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Physical Therapy for Paraplegia: Why It’s Necessary for SCI Recovery

woman practicing physical therapy for paraplegia recovery

Physical therapy for paraplegia is a major part of the spinal cord injury rehabilitation process.

This article will explain the importance of physical therapy for spinal cord injury recovery and the various types of exercises involved.

Goals of Physical Therapy for Paraplegia 

Paraplegia describes paralysis of the lower extremities. It can occur after a thoracic, lumbar, or sacral spinal cord injury.

Physical therapy for paraplegia will primarily focus on improving lower body mobility through repetitive, task-specific exercise.

Spinal cord injury recovery heavily relies on neuroplasticity, which is your spinal cord’s ability to rewire itself. The best way to promote neuroplasticity is through repetition.

The more you repeat weakened functions, the more you’ll promote neurological adaptations in the spinal cord.

Three major factors that influence neuroplasticity include:

  1. Intensity: This involves how many repetitions you perform, how long you train, and how much you’re challenging yourself. The higher the intensity, the greater the recovery outcome.
  2. Specificity: Neuroplasticity is task-specific. The training of one function doesn’t necessarily transfer over to other functions.
  3. Timing: The most recovery typically occurs during the first six months following an SCI. The spinal cord experiences a temporary state of increased plasticity which makes it easier to relearn functions. However, it’s important to understand that the spinal cord always has neuroplasticity and recovery is possible even years after your SCI.

Now that you understand the objectives of physical therapy for paraplegia, let’s go over different types of exercises to expect.

Physical Therapy Exercises for Paraplegics

Girl working on physical therapy for paraplegia in order to walk again


No two spinal cord injuries are the same.

Depending on the level and severity of your injury, the types of exercises you will be working on in physical therapy for paraplegia will vary.

In the following sections, we’ll go over the various exercises a physical therapist might assign for paraplegia recovery.

Passive Range of Motion Exercises 

physical therapist and sci patient stretching


Passive range of motion exercise does not require any exerted effort on the patient’s part. A physical therapist or caregiver will move your body for you.

However, because people with paraplegia have fully functioning arms, they can often perform passive leg exercises on their own.

Below are some passive range of motion exercises that will benefit those with paraplegia. Be sure to perform them slowly and gently.

  1. Trunk Twists: Have the patient lay down on his/her back with knees bent. Then, tilt the knees to one side, making sure that the shoulders don’t move. Hold for 20 seconds and then repeat to the other side.
  2. Knees to Chest: Have the patient lay down with one leg bent. Bring the knee up towards the chest and then straighten it, bringing it down next to the other foot. Then, switch to the other leg.
  3. Hip Abductions: Have the patient lay down with legs straight. Then, hold one leg from underneath the calf and pull to the side, so that the foot is moving outward. Bring the leg back in towards the center and repeat.
  4. Ankle Rotations: Place one hand on the patient’s ankle and the other on the foot. Rotate the foot clockwise and then counterclockwise.
  5. Toe Curls: Push the patient’s toes forward so that they curl in and then straighten them back up.

Passive range of motion exercises prevent your joints from stiffening, promote circulation, and stimulate the spinal cord.

Leg Exercises

Leg exercises are an essential part of physical therapy for paraplegia.

Consider buying a resistance band or a leg lifter to help stretch your legs. The video below will teach you how to stretch your ankles, hamstrings, glutes, and lateral rotators.

If you have some control over your leg movements, try these additional exercises:

  1. Leg Raises: Lay on your back with one leg bent. Raise the straight leg up, hold for 5 seconds, and then slowly bring it back down.
  2. Seated March: Take a seat and move your legs up and down in a marching motion. Try to bring your knees up as high as possible.
  3. Knee Extensions: Take a seat and move one of your legs forward (as if you’re kicking a ball) so that your leg is straightened. Hold it for a few seconds before bringing it back down.

Core Exercises

The core is responsible for stability and balance. When you have a weak core, even the simplest tasks like reaching over for a pencil can cause you to lose balance and fall over.

Check out the video below for seated core exercises that you can do from the comfort of your wheelchair.

Try these core exercises for paraplegia as well:

  1. Heel Taps: Lay down with your knees bent and feet flat on the ground. Gently tilt your torso to the side and tap your heel with your fingertips. Only the upper half of your body should be moving. Tilt to the other side and repeat.
  2. Sitting on a Stability Ball: Sitting on a stability ball requires you to constantly adjust your center of gravity, which continuously engages your core muscles. When getting on and off of a stability ball, make sure that it is leaning against a wall for more stability.
  3. Stability Ball Crunches: Once you’ve mastered sitting on a stability ball, try carefully leaning back and performing crunches. Crunches on a stability ball help minimize strain on the tailbone.
  4. Knee Planks: Lay down your stomach and gently get on your knees and forearms. Your back should create a straight, downwards sloping line from your shoulders to the knees. Hold for 30 seconds (or however long you can).

Developing core strength will help improve balance between your upper and lower body, which is essential for sitting upright, standing, and walking.

Gait Training

Gait training is a type of physical training that focuses on developing your ability to walk.

Examples of gait training exercises for paraplegia include:

  1. Weight-Bearing Treadmill Training: This type of gait training involves wearing a harness that controls the amount of weight you bear. By reducing pressure on the joints, you can focus on improving your walking form. The idea behind weight-bearing treadmill training is to gradually increase the amount of weight until you can support your own body weight.
  2. Aquatic Gait Training: Another way to relieve some pressure off the lower extremities is by getting into a pool. Buoyancy will help keep you afloat so that you’ll feel lighter and can focus on form.
  3. Overground Gait Training: Overground gait training utilizes equipment like walkers, canes, and parallel bars. By using assistive devices, you will get the most realistic feel for walking again because it teaches you how to shift your weight and balance.

Gait training works on building strength and endurance in your legs so that you can support your body weight and walk longer distances.

How Long Do I Need to Participate in Physical Therapy for Paraplegia?

Paraplegia recovery time will vary for each spinal cord injury patient.

Try not to focus on how long you’ll need physical therapy for paraplegia. Instead, think about how much effort you’re willing to put into recovery.

What a lot of people don’t realize is that the exercise that you do during your physical therapy session is usually not enough. It’s essential to also practice at home!

As previously mentioned, the best way to promote neuroplasticity in the spinal cord is through repetitive exercise. The more you practice, the more you’ll stimulate neurological adaptations.

Someone who intensely pursues rehabilitation and practices many repetitions will recover much faster and ultimately require less physical therapy.

The Importance of Physical Therapy for Paraplegia Recovery 

Physical therapy plays a critical role in paraplegia recovery.

A physical therapist will assess your functional abilities, create a personalized exercise plan, and guide you through exercises to maximize your mobility.

Hopefully, this article helped you understand the importance of physical therapy for paraplegia recovery. Good luck!

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