Hesperian Health Guides

Physical Therapy Following Spinal Cord Injury

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HealthWiki > Disabled Village Children > Chapter 23: Spinal Cord Injury > Physical Therapy Following Spinal Cord Injury


Persons with spinal cord injury in the neck or upper back often have part of their breathing muscles paralyzed. Slowly the remaining muscles become stronger and breathing improves. But breathing often stays weak. The person may not be able to cough well and can more easily get pneumonia.

To help the person cough, place hands as shown below. Ask him to cough, and as he does, push firmly inward on the chest. Be careful not to move the backbone.


two women press down on a person's chest and talk
Now cough.
Do this several times a day when the person has a cold, and more often if the person develops more trouble breathing or seems to have a lot of mucus in his lungs or throat.


man presses down on child's chest and talks
Breathe deep.
child lies facing down with hips propped up
To help the child breathe deep and to stimulate the breathing muscles, press lightly here while the child tries to breathe deeply in and out.

Do this for a few minutes, several times a day.
If the person has a lot of mucus in her lungs, it also helps to lie her down, like this, and pat her back briskly. This helps loosen the mucus so that it can be coughed out. Be sure she drinks lots of water to help loosen the mucus.


Do range-of-motion exercises for about 10 minutes for each arm and leg. In the first weeks, do the exercises twice a day. Later, once a day may be enough. If any signs of contracture develop, spend more time and effort on those parts of the body. From the start, exercises should be both passive (someone else moves the child’s body parts) and whenever possible, active (the child does it himself).

Range-of-motion exercises should begin with great care the day after the spine is injured. The exercises will help to improve the flow of blood (which reduces the chance of bed sores), to prevent contractures, and to build the strength of the muscles that still work. Range-of-motion exercises should be continued throughout life, when possible as a part of day-to-day activity.

  • Until any breaks or tears in the spine have healed (6 weeks or more) exercise must be very gentle and limited, with smooth motions and no jerking.
  • Especially at first, take great care that exercises do not move the position of the back and neck. Start with feet, ankles, hands, wrists, and elbows.
  • If exercises trigger severe muscle spasms or jerking, do not do them until the break is healed.
  • Do not use force in trying to get the full range of motion, as joints can easily be damaged.
  • For quadriplegics often it is better to stretch the fingers only when the wrist is bent down like this,
wrist bent down with straight fingers and a wrist bent back with bent fingers
but not when it is bent back like this.

This way enough contracture is left to be useful for taking hold of things. Although the fingers lack movement by muscles, they close around an object when the wrist is bent back.

If possible, get instructions from an experienced physical therapist.

  • Try to keep the full range of motion of all parts of the body. But work most with those joints that are likely to develop contractures, especially:
    • paralyzed parts that tend to hang
      in one position, such as the feet,
a leg with paralyzed parts
Prevent this through exercises and by supporting feet.
muscle shortening
foot hangs

For example:

DVC Ch23 Page 183-3.png
In quadriplegia the muscles that straighten the elbow are usually paralyzed,
It is important that the arms can straighten until they bend backward a little—which is the only way he can lift himself with his arms.
DVC Ch23 Page 183-4.png
For this reason, straight arm positioning and early range-of-motion exercises for the elbow are essential. While he is still kept lying down, teach him to straighten his elbows by turning his hands up and then lifting his arms.
While the muscles that bend the elbow stay fairly strong. These muscles keep the elbow bent, and in time they shorten so that the arm can no longer straighten fully.
DVC Ch23 Page 183-5.png

This page was updated:21 Nov 2019