After spinal cord injury, survivors may struggle with movement, coordination, or other worse effects. To restore strength and function, exercises are recommended. Exercises help to move the joints through their full range of motion, this prevents stiffness and promotes circulation in the paralyzed or weakened areas of the body thus promoting function and recovery. This blog will explore some of the most effective exercises for spinal cord injury that help rebuild strength and flexibility. But before doing these exercises you should check with your physiotherapist before adding these new exercises to your regimen to make sure they are safe for you.

Spinal Cord Injury Rehabilitation
The level of the spinal cord injury is an important factor to consider when designing a treatment plan or rehabilitation program because it determines which functions are affected, such as high-level injuries, as cervical spine injury can result in weakness or paralysis in both the arms and legs.
Movement is affected by the level of spinal cord injury, whereas lower-level spinal cord injuries may not affect arm function. For example, patients with C1-C4 complete spinal cord injury may affect hand function, whereas those with C8-T1 injury may have full wrist and hand control.

Exercises should match the ability level. If the patient is unable to perform a particular exercise actively, then should try active-assisted or passively with the help of a family member or caregiver. With time and a lot of repetition and practice, the patient can progress toward doing the exercises more independently.
Every spinal cord injury has different functional outcomes, most spinal cord injury patients can perform passive range of motion exercises. These exercises do not require the patient to exert their energy, a physiotherapist or caregiver moves the patient’s body. Patients who have more control of their movements should try to perform the range of motion exercises on their own.
Passive range of motion exercises should be done at least once daily to minimize tightness in the joints and stimulate the nervous system. With more consistent practice mobility and endurance also improves. These exercises reduce muscle atrophy and increase circulation. After spinal cord injury, core exercises are also essential because they help stabilize the trunk for better balance and posture.

Mentioned below are the various examples of passive range of motion exercises that can be done by the patient with the help of a therapist.

Deep Breathing:
For deep, diaphragmatic breathing, the patient should be able to see and feel his abdomen rise with his inhales and fall with his exhales. This is the easiest to practice:

  • The patient lies on his back with his hand on his belly so that he can feel it moving.
  • Focus on taking slow, deep breaths will help strengthen the core and increase oxygen intake to optimize body functions.

Shoulder Flexion
  • The patient’s arm should relax by the side.
  • The therapist raises the arm of the patient out in front, reaching as high as possible without pain.
  • Prevent the shoulder from shrugging upward and keep the rest of the body aligned.
  • Then the therapist can support the arm as it comes back down to the side and repeat.
Elbow Flexion
  • The arm should be relaxed and the hand facing the side.
  • The therapist should gently bend the elbow, rotating the forearm so that the hand turns toward the shoulder.
  • Bend the elbow without pain. Then relax the arm and repeat.
  • The patient is also made to perform elbow extension, supination, and pronation.
Knee Extension
  • The patient should be sitting.
  • The therapist slowly moves the patient’s leg upwards until his knee is nearly straight.
  • Gently bring the legs back down into the starting position, and repeat.
Ankle Dorsiflexion
  • The patient is seated on a chair or by the bedside.
  • The therapist raises the patient’s toes up toward the calf, then relaxes back to a neutral position.
  • Again, stop if the patient feels any pain.
Ankle Pumps
  • The patient sits on a chair or lies down on his back.
  • The therapist points the patient’s toes down so that the ankle is extended.
  • Then raise the feet upwards towards the knees to flex the ankles.
Knees to Chest
  • The patient lies on the bed.
  • The therapist places the patient’s hand on the upper leg just above the knee and asks the patient to bend the knee with the opposite foot so that it reaches toward his chest.
  • Then bring his foot down and straighten the knee.
Straight Leg Lifts
  • The patient lies down with the legs straightened.
  • The therapist lifts the patient’s leg without bending at the knees.
  • When the leg is high so that the patient feels the stretch, hold for a few seconds.
  • The therapist then brings the leg back down and alternates with the other leg.
Seated Marching
  • The patient sits at the edge of the seat with both feet on the ground.
  • Then the therapist alternately lifts the knees one at a time.
  • This leg exercise allows the patient to practice movements used while walking without added pressure on their joints.
Arm Circles
  • The therapist puts the patient’s arms out to the side so that body makes a “T” shape.
  • Then the therapist moves the arms in a circular motion going forward and backward.
  • The therapist can alternate between making large circular motions or smaller ones.
Making O’s and Fists
  • The therapist can use the patient’s one or both hands.
  • The therapist assists the patient in alternate tapping the tips of each finger to the thumb.
  • After touching each finger, the therapist can also assist in closing the hand into a fist.
  • The patient holds a few seconds or as long as he can and straightens the fingers back out.
Wrist Extension
  • The therapist holds the patient’s arm out in front of him with the palm facing down.
  • Then asks the patient to hold with the other hand to grab the palm and pull it back up. 
Separating Fingers
  • The patient lies the hand flat on a tabletop or wall.
  • Then the therapist assists him by spreading the fingers apart and bringing them back together.
Back Extensor Isometric Hold 
  • The patient is made to sit at the edge of the seat and lean back against the chair.
  • Hold for a few seconds or as long as he can and use his core muscles to sit up straight again.
Seated Trunk Flexion
  • The patient sits in a chair.
  • The therapist assists him in slowly leaning forward as far as he can comfortably.
  • The patient tries reaching his hands to the floor.
  • Then the therapist assists him to use his back muscles to slowly sit back up.
  • If the patient has trouble with his sitting balance, be sure that the therapist is nearby to spot the patient during this exercise.
Trunk Rotation
  • The patient lies down.
  • The therapist can bend his knees and place the patient’s feet flat on the floor.
  • Try to keep the shoulders and upper body firmly on the floor.
  • Tighten the abdominal muscles and relax the knees down toward the floor on one side of the body, then the other.
Supine Twist:
  • The patient lies on the back with the knees bent and feet flat on the bed.
  • The therapist assists by slowly letting the patient’s knees fall to one side, without moving his shoulders.
  • Bring them back to the center, and then twist to the other side.
  • The patient lies on the floor or on the bed with feet about shoulder-width apart.
  • The therapist slowly assists the patient to lift the upper body forward and lowers it gradually back down.
Seated Side Crunch:
  • The patient is seated, and the therapist helps to tilt the patient’s upper body to one side and hold for 5 seconds.
  • Then return back to the center and repeat to the other side without moving the lower body.
Figure 8s:
  • The patient sits at the edge of the seat.
  • The therapist slowly moves the torso in a figure 8 motion.
  • Moves the patient clockwise and anti-clockwise after every 3 rotations.
Kneeling Planks:
  • The patient lies with his hands and knees on the floor.
  • The therapist helps the patient adjust the body so there’s a straight downward slope from the head to the knees.
  • The patient holds this position for 20 seconds.
  • In case it is too difficult, bend the patient’s arms at the elbows and transfer the weight onto the forearms for greater stability.

As the patient begins to recover and is able to do these exercises with less help from the therapist, then he can continue doing these exercises actively with breaks in between. Further, performing the exercises on his own without help can increase his endurance and strength, and difficulty can be increased by adding resistance by using weights, a stability ball, increasing repetitions, etc.