Depending on the severity and level of a spinal cord injury, survivors may struggle with movement in the upper extremities. These consist of the shoulders, arms, elbows, wrists, and hands, all of which are necessary for function.
We use our upper extremities all throughout the day for activities of daily living, including dressing, eating, carrying, lifting, and reaching for objects. To improve function and maintain independence, survivors must engage in upper extremity exercises for spinal cord injury rehabilitation.
This article will explore various types of upper extremity exercises for spinal cord injury survivors, including wheelchair-friendly exercises, and requiring little to no equipment. First, let’s take a look at the benefits of exercising after spinal cord injury and how a home exercise program can help you stay motivated throughout recovery.
Why Is Exercise Necessary After Spinal Cord Injury?
The spinal cord serves as a communication pathway between the brain and the rest of the body. When this pathway is disrupted, the brain is unable to send signals to move specific muscles, resulting in impaired movement. The specific muscles affected depend on the level of injury.
Low-level injuries affect the lower extremities, whereas high-level injuries affect both the upper and lower extremities. For example, individuals with lumbar-level injuries may experience weakness in the legs while individuals with cervical or high-thoracic level injuries may experience weakness in the hands, trunk, and lower extremities.
Fortunately, the human body and spinal cord are extremely adaptable and can regain function via neuroplasticity, the central nervous system’s ability to rewire itself. Neuroplasticity is essential for recovery and is best activated through high-repetition of exercises, or massed practice.
The more demand for a function, such as movement, the more the nervous system strengthens its neural pathways. Therefore, to improve function and maximize recovery, it’s important to practice spinal cord injury exercises as much as you can. The more you use it, the more you improve it!
Types of Upper Extremity Exercises for Spinal Cord Injury
Every spinal cord injury is different, and survivors may experience various motor difficulties that require a unique rehabilitation plan. However, there are a few key elements that should be included in your upper extremity exercises after spinal cord injury. This includes stretching, passive range of motion, strength-training, and aerobic exercises.
Each type of exercise targets different muscle groups and helps stimulate neuroplasticity to promote recovery. Be sure to work with a therapist to make sure these exercises are safe and suitable for your ability level.
Here are the types of upper extremity exercises for spinal cord injury:
Stretching Exercises for Spinal Cord Injury
After a spinal cord injury, some survivors may experience increased muscle tone or tightness, also known as hypertonicity, that can be uncomfortable and restrict movement.
In some cases, spasticity may develop, a condition in which the muscles are hyper-reflexive and tense up more in response to pressure, a stretch, or movement. When hypertonicity and spasticity are unmanaged, it can lead to joint contractures where the muscles and joints are permanently shortened, becoming immobile and painfully stiff.
A great way to prevent contractures from developing is to stretch and move your upper body joints frequently through their full range of motion. If you have not done any stretching in a while, it may be uncomfortable at first. However, over time, your muscles will adapt and it will get easier as you regain the mobility.
Stretching can also help promote blood flow in the body after spinal cord injury. Therefore, it’s highly encouraged to begin every workout with a gentle stretching routine as part of a warm-up.
It is also important to note that stretching does not need to be aggressive or painful. As long as you’re in the right positions and getting a gentle pulling sensation, you’ll get the benefits!
Upper extremity stretching exercises after spinal cord injury can include:
1. Shoulder Rolls
For this exercise, move your shoulder blades in a circular pattern. Start by shrugging your shoulders in an up, back, and down direction. Perform small circles if needed for comfort. You can then try doing the circular motions in a forward direction. The main focus is trying to squeeze your shoulder blades back as you go through the motion.
It’s even better if you can isolate your shoulder blades by not moving your arms at all! This exercise is good for developing control of your scapular muscles, which are necessary for injury prevention and all upper extremity movement.
2. Arm Circles
This stretch can be done using one arm at a time or both. Spread your arms out to the sides and align them with your shoulders. Then, slowly make large circles forward and backward for a couple of seconds. Just like the above exercise, you can start with smaller circles and work your way up to doing larger ones as you regain strength and control. You can target your shoulder muscles a bit more if you keep your elbows straight while doing the circles.
