Exercise after spinal cord injury is essential because it helps promote circulation and maintain range of motion, bone density, and muscle mass. However, if your spinal cord injury results in quadriplegia (weakness or paralysis throughout the arms, trunk, and legs), it can become challenging to participate in exercises. Depending on the severity of your spinal cord injury, various forms of exercise may still be possible.
To help you understand the importance of exercise for individuals with quadriplegia, this article will share:
Passive Range of Motion Exercises for Quadriplegics
All individuals with quadriplegia can practice passive range of motion exercises. This type of exercise requires no exertion of energy from the patient. Instead, a physical therapist, occupational therapist, or trained caregiver will facilitate your movements for you to make sure that your joints move to their full extent.
Additional benefits of passive range of motion exercises include improved blood flow, flexibility, and reduced pain after spinal cord injury. Furthermore, passive range of motion exercises provide a perfect opportunity for your therapist or caregiver to check for any skin integrity issues that may develop.
The only time when these exercises may not be a good idea is when you have specific precautions due to your SCI (or even other injuries that happened elsewhere in your body when you were hurt).
For example, some individuals will have a neck or back brace and “spinal precautions” after their injury, which are specific ways they should NOT be moving their spine. Or, you may have injured your arm or leg during your accident, and your doctor may tell you not to move this limb in a certain way or direction.
These types of precautions are typically necessary for around 12 weeks after injury, but it will be up to your doctor when to lift them. Please be mindful of these precautions when looking through these exercises.
Remember, these exercises are designed for someone else to be performing the movement for you. However, as you continue practicing these passive range of motion exercises, you may find that you are able to actively help with some of the movements. This is a great sign of improvement! However, even if you are unable to independently move at all, these exercises are still beneficial for your joints, muscles, and circulation.
Generally, each exercise should be completed on each side of the body, ideally multiple times per week. Typically, a slow stretching motion with a 5-10 second hold at the end range of motion is most effective.
Some passive range of motion exercises you can practice at home include:
- Neck Tilts: Tilt the head to one side so that the individual’s ear moves toward their shoulder and then alternate sides. Then, tilt it forward so that the patient’s chin goes toward their chest, then backwards so their chin goes toward the ceiling. Important note: if you wear a neck brace of any kind or have been told you have “cervical spinal precautions,” do NOT perform this exercise and talk to your therapist and/or doctor about when you can try it.
- Side-to-Side Head Shake: Turn the head from side to side as if signaling ‘no’; the eyes should stay level the entire time.
- Fists: Curl the fingers inward towards the palm, creating a fist, and extend them back so that they are straight. Keep the wrists neutral (straight) while doing this.
- O’s: Touch the tip of each finger to the tip of the thumb
- Finger Splits: Separate any two adjacent fingers away from each other and then bring them back together.
- Wrist Flicks: Move the hand forward so that the palm moves towards the inner arm and makes a 90° angle. Then, move the hand back in the opposite direction. If the patient has some hand movement preserved and is working on use of a “tenodesis grasp” in therapy, then be sure to keep their fingers curled in rather than fully extended while performing this wrist exercise.
- Elbow Flexion and Extension: Bend the elbow so that the hand can touch the shoulder. Then extend it so that the arm is straight.
- Hand Flips: Hold the arm out so that it is straight and the back of the hand is facing up. With one hand, hold just above the elbow and with the other, flip the hand so that the palm faces up. Hand flips can also be completed with the elbow bent at 90° and positioned at the individual’s side.
- Hand Raises: Start with the arm relaxed at the patient’s side so that their fingers are facing their feet and the palm is facing their side. Keeping the arm straight, raise the hand forward and up so that your fingers face up toward the ceiling.
- Wing Flaps: Start with the arm straight and neutral again and move the hand outward to the side, away from the center of the body. The arm should be level with the shoulders. Then, bring them back to the starting position. When done consecutively, it’ll look like you’re trying to fly.
- Spine Twists: Have the patient lay down on his or her back with knees together and bent. After, tilt the knees towards one side and then the other. Make sure that the shoulders stay in place and don’t move. If you wear a back brace or neck brace of any kind or have been told you have “spinal precautions,” do NOT perform this exercise and talk to your therapist and/or doctor about when you can try it.
- Ankle Rotations: Put one hand just above the ankle to stabilize the leg and the other hand on the foot. Then move the foot in circular motions.
- Toe Curls: Bend the toes in towards the sole and bring them back out to normal.
