Best Exercises for Spinal Cord Injury: A Comprehensive Guide

By Scihealthhub – November 11, 2024

This post will uncover some of the best physical exercises you can start today as someone living with spinal cord injury (SCI) to improve strength, mobility and wellness. 

Physical exercise is widely recognized for its numerous health benefits, ranging from enhancing physical and cardiovascular fitness to improving mental well-being and reducing the risk of chronic diseases. 

Yet, in today’s fast-paced world, an increasing number of people are becoming physically inactive. According to a World Health Organization (WHO) report , nearly one-third (31%) of the global adult population—approximately 1.8 billion people—are physically inactive (1).

Barriers like insufficient time, lack of motivation, ignorance of the types of exercise to do and the inconvenience of exercise play significant roles in this trend, making it difficult for many to adopt or maintain a consistent exercise routine.

For people with limited mobility, especially those living with spinal cord injuries, these barriers can be even more pronounced. The physical challenges and daily adaptations required to perform even basic activities can make regular exercise seem unfeasible or, at times, out of reach.

Despite the obstacles, it’s imperative to encourage everyone—including those with spinal cord injuries—to prioritize physical exercise in ways that suit their individual abilities and needs.

This guide provides an overview of the best exercises for people with spinal cord injuries, focusing on safe, adaptable routines that enhance mobility, prevent secondary health complications, and boost overall wellness.

Why Exercise is Essential for Spinal Cord Injury

There are numerous immediate and long-term benefits of physical exercise for individuals with spinal cord injury.

Benefits of Exercise:

1. Improved Strength and Endurance: Enhances upper body strength, which is particularly important for wheelchair users.
2. Reduced Risk of Chronic Diseases: Lowers the risk of cardiovascular disease, hypertension, some cancers, and diabetes.
3. Improved Mental Health: Helps reduce stress, anxiety, and feelings of depression.
4. Reduced Risk of Secondary Complications: Lowers the likelihood of developing pressure sores, pain, muscle spasms, and spasticity.
5. Reduced Risk of Excessive Weight Gain
6. Better Sleep Quality
7. Improved Cognitive Health

How Much Physical Exercise is Needed?

Experts recommend specific guidelines on the amount of physical exercise (in terms of frequency, intensity, and duration) needed to gain significant health benefits and reduce health risks.

The World Health Organization (WHO) recommends that all adults engage in at least 150 minutes of moderate-intensity aerobic physical exercise per week, along with strength training exercises on at least 2 days per week. Strength training should focus on all major muscle groups. You can spread out this exercise over a few days throughout the week.

While you should aim to achieve this recommended amount of physical exercise, any amount is better than none. It’s perfectly fine to start small and gradually increase your workouts over time.

Additionally, all physical activity counts, whether it is part of work, house chores, sports, leisure, or transport (e.g., walking, wheeling, and cycling).

Best Exercises for Spinal Cord Injury

This collection includes some of the best exercises for individuals with spinal cord injury, as they address specific physical and health needs commonly affected by spinal cord injury.

We have grouped the exercises into four categories:

1. Upper Body Strength
2. Core Stability
3. Cardiovascular Fitness
4. Flexibility

For a well-rounded, holistic exercise program with maximum benefits, it is advisable to include a mix of exercises from all categories.

Upper Body Strengthening Exercises

Upper body exercises strengthen the chest, shoulders, and arm muscles, enhancing mobility, endurance, and the ability to perform daily tasks.

A. Shoulder Press for Spinal Cord Injury: This exercise helps build shoulder muscles.

Instructions:

Equipment Needed: Dumbbells or resistance bands (choose based on your strength level and availability). If you don’t have dumbbells, you can use two filled water bottles, cans of food, or similar items that provide some weight.

1. Sit upright in your wheelchair or on a stable chair with good back support.
2. Hold a dumbbell in each hand or grip the ends of a resistance band (anchored under your seat or feet) with your palms facing forward, positioning the dumbbells at ear level.
3. Slowly push the dumbbells (or resistance band) upward until your arms are fully extended above your head.
4. Keep your elbows slightly bent at the top to avoid locking them out.
5. Slowly lower the dumbbells back to the starting position at ear level, controlling the movement to engage your shoulder muscles effectively.

