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Spinal Cord Injury

Protecting Your Shoulders After Spinal Cord Injury

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Preventing Secondary & Overuse Injuries

Why shoulder health matters after SCI

Your arms often have to do much more work after a spinal cord injury. Depending on your mobility and level of injury, your shoulders may be used for:

  • Wheelchair propulsion
  • Transfers
  • Pressure reliefs
  • Bed mobility
  • Reaching and dressing
  • Bathing and toileting
  • Carrying or lifting objects
  • Sports, exercise, and recreation

Over time, performing the same movements repeatedly can place stress on the muscles, tendons, and joints of the shoulder. This can contribute to overuse injuries and shoulder pain, which may interfere with independence and daily activities.

The STOMPS program—Strengthening and Optimal Movements for Painful Shoulders—was developed specifically to address these problems in people with SCI. Research has shown that combining shoulder strengthening and stretching with improved movement strategies can reduce shoulder pain and improve function.

Common Secondary & Overuse Problems

Repeated loading of the upper extremities may contribute to:

  • Rotator cuff irritation or tendinopathy
  • Shoulder impingement-type symptoms
  • Biceps tendon irritation
  • Shoulder bursitis
  • Muscle strains
  • Neck and upper-back pain
  • Wrist and elbow overuse
  • Carpal tunnel symptoms
  • Joint inflammation and stiffness

Warning signs

Pay attention to changes in how your body feels or performs. Contact your healthcare provider or rehabilitation professional if you notice:

  • New or increasing shoulder pain
  • Pain that lasts after an activity
  • Pain that wakes you at night
  • Decreased strength
  • Difficulty completing transfers that were previously easy
  • Difficulty pushing your wheelchair
  • A change in your transfer technique because of pain
  • Clicking, catching, or a feeling of instability
  • New numbness or tingling
  • Loss of range of motion
  • Needing to use your arms differently to complete familiar activities

Do not simply push through persistent pain. Early modification of an aggravating activity may prevent a small problem from becoming a larger one.

Strategies to Reduce Your Risk

1. Reduce repetitive loading

  • Alternate demanding activities with lighter activities.
  • Avoid performing the same repetitive task for long periods.
  • Break large tasks into smaller sessions.
  • Take regular rest breaks.
  • Change positions throughout the day.
  • Avoid unnecessary transfers when another safe option is available.
  • Alternate which arm performs a task when appropriate.

Varying activities and strengthening the muscles that stabilize the shoulder are recommended strategies for reducing overuse problems after SCI.

Think: “Spread the load.”

Instead of doing 30 minutes of repetitive upper-extremity activity at once, consider breaking it into shorter periods with other activities between them.

2. Protect your shoulders during transfers

Transfers can place substantial loads through the shoulders. Whenever possible:

  • Position the wheelchair as close as safely possible.
  • Remove obstacles before transferring.
  • Use appropriate transfer equipment when indicated.
  • Keep the movement controlled rather than relying on a sudden push.
  • Use your legs and trunk as much as your strength and injury level allow.
  • Avoid repeatedly performing transfers that are not necessary.

Work with your PT/OT to evaluate your individual transfer technique. A small change in wheelchair position, surface height, hand placement, or body mechanics can substantially change the load placed on your shoulders.

3. Modify pressure-relief techniques

Repeated push-up pressure reliefs can place substantial stress on the shoulders. When appropriate for your level of injury and equipment, consider alternatives such as:

  • Forward-lean pressure reliefs
  • Side-to-side weight shifts
  • Other pressure-relief techniques recommended by your rehabilitation team

The Northwest Regional SCI System specifically recommends considering side-to-side or forward-lean pressure reliefs rather than repeated push-up pressure reliefs because of the stress placed on the shoulder.

Important: Never change your pressure-relief routine without making sure the alternative provides adequate pressure relief for your skin.

4. Optimize wheelchair propulsion

Efficient wheelchair propulsion can help reduce unnecessary shoulder stress. Consider:

  • Keeping your wheelchair properly fitted and maintained.
  • Using smooth, long strokes rather than many short, rapid strokes.
  • Avoiding excessive force when negotiating routine surfaces.
  • Using your environment and wheelchair skills to minimize unnecessary pushing.
  • Using appropriate power-assist or power mobility when recommended.

