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Spinal Shock: Why Your SCI May Not Be As Bad As It Initially Seems

doctor explaining spinal shock after SCI

Spinal shock describes the temporary loss of all reflexes, sensation, and motor control below one’s level of injury.

It isn’t until spinal shock subsides that individuals will better understand what functions are or are not affected by spinal cord injury (SCI).

To help you understand what spinal shock is and what to expect, this article will discuss its causes, symptoms, and treatment.

What Causes Spinal Shock?

While the underlying mechanisms of spinal shock have yet to be fully understood, it’s suggested that spinal shock is caused by swelling.

Immediately following SCI, the body attempts to heal itself by activating an inflammatory response. This triggers an outbreak of biochemical reactions in an attempt to protect and stabilize the spinal cord. However, these processes are harsh and can cause secondary damage in the form of cell deaths, inflammation, swelling, and reduced blood flow.

Swelling can further restrict blood flow, which disrupts the delivery of oxygen and other essential nutrients to tissues.  As a result, autoregulation (the ability to maintain a constant blood flow) below the level of injury becomes impaired.

Our bodies need blood to fuel cellular activity. Without sufficient amounts of it, the body can start to dysfunction.

Due to the complete loss of functions, it is possible to mistake an incomplete spinal cord injury for a complete one. It isn’t until the swelling subsides that functions below the level of injury may begin to return. Make sure to speak with your medical team about whether they believe you are in spinal shock or not.

In the next section, we’ll discuss symptoms of spinal shock.

Signs and Symptoms of Spinal Shock

individual with spinal shock explaining symptoms to PT

Individuals typically experience different symptoms depending on how much time has elapsed since their initial injury.

Generally, individuals with spinal shock go from one extreme to the other. Initially, they experience flaccid, limp muscles and an absence of reflexes below their level of injury. Then, symptoms transition to a state of hyperreflexia, where the muscles become extremely reactive to stimulation.  

If a patient has no motor control or sensation following SCI, a physician usually checks for a bulbocavernosus reflex. If the anal sphincter does not contract with stimulation, it indicates that spinal shock is present.

Outlined below is a quick overview of the 4 phases of spinal shock:

  • Phase 1 (0-24 hours): areflexia (absent reflexes)/hyporeflexia (below normal reflexes), flaccid paralysis, loss of sensation
  • Phase 2 (1-3 days): initial reflex return
  • Phase 3 (4 days- 1 month): early hyperreflexia (overactive reflexes)
  • Phase 4 (1-12 months) spasticity/hyperreflexia

Individuals may also initially experience hypotension (low blood pressure) and bradycardia (slow heart rate).

Depending on the severity of the injury, spinal shock can last for days to weeks. The average duration is 4-12 weeks. While an official consensus has yet to be reached, many define the end of spinal shock as “the return of the bulbocavernosus reflex, the recovery of deep tendon reflexes, or the return of reflexic detrusor activity.”

Up next, we’ll discuss how to treat spinal shock.

Spinal Shock Treatment

spinal shock heals on its own over time

One of the primary goals of SCI treatment is to stabilize the spinal cord as quickly as possible. Depending on the severity of the injury, surgical intervention may be necessary. Preventing the progression of secondary damage after an SCI can help minimize swelling and reduce overall damage to the spinal cord.

As a temporary outcome of spinal cord injury, spinal shock is expected to resolve on its own.

Once swelling of the spinal cord starts to die down, blood flow should be restored and individuals may experience a gradual return of reflexes, sensation, and motor control below their level of injury.

The return of any functions below the level of injury is a great sign of recovery. It indicates the SCI is incomplete, meaning that neural connections between the brain and areas innervated below the level of injury exist! Those connections are capable of using neuroplasticity (the central nervous system’s ability to adapt and reorganize itself) to potentially recover affected functions.

Why Your SCI May Not Be as Bad as it Initially Seems

If you’re experiencing a complete loss of reflexes, sensation, and motor control below your level of injury, ask your physician about spinal shock. Often, some functions may return as swelling subsides and blood flow is restored.

We hope this article helped you understand that the initial outcomes of a spinal cord injury are not always permanent and with time, functional outcomes may improve. Good luck!

Photos from top to bottom: iStock/TuiPhotoengineer/Halfpoint

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