Repetitions: Aim for 10-15 repetitions per set and perform 2-3 sets per day.

B. Bicep Curls for Spinal Cord Injury: This exercise helps to improve arm strength and functionality.

Instructions:

Equipment Needed: Dumbbells, resistance bands, or household items (like water bottles or canned goods)

1. Sit upright in your wheelchair or on a stable chair with your back supported.
2. Hold a dumbbell in each hand or grab the ends of a resistance band (anchored under your seat or feet).
3. Keep your elbows close to your body with your arms fully extended and maintain a neutral wrist position (avoid bending your wrists).
4. Slowly bend your elbows, bringing the weights or resistance band handles up towards your shoulders.
5. Focus on squeezing your biceps at the top of the movement.
6. Keep your elbows stationary and close to your sides — only your forearms should move.
7. Gradually lower the weights or band back down to the starting position, fully extending your arms.
8. Control the movement to engage the muscles throughout the exercise.

Repetitions: Aim for 10-15 repetitions per set and perform 2-3 sets per day.

C. Chest Press for Spinal Cord Injury: This exercise targets the chest muscles (pectorals), shoulders, and triceps.

Instructions:

Equipment Needed: Dumbbells, resistance bands, or household items (like filled water bottles or cans)

1. Sit upright in your wheelchair or on a stable chair with good back support.
2. Hold a dumbbell in each hand or grab the ends of a resistance band (anchored behind your back or chair).
3. Start with your elbows bent, holding the weights close to your chest with your palms facing forward.
4. Slowly extend your arms forward, pressing the weights or resistance band handles away from your chest.
5. Keep your movements controlled and push until your arms are fully extended, avoiding locking your elbows.
6. Slowly bend your elbows, bringing the weights or handles back to the starting position at chest level.

Repetitions: Aim for 10-15 repetitions per set and perform 2-3 sets per day.

D. Wheelchair Push-Ups: This exercise builds upper body strength, helps prevent pressure sores, and enhances transfer abilities.

Instructions:

1. Sit upright in a stable wheelchair with locked wheels to prevent movement during the exercise.
2. Place your hands on the armrests and push down to lift your body slightly off the seat. Keep your shoulders aligned with your hips.
3. Hold the lifted position for a few seconds (5-10 seconds).
4. Gradually lower yourself back down to the seat in a controlled manner, avoiding a quick drop.

Repetitions: Start with 5-10 repetitions and increase as your strength improves.

Core Stability Exercises

Core exercises are essential for maintaining balance and posture, reducing strain on the back muscles, and supporting overall function, especially for individuals with spinal cord injury.

A. Prone Back Extension: This exercise strengthens the spinal extensors, which support and stabilize the spine. It helps relieve back pain and improves posture by counteracting the forward slumping often seen in wheelchair users or individuals who spend extended time sitting.

Instructions:

1. Lie face down on a firm bed or mat with your legs straight and toes pointing away from your body.
2. Place your arms by your sides or rest your hands gently under your shoulders with elbows bent (for minimal support if needed).
3. Slowly lift your head, neck, chest, and upper back off the bed, focusing on using your back muscles rather than pushing up with your hands.
4. Keep your gaze slightly forward to avoid straining your neck.
5. Hold this lifted position for a few seconds, feeling the muscles in your back engage.
6. Gently lower yourself back down to the starting position.

Repetitions: Repeat the movement 5-10 times, depending on your strength and comfort level.

B. Seated Torso Twists for Spinal Cord Injury: This exercise helps improve core strength, enhance flexibility, and increase the range of motion in the upper body.