Have your wheelchair and propulsion technique assessed if you are experiencing increasing shoulder pain or fatigue.

5. Make your home work for you

Your environment can either increase or decrease the amount of work your shoulders have to do. Look for opportunities to reduce reaching and lifting such as:

  • Moving frequently used items to shoulder-height or lower.
  • Avoiding frequently reaching above shoulder level.
  • Keeping heavy items within easy reach.
  • Storing commonly used objects close to your usual seating position.
  • Using lightweight equipment when appropriate.
  • Using adaptive equipment when it reduces repetitive strain.

6. Be careful with lifting

When lifting is necessary:

  • Keep the object close to your body.
  • Avoid lifting heavy objects with your arms fully extended.
  • Avoid repeated overhead lifting.
  • Ask for assistance with heavy or awkward objects.
  • Break heavy loads into smaller loads when possible.

7. Listen to your shoulders

Pain is useful information.

If an activity consistently causes pain:

Stop → Modify → Recover → Reassess

Instead of repeatedly performing the activity until the pain becomes severe, identify what is creating the problem.

Ask:

  • Is the activity repetitive?
  • Am I reaching too high?
  • Am I using too much force?
  • Can I change my position?
  • Can I use adaptive equipment?
  • Can I divide the activity into smaller sessions?
  • Can someone else perform the task?
  • Can my PT/OT help me change my technique?

Home Exercise Program

Perform 3 days per week with a rest day between exercise days, incorporating shoulder stretching and strengthening.

1. Chest/Anterior Shoulder Stretch

Goal: Reduce tightness in the muscles at the front of the shoulder and chest.

  • Sit or lie in a comfortable position.
  • Gently bring the shoulders into a comfortable stretched position.
  • Do not force the range.
  • Hold 30 seconds.
  • Repeat 2–3 times.

2. Posterior Shoulder Stretch

Goal: Maintain mobility of the back of the shoulder.

  • Bring one arm across the body.
  • Use the opposite arm to gently assist.
  • Keep the movement comfortable.
  • Hold 30 seconds.
  • Repeat 2–3 times per side.

3. Shoulder External Rotation

Goal: Strengthen the rotator cuff.

  • Keep your elbow close to your side.
  • Rotate the forearm outward against light resistance.
  • Return slowly to the starting position.

3 sets × 8–15 repetitions

4. Scapular Retraction

Goal: Strengthen the muscles that stabilize the shoulder blade.

  • Sit or stand tall.
  • Gently draw the shoulder blades back and slightly down.
  • Avoid shrugging.
  • Hold briefly and relax.

3 sets × 15 repetitions

5. Shoulder Elevation in the Scapular Plane

Goal: Strengthen the shoulder while emphasizing controlled movement.

  • Raise the arm slightly forward and out to the side rather than directly to the side.
  • Keep the movement smooth.
  • Use light resistance as prescribed by your therapist.

3 sets × 15 repetitions

6. Shoulder Depression

Goal: Strengthen muscles involved in stabilizing and controlling the shoulder during functional activities.

  • Begin with good upright posture.
  • Gently press the shoulders downward without shrugging.
  • Return slowly to the starting position.

3 sets × 8–15 repetitions

Exercise Safety

During exercise:

  • Use controlled movements.
  • Start with light resistance.
  • Do not exercise through sharp or worsening pain.
  • Allow adequate recovery between sets.
  • Do not hold your breath.
  • Stop if you develop unusual symptoms.

Rest periods between sets and allowing a recovery day between exercise sessions.

Your exercise program may need to be modified if you have:

  • Current shoulder pain
  • Recent surgery or injury
  • Significant weakness
  • Tetraplegia
  • Joint instability
  • Limited range of motion
  • New neurologic symptoms
  • Significant changes in sensation

A PT/OT should determine the appropriate resistance, positioning, and progression for your individual presentation.