3. Cross-Body Shoulder Stretch
First, sit up tall with your chest up and back straight. Reach one arm across your chest and bend your other arm to hold it in place. Gently pull your arm further across your body until you feel the stretch in the shoulder and then hold for about 20 to 30 seconds. Then switch with the other arm. Remember, you control the strength of the stretch, so stop or pull more gently if you’re feeling any pain.
4. Overhead Triceps Stretch
To stretch your triceps, raise one arm up over your head, then bend your elbow until your hand is behind your head or back. Use the other arm to press down on the elbow and slowly stretch. You can add a stretch for your latissimus dorsi, aka “lats,” by adding a small side-bend in your trunk. Hold for about 20 to 30 seconds, then repeat with the other arm.
5. Wall-Chest Stretch
For this stretching exercise, position yourself next to a wall or by a doorway. Extend your arm out to the side and place the palm and inner arm against the wall with your elbow slightly bent. Gently lean forward and rotate your body to the opposite side until you feel a gentle pull across the front of your shoulder and chest.
Hold for 20 to 30 seconds, then repeat with the other side. If you’re doing this exercise in the middle of the doorway, you can place both arms on the doorframe to get a stretch on both sides simultaneously.
Try this stretch in different positions as shown below. The higher your hands are, the more intense the stretch.
6. Wrist Flexion & Extension Stretch
For this stretching exercise, place one arm straight out in front of you and with your other hand, push the back of the palm down to make a 90° angle facing the floor. Hold for a few seconds and then push the palm back up with your fingers facing the ceiling. Then alternate with the other wrist. If at first it’s difficult to practice this stretch with your arm out in front of you, you can complete it with your elbow bent at your side to build strength.
7. Interlocked Fingers Stretch
Lastly, stretching your fingers can also help prevent stiffness and promote blood flow in your hands. For this exercise, bring your hands together and interlock your fingers. Then slowly straighten your arms out in front of you and gently twist your wrists so that the backs of your hands are facing you. Hold for at least 15 to 20 seconds, but make sure not to exert more force than you can tolerate.
Range-of-Motion Exercises for Spinal Cord Injury
To improve movement after spinal cord injury, individuals must repeatedly practice affected movements to encourage neuroplasticity. You can think of the phrase “use it or lose it” to motivate yourself to practice.
Neuroplasticity is occurring all the time, but to enhance it after an injury you must engage in massed practice. The more a skill or function is practiced, the more the brain will strengthen its neural pathways to improve that function. Therefore, range of motion exercises are extremely beneficial in restoring motor skills after spinal cord injury.
Passive and active-assisted range of motion exercises do not require you to use excessive force or energy. Rather, a therapist or caregiver assists you by moving your body for you. Or, you can use one side to help the other.
Passive refers to the limb being completely relaxed while it’s being moved, while active-assisted means that your muscles are still working but may just be getting a little extra help to get through the motion. However, as long as you pay attention to the movement while you practice, passive and active-assisted exercise still helps activate neuroplasticity.
Furthermore, individuals who have more control over their movements are encouraged to try to actively perform these range of motion exercises on their own, once cleared by a therapist.
Here are some of the most effective passive range of motion exercises you can try with your caregiver or therapist:
8. Palm Up, Palm Down
First, start by placing one hand on a table or surface with your palm facing up. Then use your opposite hand to help you push your palm back down. Practice flipping your palm a few times, then alternate with your other hand.
Your caregiver can also help flip your palm as you continue to build strength and regain mobility. This exercise may seem simple, but it helps improve hand and wrist coordination. We use this movement all the time for opening doors, turning keys, and fastening buttons on our clothing when we dress.
9. Elbow Flexion
Gently bend your elbow to bring your handtoward your upper arm as much as you can without pain. Then extend your arm and slowly return to the starting position with your elbows as close to the side as possible. Try to keep your palm facing towards you throughout this exercise. Then, repeat with your opposite arm. Your caregiver or therapist may assist this movement by supporting you at the wrist.
