Ludwig Guttmann was born in Germany in 1899 and met his first spinal injury patient in 1917 while working at the Hospital in Konigshutte. A coal miner had broken his back in an accident in the mine. As was generally the case at the time, the miner died five weeks later from sepsis. By 1933 Dr. Guttmann was considered the top neurosurgeon in Germany, but with the arrival of the Nazis in power, he was consigned to working at the Jewish hospital in Breslau. Being a Jew himself he was not allowed to practice medicine professionally. In early 1939 he managed to leave Germany with his wife and children and came to England as a refugee, where he soon resumed his career as a doctor, specialising in neurosurgery.
In September 1943 the British Government asked Dr. Guttmann to establish the National Spinal Injuries Centre at Stoke Mandeville Hospital in Buckinghamshire. There were many soldiers wounded with spinal injuries and Guttmann believed that he could help them survive such injuries and go on to live fulfilling lives. Until Dr. Guttmann began this work, spinally injured patients tended to live for only about six months before dying, either from urinary tract infection or from septicaemia as a result of pressure sores. It wasn’t so much neurosurgery as the improvements he made in the nursing skills that enabled patients to survive, but surviving is only half the battle. The real challenge is to find a way of living following a spinal injury and this is where his rehabilitation strategy came into play.
Dr. Guttmann used sport as a way of motivating people to carry on with life as a wheelchair user. Sport, or games, not only provided for exercise, but more importantly for social engagement. Partaking in not just activity, but physical activity, enabled people to realise that there could be life after spinal injury. On the same day that the Olympics started in London in 1948, the first Stoke Mandeville Games were held. The Games became an annual event and soon an international event. They then evolved to become the Paralympics which was initially the Paraplegic Olympics and only later grew to encompass all types of disability.
Nearly seventy years after survival with spinal injury became a real possibility, very little has changed. The nursing skills have continued to improve and it is no longer just the paraplegics that can be saved, but also tetraplegics with neck breaks and even those with such a severe spinal injury that they cannot breath unaided and require the constant support of a breathing machine. However, the rehabilitation strategy has stayed exactly the same, being based upon conscious muscular effort to achieve limited mobility as a wheelchair user, with encouragement to take up sport figuring strongly. The question is, did Dr. Guttmann have it so right in his rehabilitation strategy that it is still the best way forward today or are we stuck in the past and failing to move on from the good work that Guttmann started.
When I broke my back, sixteen years ago, I knew no other approach than to achieve what I could through my own conscious muscular effort and this was the approach promoted within the physiotherapy gym in the spinal unit. At the back of my mind I never gave up hope of recovering from the injury, but it was always drummed into you that you had to accept that paralysis was permanent and had to learn to live with the bodily function you were left with. So this is what I did and after seven months I left hospital and did my best to embrace life as a paraplegic. I’m sure that people in spinal units this summer will have been inspired by the paralympics, but for me it was posters of paraplegics skiing and climbing hills that inspired me. A charity called Back Up, started by a skier who broke his back, organise outward bound events for the spinally injured and three months after leaving hospital I was in the Lake District on an adventure holiday with Back Up. We climbed a hill, canoed, sailed, camped, abseiled, rode a horse and had a fantastic time. There seemed no better way of realising what could be achieved as a paraplegic.
There’s more to life than holidays, but nonetheless I continued to pursue the active outdoor life, trekking around with dogs, climbing hills, rafting down rivers and camping out. This may not have been games or paralympics, but it was the social sporting activity that Dr. Guttmann advocated and it was giving me a life worth living. However, there is only so much you can push yourself to physically achieve as a paraplegic without further affecting your state of health. The reality is that all paraplegics are terribly badly damaged and live in bodies that lack the ability to function properly in the sense of physical activity. My dog can live with three legs, but no animal could live as a paraplegic. Only a human can do so because only a human can use his mind to compensate for lack of physical ability, but there is a price to pay for this. As paraplegics we have to cheat our own bodies in order to undertake all aspects of our physical lives. In gentle day to day living this does not present too much of a problem, but the more we excel in physical activity, the more we compound the problems and further heighten the disability.
It wasn’t long before I realised that active exercise, particularly anything competitive, was not the way to conquer spinal injury. A certain amount of activity is necessary to maintain a degree of strength and function, but I learnt that the art of living with disability is to always be kind to the body and to learn to do things in ways that puts the least stress upon it. I have actually always lived an active outdoor life, but more and more became extremely careful not to use my body beyond its limits. It wasn’t until I met Leonid Blyum and became involved in Advanced Bio-Mechanical Rehabilitation that I found the path that needed to be trod in order to conquer spinal injury. The body is so depleted in quality by a spinal injury that it is impossible to recover through conscious effort, but through the techniques of ABR Therapy it is possible to deliver a mechanical input into the body, by hand, to slowly but surely rebuild the damaged structure. Something that I have been doing for the last eleven years with a great deal of success in making substantial progress towards conquering spinal injury.
There may be those that curse Dr. Guttmann for ensuring that people survived following a spinal injury, but personally I thank him and believe that he undertook enormously important work in the progress of mankind’s evolution. However, if we are to honour Dr. Ludwig Guttmann we must not think that the future of spinal injury rehabilitation ends with his work and we must always strive to find a way of improving the lot of the spinally injured. Guttmann showed it was possible to survive a spinal injury and helped people to find a life through sport. Now we must take this further and learn to instil true health back into para and tetraplegics. I hope that I can do something to show the way.