forces (vata, pitta, kapha) responsible for
determining an individual’s constitution controlling the
functions of mind and body.
One of the three doshas; responsible for body structure.
One of the three doshas; responsible for digestion and
One of the three doshas;
responsible for physical and psychological movement, circulation
and nervous system.
Your inherent nature, as expressed by the proportion of the
three doshas you were born with.
Your current state; the ratio of the three doshas that
fluctuates along with your health.
According to animal studies, the Ayurvedic herb
Mimosa pudica (the sensitive or touch-me-not plant) promotes neuronal
health. Specifically, scientists have observed in rats with experimental
injury of the sciatic nerve regeneration was 30-40% higher in the animals
treated with the Mimosa pudica extract.
The author of this report carried out a small pilot
study testing the effects of a multi-herbal product containing Mimosa
pudica in paralyzed veterans (i.e., “Re-Gen
Nerve” from Maharishi Ayur-Ved
Products, Colorado Springs, CO, USA). Twelve men and one woman with an
average age of 52 were recruited, nine with SCI, two with multiple
sclerosis, and one each with spinal meningitis, and spinal cerebellar
degeneration. Although no statistically significant functional
improvements were noted as expected for a small pilot study of limited
duration, subjects reported a variety of subtle effects.
Another commonly used Ayurvedic herb that may
provide some benefit for SCI is ashwagandha (Withania somnifera), a
shrub in the tomato family that is common in the Indian subcontinent.
Traditionally, ashwagandha is considered a rasayana or rejuvenating
herb, as well as an adaptogen, an agent which works to normalize
physiological function. Dr C. Tohda (Japan) has shown that
ashwagandha’s active constituents promoted improved locomotion in mice
5) YOGA: With appropriate
adaptation and assistance, yoga is a valuable healing tool with much to
offer individuals with SCI. Matthew Sanford, a 40-year-old yoga instructor who sustained a
thoracic (T4-6) spinal cord injury (SCI) injury from a 1978 roll-over
auto accident, teaches yoga to others with disability, including all
levels of SCI. His
book Waking: A Memoir of Trauma and Transcendence (2006)
describes how learning yoga helped him to transcend his injury through
better mind-body-spirit integration, and to energetically reconnect to
paralysis-affected body parts.
Through yoga, he has gained a much greater sense of
a mind-body alignment, which he calls presence. Sanford believes we
define sensation too narrowly, in part, because we defer too much to the
limiting opinions of health-care experts rather than cultivating and
listening to the voice from within. By so doing, we shut off the subtle
lines of communication that remain after injury. Yoga helps us hear and
reestablish the link to the inner voice again.
He believes that there are many possibilities for
healing within the mind-body relationship other than walking. Due to
yoga, Sanford has become more present in his body, senses more clarity
in his spine (focal point of yogic awareness) as he moves, is more
grounded and balanced, and his overall strength and movements have an
improved “bang for the buck.” Together these results can produce many
life-enhancing benefits for those with SCI, including, for example, more
efficient transfers, improved bowel-and-bladder sensation, sexual
function, etc. Finally, although downplaying the possibility, by getting
more life-force energy once again moving through areas of
paralysis-associated energy stagnation, yoga may, indeed, cultivate an
environment more conducive to physiological regeneration.
People with SCI do not have the same gross-body
distractions, allowing them to delve deeper into the core of yoga. By
muting the sensory overload, Sanford’s injury facilitated a greater
connection to the life-sustaining energy that flows through his body, a
connection which most able-bodied students strive to achieve. Comparing
his paralysis-affected physicality to an artichoke’s outer layer, he
notes: “I received something in exchange for absorbing so much trauma at
age thirteen. I experienced a more direct contact presence of
consciousness – the heart of the artichoke. Although my life has taken
much away, it has also revealed a powerful insight.”
By learning to sense his subtle electromagnetic
nature through ongoing yoga practice, Sanford connects to his paralyzed
limbs without going though a hard-wired, neuronal connection. So to
speak, Sanford receives information from paralyzed limbs through radio
waves rather than a telephone wire (i.e., neuronal connections). The
transmitted information may be more subtle, but, as receiving ability is
developed, it becomes increasingly rich in informational content – like
the difference between crude Morse code and a TV signal.
Under yoga philosophy, life-force energy prana
is circulated throughout the body through energy channels called
nadis that parallel anatomical structures and are somewhat
comparable to acupuncture meridians. Especially relevant to SCI, the
body’s most important channels are the Shushmana, located in the
spine’s central column (an energetic counterpart of our spinal cord) and
the Ida and Pingala channels (the energetic equivalent of
nerve plexuses that radiate out from the cord) that crisscross through
the Shushmana. The caduceus, medicine’s foremost symbol in which two
snakes intertwine around a staff, is a representation of these
life-force channels. Learning to correctly move energy through
these spinal-cord-related channels through advanced Kundalini
yogic practices can mitigate SCI’s impact.