10. Table Slides
This exercise is great for shoulder mobility in multiple directions. Start by sitting in a chair in front of a table. Clasping your hands together, slowly reach forward and return to sitting tall & upright. Then repeat to the left and to the right. You can place a water bottle or some other object to act as a target to reach for on each repetition.
Repeat a few times or as much as you can, and try to stretch a bit further each time. Tip: put a small hand or dish towel underneath your hands to reduce friction and make the sliding easier!
11. Circle Movement
Lace your fingers together and wrap both hands around the water bottle on the table. Then, slowly make large circular movements with your arms. As you move in a circular motion, focus on stretching your affected arm. After moving in one direction, also try to reverse. One direction helps build strength, while the opposite direction helps reduce tension.
12. Shoulder Flexion
For this exercise, interlace your fingers or clasp your hands together. Keeping the arms straight and, with the help of your caregiver or on your own, raise your hand forward and up overhead to stretch your shoulders. If this is too challenging, you can do the exercise while laying down on your back and work your way up to doing it while sitting. This exercise is important for reaching overhead, like you’re trying to get something from a high shelf.
13. Cane Reach
For this exercise, grab a cane and hold both of the ends. Then, gently lift your affected arm up using your other hand for assistance (you can rest the cane on your leg for extra support). Hold this arm stretch for a few seconds or as long as you can and gently release it.
For an added challenge, turn your head and rotate your trunk towards that side. This is a great upper extremity exercise for the shoulders. However, it’s important to take breaks and only do what you can handle to avoid overstraining your shoulders.
Ask your therapist or caregiver to take over if you tire out quickly. As you practice more consistently, your endurance will improve.
Strength-Training Upper Extremity Exercises for Spinal Cord Injury
Generally, everyday movements such as walking, standing, and lifting objects are enough to maintain your current level of muscle mass. However, after a spinal cord injury, these daily activities can be more difficult to accomplish. This lack of activity can cause muscles to shrink (muscle atrophy). Fortunately, survivors can engage in strength-training exercises that help lower the risk of muscle atrophy and stimulate neuroplasticity.
You can rebuild strength by adding weight or resistance to any of the upper extremity exercises mentioned above. For example, when doing elbow flexion, you can hold a dumbbell, water bottle, or canned food to increase the difficulty and stimulate muscle growth. Be mindful to do exercises with added weight slow and controlled to avoid the risk of injury or overworking your muscles.
Here are some upper extremity exercises for spinal cord injury that help rebuild strength:
14. Wheelchair Dips
For this exercise, first and foremost, make sure the brakes are engaged and your wheelchair is secured. Then, put your hands on the armrests and straighten your arms. Slowly lift yourself up from the seat of the chair and slowly lower back down. This exercise is excellent for strengthening the triceps and shoulders, with a movement that is great for position changes in the chair, transferring in and out of the wheelchair, and doing pressure reliefs to decrease the risk of pressure ulcers.
15. Bicep Curls
Place your arms as close to your trunk as possible while holding a dumbbell in either one or both hands. The palms and inner arm should be facing up. Without moving your upper arm, bend the elbows to bring the dumbbell up towards your shoulder, hold it for a second if you can, and then bring it back down.
16. Triceps Extensions
This exercise is important for carrying or lifting loads overhead. Hold a weight such as a medicine ball or dumbbell with both of your hands and slowly raise it over your head. Then gently lower the weight behind your head to bend your elbows. Lift the weight back up and straighten out your arms. Start with a light weight and work your way up as you build more strength.
Aerobic Upper Extremity Exercises for Spinal Cord Injury
Aerobic exercise is a great way to promote blood circulation throughout the body, develop cardiovascular endurance, and stimulate the nervous system. Aerobic exercises for the upper body tend to be more advanced, but there are ways to slowly work your way up to more difficult exercises.
Below are some of the most effective aerobic upper extremity exercises that mimic the same movements used in sports. These exercises can be done in a sitting or standing position, but make sure to stop if you feel any pain or discomfort. For more guidance and assurance, ask your therapist which aerobic exercises are right for you.
