Practicing spinal cord injury shoulder exercises consistently can help increase range of motion, lengthen stiff muscles, and reduce pain. Shoulder pain is often caused by overusing the arm after a spinal cord injury.

Some survivors may also experience weakness or immobility in the shoulders. If the shoulders are neglected for too long, it can create more serious issues inside the shoulder joint. Therefore, movement is essential.

For many survivors, shoulder exercises can help improve mobility and range-of-motion, which may also help reduce pain. This article will discuss some of the most effective SCI shoulder exercises you can try with your therapist or at home.

To have a better understanding how these exercises are beneficial, let’s explore how a spinal cord injury affects the shoulder blades and muscles.

How a Spinal Cord Injury Affects the Shoulder Muscles

The presence of shoulder pain and weakness often depends on the type of spinal cord injury (complete or incomplete) and the level of injury. Typically, movement and/or sensation below the level of spinal cord injury are affected. For example, an injury at or above the shoulders (C5 or higher) causes weakness in the shoulders.

With a C6 level of spinal cord injury or lower, the shoulders may not be directly impacted. However, many may struggle with weakness or paralysis in the legs, potentially requiring the use of a wheelchair. As such, the arm and shoulder muscles may become overworked during wheelchair use, resulting in pain and even injury. 

Fortunately, exercise can help reduce pain and improve muscle strength and mobility in the shoulders. Exercise stimulates the spinal cord and activates neuroplasticity, the nervous system’s ability to heal and rewire itself. Neuroplasticity is most effective through high repetition of exercises, or massed practice. The more you practice, the higher the chances of rebuilding shoulder muscle strength and increasing movement.

Not only does exercise help activate neuroplasticity, but it can also help prevent shoulder complications from worsening into subluxation (partial dislocation) or other conditions.

Therefore it’s essential to find the most suitable spinal cord injury shoulder exercises for you. You should run them by your physical therapist to make sure they are safe for you, and you can also ask your therapist for more exercise recommendations. 

Performing SCI Shoulder Exercises Safely in a Wheelchair

As previously mentioned, a lower-level spinal cord injury (typically T2 or lower) doesn’t usually affect the upper body. However some may still experience shoulder pain due to overuse of the muscles, particularly survivors with paraplegia. This can include wheelchair propulsion uphill, transfers, and reaching overhead especially during activities of daily living.

SCI survivors who experience shoulder pain can also have injured rotator cuff tendons, which include the sections of the small muscles that attach the bone of the arm. Rotator cuff tendons provide support to the shoulders to help it move properly.

When a shoulder does not move properly, the rotator cuff tendons can become overcrowded or pinched (impingement syndrome). This condition can be painful and can cause tears in the tendons which can create further damage. Additionally, improper movement of the shoulders can lead to painful arthritis.

Spinal cord injury shoulder exercises can help reduce pain and strengthen the tendons. However, because the shoulders are vulnerable and being used excessively, it’s crucial NOT to overwork them even more. Performing daily activities should not feel overly strenuous or create more pain.

Working with physical and occupational therapists is important because they can provide realistic solutions to perform daily tasks more comfortably, while you work on improving your strength.

Once cleared by your therapist, you can try the following spinal cord injury shoulder exercises to boost mobility. Just be sure to take precautions such as taking necessary breaks and stopping immediately if you feel fatigued or any pain or discomfort.

11 Spinal Cord Injury Shoulder Exercises to Boost Mobility

Spinal cord injury shoulder exercises can be done passively or actively depending on the severity of the injury and your ability level. Passive exercise involves assisting your affected muscles through a movement. You can use your unaffected side to assist you or a trained caregiver or therapist can help.

Active exercise involves making the movement on your own and is usually done without assistance. Both passive and active exercise helps stimulate neuroplasticity in the spinal cord, promote circulation, and improve range of motion.

You should start with slow, controlled movements and work your way up to more challenging exercises. Only with your therapist’s approval should you ever consider adding weight or wearing weighted cuffs during shoulder exercises. 

Here are 11 spinal cord injury shoulder exercises to help boost strength and mobility:

1. Arm Circles

For this first SCI shoulder exercise, spread your arms out to the sides to create a “T” shape. Then, move your arms in circular motions going forward and backward. Alternate each arm making small and large circles. This can help promote range of motion in your shoulder joints.

