Spasticity and pain and the improvement of muscle strength in athletes with partial spinal cord injury

Spasticity and chronic pain are common secondary complications following spinal cord injury (SCI), significantly impacting functional recovery and quality of life. Robot-assisted gait training (RAGT) using the Lokomat has been proposed as an effective rehabilitation method to improve motor function and reduce these symptoms. However, the impact of training frequency on rehabilitation outcomes remains unclear, particularly in athletes and physically active individuals. This study aimed to evaluate the effects of Lokomat training on spasticity reduction, pain alleviation, and improvements in gait function and lower limb muscle strength in athletes and physically active individuals with partial SCI. A total of 45 participants (AIS B-D, chronic SCI) were randomly assigned to three groups: group A (n = 15): Lokomat training once per week, group B (n = 15): Lokomat training twice per week, and group C (n = 15): conventional rehabilitation (control group). Spasticity (SCI-SET), pain (VAS), gait function (WISCI II), and muscle strength (LEMS) were assessed at baseline, week 6, and week 12. Group B (2x/week) demonstrated the greatest improvements, with spasticity and pain reductions of ~50% (p < 0.01, large effect sizes). Gait function (WISCI II) and muscle strength (LEMS) significantly improved compared to Group A (1x/week) and Group C (p < 0.05). Group A showed moderate improvements, while Group C exhibited minimal, non-significant changes. Higher Lokomat training frequency (2x/week) significantly enhances spasticity reduction, pain relief, gait function, and muscle strength recovery. These findings support intensive RAGT protocols for SCI rehabilitation, particularly in athletes seeking optimal functional recovery. A minimum of 2 sessions per week is recommended for maximal neuroplasticity-driven recovery, reinforcing the importance of training intensity and consistency in SCI rehabilitation.