Basically, like turning up a spigot’s water
pressure or taking the crimp out of the hose that blocks the
life-nurturing flow to the garden, yoga enhances vital-force flow
throughout the body and, in turn, the physiological functions that
support health, such as blood circulation and nervous-system
Yogic poses, called asanas,
are key tools to obtaining benefits. Evolving over the millennia,
standing, sitting, bending, twisting, and reclining poses have been
developed to enhance function in every body part. Various poses,
especially in combination, are prescribed for diverse ailments,
including those involving heart and circulation, respiratory, digestive,
urinary, hormonal, immune, and brain and nervous systems.
Due to his paralysis, Sanford initially emphasized
traditional sitting poses. Unlike able-bodied people who attempt to
physically align themselves with the pose and then perhaps feel the
energy, Sanford teaches “backwards yoga” to students with disability.
Basically, if he feels the right energetic resonance, he attempts to
trace this energetic core back into the physical and outward through his
Pranayama focuses on conscious
breathing and its link to mind and body; it cultivates life-enhancing
flow of prana through the body. Because poses remove
flow-impeding barriers, pranayama’s benefits are best achieved after the
poses have been mastered. Control of inhalation, exhalation, or breath
retention influences the nervous system in different ways. Due to its
power, pranayama should be practiced under the supervision of an
Often done in conjunction with poses or breathing
exercises, meditative practices turn off life’s sensory cacophony
and the ensuing monkey-mind in which thoughts constantly bounce around
our consciousness. Once an individual with SCI learns the various
practices by working with a good teacher, his program should incorporate
solo sessions. This allows one to connect to, bring to the surface, and
better understand deeply ingrained, subconscious beliefs, assumptions,
or issues about the injury that may inhibit healing. For example,
Sanford’s yoga practice triggered “body memories” that helped him
further understand forgotten circumstances surrounding his car accident.
This ultimately led him to a deeper sense of freedom within his
Sanford teaches Iyengar yoga a derivation of
traditional yoga, which emphasizes alignment and precision in poses
adapted to individual needs. This is facilitated through the use of
props as needed, such as wooden blocks, folded blankets, straps, etc.
Individuals with SCI who are considering yoga should attempt to find an
instructor well versed in this tradition.
Dr. Dalia Zwick
(USA) has provided the following tips for teaching Iyengar yoga to
individuals with SCI:
|Treat the whole
|Adjust yoga to
the way all can do it.|
to enhance and build effectiveness.|
to alignment and function.|
|Use weights and
timings to lessen contractures.|
poses or symmetrical postures in an asymmetrical way to gain
flexibility and awareness of structure and functionality.|
and be aware that the intricacies have effects far from the site of
function, control, and mechanics as well as how to use breathing
muscles, including the diaphragm.|
breathing into active and passive postures.|
passive postures are not necessarily passive. They provide the venue
and time to allow things to happen.|
prepares and builds abilities and compliance in range of motion and
strength and positioning sense.|
|Teach as well as
treat so that the client can apply what is done in the session to
daily life and home practice.|
advantage of what’s possible and envision more possibilities than
are on the surface.|
weight-bearing postures in different orientations and different
bases of support.|
|Teach the muscles
to consciously support weight bearing and coordinate with other
muscle groups to share the burden of support.|
increasing circulation, with all of its benefits.|
Overall, Zwick concludes that yoga can be
integrated into an exercise program for clients with SCI to address
issues of strength, flexibility, and physical balance. By so doing, the
therapist can “get them moving toward a better level of functioning in
their daily lives.”
I came to
Iyengar yoga twelve years after my original injury because I
missed my body. I had reached a point where living as if I was
only a floating upper torso was no longer tolerable. I had
grown weary of willfully dragging my paralyzed body through my
life. I wanted to reconnect, to feel my entire body again in
whatever way was still possible. I figured what better way to
start than a four-thousand year old discipline that is expressly
dedicated to the integration of mind, body, and spirit.
years later, I have a vibrant sense of my whole self that I
never believed was possible. The disciplined practice of yoga
has shown me the subtle, energetic connections that exist
between mind and body. These connections are never going to make
me walk again, but they offer a sense of wholeness and vitality
that inform every aspect of my life. I can be "present" within
both the paralyzed and unparalyzed parts of my body. This
realization has given me a profound sense of inward freedom. I
wish the same for everyone.
Matthew Sanford, 2007