Laurance Johnston, Ph.D.

Sponsor: Institute of Spinal Cord Injury, Iceland

1) Body Acupuncture

2) Scalp Acupuncture

3) Qigong

4) Ayurveda

5) Yoga

1) Body 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 circulation.

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 summarized below:

·         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., endorphins).

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, including SCI:

·         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.

2) Scalp Acupuncture is a specialized form of acupuncture that has helped many people with nervous-system disorders, including spinal cord dysfunction. 

Supplementing 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.

Although the 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.

In addition, numerous people with multiple sclerosis, SCI, ALS, and head injury have also benefited from scalp acupuncture.

Numerous 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.

Treatment: 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 periodically manipulated.  

An essential 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, etc.

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.

3) QIGONG: As described earlier, according to Traditional Chinese Medicine (TCM), a life-force energy called qi permeates all living things. Depleted by demands of daily living, qi is naturally replenished through breathing, eating, and closeness to nature; it is deliberately enhanced by meditation, qigong, tai chi, and other principles of traditional Chinese medicine, such as acupuncture.  When qi is consistently diminished, out of balance, or polluted, sickness ensues; its absence means death.

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 author and master Kenneth Cohen (CO, USA) relates a poignant story about teaching a young man with SCI a qigong meditation: “After ten minutes the man began to cry, exclaiming that his legs were sweating for the first time since his car accident several years earlier. He could also feel some warmth in his legs.” Cohen believes these meditations improve blood circulation and potentially repair damaged nerves.

Dr. Roberta Trieschmann (AZ, USA), a preeminent SCI clinical psychologist and author, has incorporated qigong-related elements into her practice to improve the overall health and functioning of people with physical disabilities. For example, by using these practices, an incomplete quadriplegic was able reduce his devastating central cord pain; and a woman legally blind due to multiple sclerosis was able to improve her sight enough to drive and read.

“Both of these individuals were massively depressed by their circumstances and had lost all hope that life could be better for them,” Dr. Treischmann says. “Yet by understanding the role of energy in their life and changing the methods of managing their energy, they have been able to produce change in their function at the physical level even though a myriad of physicians could offer no hope for any improvement in their condition.” 

According to Cohen, “wisdom and wellness go together.”  He adds “One cannot always expect a cure from qigong, but one can always expect some healing,” defining a cure as a “measurable physiological change and healing as improved quality of life, happiness, and self-understanding.” With this perspective, although physiological changes may be modest, improvements to quality of life may be profound.

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 seasonal changes).

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.

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 with SCI.

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 conduction. 

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 paralyzed body.

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 experienced teacher.

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 mind-body relationship.

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:

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.”