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Physical Therapy for Paraplegia: Goals and Exercises

woman practicing physical therapy for paraplegia recovery

Physical therapy plays an essential role in paraplegia rehabilitation after spinal cord injury. Every SCI is unique, so the personalized recovery plan that a physical therapist can create for you will help optimize recovery.

Physical therapy helps individuals with paraplegia improve their mobility through highly repetitive, task-specific exercises. They’re designed to expand range of motion, strengthen the muscles, and improve overall mobility.

To help you understand the importance of physical therapy for paraplegia rehabilitation, this article will go over how SCI recovery works and the various processes involved.

Goals of Physical Therapy for Paraplegia 

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

Spinal cord injury recovery heavily relies on neuroplasticity, which is the spinal cord’s ability to rewire itself. By consistently practicing weakened movements, the spinal cord will perceive a demand for that function and adapt by rewiring and strengthening its neural pathways.

Three major factors that influence neuroplasticity include:

  • Intensity 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.
  • Specificity is necessary because the training of one function doesn’t necessarily transfer over to other functions. Every movement fires a different set of neural pathways in the spinal cord.
  • Timing is essential because the most recovery typically occurs during the first six months following an SCI. The spinal cord temporarily experiences a heightened state of 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.

Physical therapy for paraplegia utilizes these three factors to promote optimal rehabilitation after spinal cord injury. Consistent practice will stimulate neuroadaptive changes in the spinal cord and promote functional improvements.

Up next, we’ll go over the various types of exercises physical therapy can consist of.

Physical Therapy Exercises for Paraplegics

girls with paraplegia at physical therapy

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

Depending on the severity of your spinal cord injury, physical therapy for paraplegia recovery will involve different types of exercises. For example, it’s not realistic for someone with no motor control in their legs to practice walking right away.

In the following sections, we’ll discuss how different types of exercise can help individuals with paraplegia improve their mobility.


Many individuals with paraplegia experience involuntary muscle contractions called spasticity due to disrupted communication between the brain and muscles. Stretching the legs can help lengthen spastic muscles and minimize pain caused by additional pressure on the joints.

The effects of stretching can last for hours and help prevent injuries during more strenuous exercise. Additionally, well-stretched muscles can bear more pressure and achieve full range of motion, which makes it easier to perform more active forms of exercise.

Passive Range of Motion Exercises

Even if you have no motor control in your legs, individuals with paraplegia can benefit from physical therapy. Physical therapy for those with severe paraplegia typically involves practicing passive range of motion exercises.

During passive exercise, someone else moves your paralyzed limbs for you; however, most individuals with paraplegia should be able to use their arms to move their legs.

Discover passive range of motion exercises for paraplegics»

Practicing passive range of motion exercises will help prevent joint stiffness, promote circulation, and stimulate the spinal cord.

Strengthening Exercises

Due to limited motor control in the legs, many individuals with paraplegia become less physically active. Strengthening exercises are an essential part of physical therapy for paraplegia because they help maintain muscle mass.

Lack of movement and weight-bearing after SCI can cause the muscles to shrink. Individuals with muscle atrophy are more susceptible to falls, fractures, poor circulation, and decreased metabolic rate. 

Practicing strengthening exercises at physical therapy will help prevent muscle atrophy and make it easier to perform everyday activities.

Gait Training

spinal cord injury patient with paraplegia practicing physical therapy exercises

Gait training is a type of physical therapy that focuses on learning to walk again after paraplegia. It often involves the use of supportive devices like parallel bars, walkers, and weight-bearing equipment.

Gait training not only focuses on developing coordination and strength in the legs, but also on building balance through the core. For example, you’ll learn how to stand and shift your weight from one side to the other without losing stability.

Generally, gait training will focus on improving form and safety during upright mobility. To do this, individuals may use a harness while using a treadmill or perform exercises in the pool. As patients improve their form and develop more strength in the legs, they’ll gradually be able to bear more weight on their hips, knees, and ankles.

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

Because every spinal cord injury is unique, paraplegia recovery time will vary for each individual. As previously mentioned, intensity, specificity, and time play critical roles in the recovery process.

Individuals must be willing to put in the effort to recover. What many people don’t realize is that the exercises practiced in a physical therapy session are usually not enough. Thousands of repetitions are required to promote neuroadaptive changes in the spinal cord, so it’s essential to also practice at home.

Generally, individuals who intensely pursue rehabilitation improve quicker and ultimately require less physical therapy.

It’s also important to understand that that recovery is not linear. The spinal cord never runs out of neuroplasticity and individuals can improve years after their injury. Even after periods of no noticeable progress, recovery is possible as long as you continue to practice weakened movements.

The Importance of Physical Therapy for Paraplegia Recovery 

Physical therapy does not guarantee a full recovery from paraplegia, but it will help stimulate neural pathways in the spinal cord and minimize the risk of complications like stiffness, muscle atrophy, and poor circulation.

Highly-repetitive, task-specific exercise is essential for promoting neuroplasticity in the spinal cord, and physical therapy will guide individuals through exercises that can help.

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

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