Instructions:

1. Sit upright in your wheelchair or on a stable chair with a backrest.
2. Place your hands together in front of your chest in a prayer-like position.
3. Engage your core muscles to stabilize your torso.
4. Slowly twist your upper body to the right as far as you comfortably can, keeping your hips and lower body stable.
5. Hold the twist for a second or two, focusing on engaging your core muscles.
6. Gradually return to the starting position at the center.
7. Repeat the twist to the left side.

Repetitions: Aim for 10-15 repetitions per set and perform 2-3 sets per day.

C. Pelvic Tilts for Spinal Cord Injury: This exercise helps strengthen the lower abdominal muscles and improves the mobility and stability of the lower back and pelvis.

Instructions:

1. Sit upright in your wheelchair or on a stable chair with a straight back.
2. Place your hands on your thighs or the sides of the chair for support.
3. Gently tilt your pelvis backward while engaging your lower abdominal muscles.
4. Hold this position for 2-3 seconds, focusing on tightening your abdominal muscles.
5. Return your pelvis to its neutral starting position.

Repetitions: Aim for 10-15 repetitions per set and perform 2-3 sets per day.

D. Seated Side Bends for Spinal Cord Injury: This exercise helps enhance trunk stability, balance, and posture.

Instructions:

1. Sit up straight in your wheelchair or chair, keeping your feet flat on the floor.
2. Raise one arm above your head.
3. Slowly lean to the opposite side of the raised arm, as if trying to reach toward the floor with the hand on that side.
4. You should feel a gentle stretch along the side of your torso.
5. Hold the stretch for a few seconds, then slowly return to the upright position.
6. Switch arms and repeat the stretch on the other side.

Repetitions: Aim for 10-15 repetitions per set and perform 2-3 sets per day.

Cardiovascular Exercises

Cardio workouts improve heart health and increase endurance, which is essential for overall fitness.

A. Arm Cycling (Ergometer): This exercise is excellent for cardio and upper body endurance. It strengthens the upper body, enhances endurance, and improves heart health.

Instructions:

Equipment Needed: Arm cycle machine (also known as an upper body ergometer or hand cycle). If an arm cycle machine is unavailable, you can use a manual arm crank or resistance bands.

1. Sit upright in your wheelchair or on a stable chair. Ensure you are positioned comfortably in front of the arm cycle machine.
2. Adjust the seat height or the wheelchair positioning so that your arms are level with the hand pedals.
3. Grasp the hand pedals firmly with both hands, keeping your back straight and shoulders relaxed.
4. Engage your core muscles for added stability during the exercise.
5. Start pedaling with your arms in a forward circular motion, similar to riding a bicycle with your hands.
6. Aim to cycle at a consistent speed, gradually increasing the intensity or resistance as you build endurance.
7. For a balanced workout, try cycling in reverse after completing a forward set to target different muscle groups in your shoulders and upper back.
8. Start with 5-10 minutes of arm cycling if you are a beginner, gradually increasing the duration to 15-30 minutes as your endurance improves.

Alternative Option: If you don’t have access to an arm cycle machine, use a manual arm crank or simulate the cycling motion with light resistance bands.

B. Wheelchair Pushes: This exercise improves cardiovascular fitness while strengthening the upper body.

Instructions:

1. Sit upright in your wheelchair with your back straight. Ensure the brakes are off, and you have a clear, obstacle-free space to move.
2. Position your hands on the wheelchair rims (handrails), keeping your elbows slightly bent.
3. Push the handrails forward in a smooth, controlled motion using your arms and shoulders.
4. Fully extend your arms as you push, moving the wheelchair forward.
5. Once you’ve pushed forward, quickly bring your hands back to the starting position on the rims without losing momentum.
6. Repeat this movement continuously at a steady pace.
7. Perform the exercise in intervals, such as 30 seconds of pushing followed by 30 seconds of rest.

Repetitions: Start with 5-10 repetitions and gradually increase the duration or number of intervals as your strength and endurance improve.

