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Body image and acceptance after spinal cord injury

Self-love coach, nutritionist and yoga teacher, Casey Gemma, shares how her body image changed following SCI and how she has found acceptance of her new physique.

In the early stages of spinal cord injury, watching our bodies physically change can be a constant reminder of how our lives have changed.  I witnessed the rapid muscle atrophy in my once strong legs. I noticed my belly sticking out, as I had lost the muscles in my abdomen and looked permanently bloated. It was a daily reminder that I could no longer use my legs or core. I felt I had lost all control over my own body, I felt weak.

Body composition changes quite quickly after a SCI and we are likely to see an increase in body fat and a decrease in muscle mass below the level of injury. Although this may seem insignificant in comparison to loss of sensation and function, it can be very difficult to witness our bodies changing out of our control. This was certainly true for me.

I am a T8 complete paraplegic and at the time of my accident, I was the strongest and fittest I had ever been. By the time I was weighed in hospital, a few weeks after my accident, I had lost 10kg. I remember being so shocked looking in the mirror. I thought I looked so weak, and barely recognised myself and my own body.


Acceptance for me began when my physio, Kirsty, entered the room with some small weights and resistance bands, smiling. I began strengthening the areas of my body that I could still control. Then came a deeper level of acceptance. ‘I am alive’ I told myself. I’m nearly two years into my injury now, my body looks completely different to how it did pre-injury but 90% of the time I am okay with that.

My ten steps towards improving your body image

  1. Try not to compare your post-injury body, to your pre-injury body
  2. Review your social media and mute any accounts or posts that you feel drawn to compare yourself to. Follow more accounts that make you feel good instead, especially other SCI warriors!
  3. Write down all your positive qualities aside from appearance… and remind yourself of these daily
  4. Wear clothes that make you feel good. Treat yourself to some new outfits that compliment your post-injury body
  5. Create a healthy bowel routine and eat plenty of probiotics (good bacteria) to reduce bloating
  6. Eat a healthy diet with plenty of protein and veggies, aiming for three healthy meals a day to preserve muscle mass and stay a healthy weight. Reach out to a nutrition expert if you are struggling
  7. On most days, aim to do a physical activity that you enjoy. This will help you to stay healthy and manage your weight
  8. Try some SCI specific yoga and/or mindfulness to reconnect to your post-SCI body
  9. Remember how much your body has been through and write a thank you letter, or a gratitude list, reminding yourself to focus on what your body can still do rather than how it looks
  10. And on days when all else fails and negative self-talk sets in, replace it with positive self-talk even if you have to ‘fake it until you make it’!

Further information

This story appeared in the Spring 2023 issue of our magazine FORWARD as part of our daily living section. If you would like to receive regular copies of FORWARD by post or email, visit our shop to subscribe.