2. Arm Bows

To start, spread your arms out to the side and bend your elbows to a 90° angle and have your forearms facing forward. Rotate your forearms forward and until they are leveled with your upper arm. Rotate them back to your starting position and gently bring them back down, until the hands face down. This shoulder exercise will help stretch your rotator cuff muscles.

3. Arm Against Wall

Hold one arm straight out to the side and lean the inner part of that arm against a wall. Slowly turn your body in the opposite direction (i.e. if your right arm is against the wall, your body should turn left). Hold for 30 seconds and then stretch out your other arm. Stretching can help relieve tightness in the chest and shoulders.

4. Arm Across Chest

Wrap one arm across the chest and use your other arm for support. Hold for about 20-30 seconds and then switch arms. Repeating this stretch can help improve range of motion in the shoulder joint and flexibility in your deltoids.

5. Overhead Shoulder Stretch

For the overhead shoulder stretch, bend one arm behind your head and use your other arm to gently press the elbow back (you can think of it as lining your elbow with your head). Hold for about 30 seconds, then release and switch arms. This will help stretch your chest, shoulders, deltoids, and triceps.

6. Shoulder Blade Squeezes

First, start by taking a deep breath to expand your chest. Then, move your arms back, squeezing the shoulder blades together. You should feel a slight stretch in your upper back and across your chest. This exercise is beneficial for shoulder and upper extremity mobility because it helps with movements used in daily activities such as pushing, pulling, and holding objects, along with improving posture.

7. Shoulder Shrugs

To practice shoulder shrugs, lift your shoulders as high as you can, and then slowly lower them. Repeat about 10 sets. To increase the challenge, try holding the shrug a few seconds longer. This shoulder exercise can help strengthen your trapezius (upper back) muscle, which is responsible for shoulder blade mobility and stability.

8. Shoulder Rolls

After mastering shoulder shrugs, you can try shoulder rolls by rotating your shoulders forward and backward in circular motion. Aim to do 5 forward shoulder rolls followed by 10 backward shoulder rolls.

The forward motion in shoulder rolls is similar to that of pushing a wheelchair. Since many SCI survivors in a wheelchair already practice rolling their shoulders forward, it can be beneficial to focus on backward shoulder rolls. Shoulder rolls help loosen up tight muscles and develop better posture.

9. Seated Upper Back Stretch

Before getting started, make sure that the brakes on your wheelchair are set and your feet are flat on the ground. Place your hands only face down on the armrest (elbows should be bent, and forearms should not be touching the armrest). Then, press down with your hands and move your elbows towards the center of your back and hold for about 15 seconds. Upper back stretches help are a great exercise for improving posture, lowering muscle tension, and reducing stiffness.

10. Half Jumping Jacks

Carefully swing your arms above your head and bring them back down, making jumping jack motions with your arms. This helps promote shoulder abduction, which is the ability to lift your arms away from your body. As well as adduction, lowering your arms back down towards your body.

11. Punches

For this last spinal cord injury shoulder exercise, get into a seated position or try to position yourself in your wheelchair. Turn diagonally ensuring that one arm is facing forward and the other one is behind you. Then, slowly throw 10 punches straight forward, alternating with each arm. For an added challenge, change your target. For example, throw 10 punches upward, 10 punches downward, and 10 punches diagonally. This is a great way to work out your shoulders.

Any shoulder exercise can be done actively or passively with the assistance of your therapist or trained caregiver. Practicing consistently is a key component in rehabilitation after SCI. Also, continue to increase the challenge of your exercises as you improve.

Practicing Shoulder Exercises After Spinal Cord Injury 

A spinal cord injury can often cause shoulder pain or weakness, especially in individuals who use their arms constantly to move their wheelchair. To prevent further injury or complications, it’s important to perform shoulder exercises after spinal cord injury.

However, it’s also imperative not to overwork your shoulder muscles while exercising. Your therapist can provide more guidance regarding the types of SCI shoulder exercises you should do based on your ability level.

We hope this article encourages you to practice shoulder exercises after spinal cord injury to boost upper extremity strength and mobility.

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