Because these are meant to be aerobic, aim to perform these exercises for a prolonged duration at a sustainable pace. Start with what you can handle, even if it’s only for 1 to 2 minute intervals at a time. Over time, try to build up your endurance to being able to do the exercise continuously for at least 10 to 15 minutes, taking rest breaks as needed.
Here are some upper extremity aerobic exercises for spinal cord injury:
This upper extremity exercise mimics the movements done in rowing. You can do the rows while holding a cane, broomstick, or umbrella. Place your arms out in front of you and then slowly bend your elbows and pull your arms back in towards your body. Keep an upright posture and focus on squeezing your shoulder blades back as you row.
18. Swim Strokes
Mimicking swimming strokes can help stimulate blood flow and rebuild arm strength. These can include backstrokes, butterfly, freestyle, and breaststrokes. You can practice different swimming strokes sitting down in your wheelchair or wherever you feel the most comfortable. For instance, take one arm and slowly push it forward and alternate with your other arm as if you were in a swimming pool.
Swimming is one of the best aerobic exercises because it targets a variety of muscle groups. Once cleared by your therapist, you may be able to try aquatic therapy for spinal cord injury.
Just like swimming, boxing involves a variety of different arm motions that help exercise the upper body. For this exercise you don’t need a punching bag. You can shadowbox by simply mimicking the different types of arm motions, or punches such as the jab, hook, uppercut, and cross. These motions can get your heart pumping and strengthen your arms.
20. Hand Cycling
Handcycles are bikes where individuals pedal with the arms instead of the legs. This is a great upper extremity exercise for spinal cord injury survivors because it mimics the same arm motions and helps stimulate the heart and brain.
Strength-training, aerobic exercises, and stretching techniques are all essential to improve upper body mobility and overall function. While your therapist can provide the equipment you need to engage in upper extremity exercises for spinal cord injury, it can be helpful to invest in your own physical therapy tools. This way, you can practice however much you’d like from the comfort of your own home, and at your own pace.
How to Stay Motivated While Exercising at Home
After your therapy session, your therapist may provide you with sheets of exercises you can do at home. While these sheets are helpful, it can be difficult to stay motivated and practice high-repetition of exercises by yourself.
Therefore, to help you stay extra motivated to practice upper extremity exercises at home, you can try gamified neurorehabilitation devices such as FitMi and MusicGlove. Both are interactive home exercise programs that are great for spinal cord injury survivors to engage in in between therapy sessions.
MusicGlove is a hand-therapy device designed to improve dexterity in the hands. This device is especially attractive because it combines music, gaming, and hand therapy exercises to help you stay motivated and practice high-repetition exercises. MusicGlove encourages individuals to practice 100 repetition exercises in a 30 minute session. In fact, MusicGlove has been clinically proven to boost hand function in just 2 weeks!
FitMi is another neurorehab device designed to improve mobility after spinal cord injury. It provides survivors with full-body rehab exercises that target a variety of muscle groups including the arms and shoulders. FitMi motivates you to practice high-repetition of upper extremity exercises based on your ability level. It also unlocks more challenging exercises as you improve and keeps track of your progress.
MusicGlove and FitMi are popular neurorehab devices that promote high-repetition exercises in a fun, engaging way. They provide a great way to stimulate neuroplasticity in the spinal cord and boost motor recovery.
Engaging in Upper Extremity Exercises After Spinal Cord Injury
While a spinal cord injury can cause a variety of secondary effects such as paralysis, limited mobility, and spasticity, there are many ways to improve function. To rebuild strength and restore movement in the upper body, survivors must engage in upper extremity exercises for spinal cord injury.
Exercise in general has many benefits such as developing strength, endurance, promoting blood flow, and stimulating the brain to activate neuroplasticity, which is necessary to improve function. High-repetition of exercises, especially, are essential to strengthen the neural pathways for all functions.
The more you practice consistently, the more you engage your muscles, and the more familiar the nervous system becomes with the movements. Remember to start with exercises based on your ability level and work your way up to more complex exercises.
We hope these upper extremity exercises for spinal cord injury encourage you to stay engaged in the rehabilitation process and maximize recovery.