C. Seated Boxing: This exercise helps improve cardiovascular fitness, upper body strength, and coordination.

Instructions:

1. Sit upright in your wheelchair or a sturdy chair with your feet flat on the ground.
2. Hold your hands in front of your face, forming loose fists as if in a traditional boxing stance.
3. Keep your elbows slightly bent and your fists at chin level.
4. Extend one arm forward in a quick punching motion, fully extending your arm but avoiding locking your elbow. Rotate your fist so that your palm faces down as you punch.
5. Follow with the opposite hand in a similar punching motion.
6. Alternate punches in a continuous, rhythmic motion (e.g., jab-cross-jab, or jab-cross-hook-uppercut).
7. Aim to maintain a steady pace for 1-3 minutes per round, taking short breaks in between.
8. Optional: For added resistance, hold light dumbbells or wrist weights while performing the punches.

Range of Motion (ROM) and Stretching Exercises

Range of motion and stretching exercises help maintain flexibility, reduce muscle tightness, and alleviate pain from prolonged sitting.

A. Wrist Circles

Instructions:

1. Slowly rotate your wrists in a circular motion, moving clockwise for 10-15 seconds.
2. Then, reverse the direction, moving counterclockwise for another 10-15 seconds.

B. Shoulder Circles

Instructions:

1. Slowly lift your shoulders up towards your ears.
2. Move your shoulders backward in a circular motion, then lower them and bring them forward to complete the circle.

C. Neck Stretch

Instructions:

1. Side Neck Stretch: Gently tilt your head to the right, bringing your right ear towards your right shoulder. Hold this position for 15-30 seconds, then return your head to the center and repeat on the left side.
2. Forward Neck Stretch: Slowly lower your chin towards your chest, feeling a stretch along the back of your neck. Hold the position for 15-30 seconds, then gently lift your head back to the starting position.
3. Rotational Neck Stretch: Turn your head slowly to the right, as if looking over your shoulder. Hold the stretch for 15-30 seconds, then rotate your head to the left side and hold for the same duration.

D. Passive Stretching for Legs: This typically requires assistance from a partner, therapist, or the use of equipment.

Instructions:

1. Hamstring Stretch:

• Lie flat on your back or sit upright with one leg extended and the other bent.
• With a loop or the assistance of a partner or therapist, gently lift the extended leg, keeping the knee straight until a gentle stretch is felt in the back of the thigh.
• Hold for 15-30 seconds, then switch legs.

2. Quadriceps Stretch:

• Lie on your back or sit with your legs extended.
• Gently bend one knee, bringing your heel toward your glutes until a stretch is felt in the front of the thigh.
• Hold for 15-30 seconds, then switch legs.

3. Calf Stretch:

• Sit with your leg extended and gently pull your toes back toward your shin with a loop or assistance, stretching the calf muscle while keeping your knee straight.
• Hold for 15-30 seconds, then switch legs.

3. Hip Flexor Stretch:

• Lie on your left side with both knees slightly bent.
• A therapist or partner will gently pull the right leg backward while stabilizing the pelvis, stretching the hip flexors.
• Hold for 15-30 seconds, then switch legs.

Safety Tips for Exercising with a Spinal Cord Injury

1. Consult a Healthcare Professional: Always consult your doctor or physical therapist before starting a new exercise program.
2. Adapt Exercises as Needed: Tailor routines based on your injury level and physical capabilities.
3. Monitor for Signs of Fatigue: Avoid overexertion and rest if you experience dizziness, fatigue, or pain.
4. Stay Hydrated: Hydration is essential, especially during cardio or resistance exercises.
5. Use Proper Support Equipment: Adapt cushions, resistance bands, or weights to suit your needs and injury level.

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Conclusion

Regular exercise is a powerful tool for improving strength, flexibility, and cardiovascular health, which in turn enhances independence and quality of life for people with spinal cord injuries. One common barrier to adopting an exercise routine is the lack of knowledge about suitable exercises. This guide aims to address that by providing a comprehensive overview of some of the best exercises tailored for spinal cord injury. To further optimize your routine, consider working with a physical therapist or trainer experienced in spinal cord injuries to ensure a safe and personalized approach for maximum benefit.

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