The following hip and knee passive range of motion exercises should be performed lying down.
- Hip Circles: Bend one knee so that the thigh is perpendicular to the mat/bed and there’s a 90° angle with the knee. Then, rotate the hip in circles by holding and moving the thigh. The bigger the circles, the better the hip movement.
- Foot Claps: The legs should be straight. Pull one to the side, creating separation between the feet until there’s slight resistance. Then, bring your feet back together.
- Knees to Chest: With one hand on the upper leg just above the knee and the other on the foot, bend one knee so that it’s reaching towards the chest. Then, bring the foot back to the other leg and straighten the knee.
For a demonstration of how passive range of motion exercises are performed, watch the video below.
The best way to tell if you’re ready for more active forms of quadriplegic exercises is to become comfortable performing range of motion exercises on your own, without the assistance of a therapist or caregiver.
Upper Body Quadriplegic Exercises
Often, individuals with quadriplegia and their rehabilitation teams will focus on improving upper-body mobility. By doing so, individuals can significantly increase their independence with activities of daily living and use their arms and hands to assist with mobility of the lower body. That being said, it’s also important to practice exercises for your lower body as well, to whatever degree possible.
Here are additional quadriplegic exercises that focus on developing upper body strength and mobility.
Don’t worry about your speed and focus on technique. Speed will build with repetition.
- Neck Tilts: Tilt your neck so that your left ear moves towards your left shoulder and then do the same for your right side. Important note: if you wear a neck brace of any kind or have been told you have “cervical spinal precautions,” do NOT perform this exercise and talk to your therapist and/or doctor about when you can try it.
- Shoulder Raises: Shrug your shoulders up towards your ears and then bring them back down.
- Shoulder Rolls: Roll your shoulders forward and backward.
- Arm Rows: Put both arms straight in front of you and bend your elbows back.
- Arm Across Body: Bring one arm out across your chest and use your other arm to hold it there.
- Torso Twist: Gently twist your upper body to one side while keeping your lower body still. If you wear a back brace or neck brace of any kind or have been told you have “spinal precautions,” do NOT perform this exercise and talk to your therapist and/or doctor about when you can try it.
- Arm Raises: Raise your arm towards the ceiling as high as you can. But, if you have cervical spinal precautions, do not raise your arms any higher than shoulder-height.
- Arm Circles: Raise your arms to the side so that your body makes a “T” shape and move them in little circles forward and backward.
- Hallelujahs: Lift both arms out towards the sky, no higher than shoulder-height if you have cervical spinal precautions.
- Arm Flaps: Make that “T” shape with your arms raised to the sides and move them up and down.
- Palm Flips: Put your arm out straight in front of you with your palm facing down and then flip it so that your palm faces up. This can also be completed with your elbow bent at your side.
- Finger Clenches: Make a fist and clench all your fingers together. Then, open your hand and stretch out your fingers as much as you can.
How to Improve Mobility with Quadriplegia
There are many negative consequences associated with a sedentary lifestyle including blood clotting, pressure sores, and bone thinning. Therefore, it’s essential for individuals with quadriplegia after spinal cord injury to move around throughout the day.
If you can’t control your movements, it’s important to seek help and ask a caregiver to passively move your body for you. However, this does not mean you can idly sit around until they finish moving your body. You should be focusing on the movements too and be alert for any changes in sensation or motor control.
Individuals with incomplete quadriplegia have the potential to improve functions below their level of injury because the spinal cord is capable of utilizing neuroplasticity. Neuroplasticity refers to the central nervous system’s ability to rewire itself and strengthen functions weakened by injury. Consistently repeating affected movements helps stimulate neuroadaptive changes in the spinal cord and strengthen new connections. The more you practice, the better movements become.
By participating in intensive rehabilitative therapies and practicing high repetitions of targeted exercises and activities, individuals with incomplete quadriplegia may be able to promote neuroplasticity and recover movement. Additionally, individuals should practice the exercises they learn at physical or occupational therapy at home. To stay motivated, gamified neurorehabilitation devices like FitMi home therapy can help.
Quadriplegic Exercises: Key Points
While it can be challenging for individuals with quadriplegia to exercise, there are ways to promote movement throughout the day. Exercise does not necessarily have to be strenuous to be effective.
We hope this article helped you understand what individuals with quadriplegia can do to incorporate more physical activity into their daily routines and the benefits these exercises bring.