Exercise & Fitness

Stretching Is Essential After SCI - Stretching isn’t just therapy, it’s basic maintenance for your body. If you don’t stretch, your muscles will contract, your spasticity and pain will get much worse and you will not be able to move joints like your hips and knees (which will severely limit your independence and ability to lay in prone/supine (on stomach or on back). Whether you’re newly injured or 20 years post-injury, daily stretching is one of the most powerful tools to:

• Prevent contractures (tight muscles/joints)

• Improve posture and comfort in your wheelchair

• Reduce spasticity and stiffness

• Maintain range of motion for transfers, dressing, and reaching

• Decrease risk of pressure injuries

• Improve circulation and digestion

• Promote better breathing and trunk mobility

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You Should Stretch Independently (If You Can)

If you’re paraplegic or have some upper body function, you can likely stretch most areas independently. Many people with SCI rely on caregivers for stretching, especially in inpatient rehab. If you've been cleared by your doctor to begin stretching and have the strength and range to stretch yourself, LEARN TO DO IT YOURSELF! Stretching independently promotes ownership of your health, builds strength, balance, and body awareness (try stretching in a bed instead of a mat, it’ll be a challenge for a while, but it will build strength and balance), reduces dependence on others, and allows for more flexibility in your routine.

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How Often & How Long to Stretch

• DAILY! (should take approx. 5-20 minutes)

• Hold each stretch for 20–60 seconds!

• Repeat each stretch 2–3 times per side

• Hold stretches, avoid bouncing, if you notice any pain or AD symptoms stop!

• Stretch whenever you can (i do first thing in the morning) but for best results, stretch when muscles are warm (after a shower or workout).

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LOWER BODY & TRUNK STRETCHES (All these are important!)

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1. Long sitting, Hamstring Stretch

• Sit on bed or other surface with your legs straight out in front of you.

• Keep knees as straight as possible by using your elbows or hands to gently lean on them

• Keep legs together (hold stretch for 20+ seconds) , then spread legs apart and stretch down right-side, left side and center (holding each for 20+ seconds)

• Feel stretch behind thigh, however based on your injury, you may not be able to feel

• Keeps knees and hips flexible for transfers and dressing.

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2.  Prone on Elbows, Hip Flexor Stretch

• Get approval from therapist/doctor before starting this, especially those with fusions in the thoracic and/or lumbar areas of the spine! This can be dangerous if not done correctly but is still very important to complete if at all possible.

• Gently turn over onto stomach (cross legs while turning to minimize damage to spine and hardware), then prop on your elbows, hold for at least 3 minutes (the longer the better)

• If you cannot lie on your stomach try this: Lie on your back near the edge of bed. Let one leg hang off the edge while the other leg stays bent. Gently press the hanging leg downward.

• If you cannot do either of these roll up a towel, put towel under your lower back and lay on your back (like a lumbar pillow), can use bigger items (or more towels) for a better stretch.

• Counteracts sitting posture; reduces hip tightness.

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3. Butterfly or Figure 4 Stretch, Groin (Hip Internal Rotator) Stretch

• Butterfly Stretch: Seated on bed, mat or other surface, bend knees and put bottom of feet together, gently pull feet toward you as much as possible, then gently lean forward.

• Figure 4 Stretch: Keep one leg straight, bend the other leg, place ankle of bent leg on top of opposite knee and gently press downward on bent knee

• Helps prevent legs turning inward, loosens hips and helps with pelvic movement in transfers, dressing and other important ADLs.

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4. Calf Stretch (With Strap or Wall)

• Best done in conjunction with long sitting stretch. Try to keep knees as straight as possible to increase stretch and to stretch multiple joints at once!

• Loop a strap, yoga belt or towel around foot and gently pull toes toward you or press foot against a wall or other vertical surface.

• Prevents foot drop and helps with tone management.

5. Trunk Extension (Seated in W/C)

• Place hands on knees, pull your body forward, trying to arch your back

• OR, Do a chair pushup (pressure relief pressing body straight up trying to lift bottom off cushion) then try to push your shoulders down and back as far as possible (Make sure you are holding on tight. If you have spasms, it may be best to do this directly in front of a bed).

6. Trunk Rotation (Seated or Supine)

• Seated: Gently twist torso side-to-side, holding where tightness or stretch is felt. I think this feels best in conjunction with a chair push up (pressure relief technique, like trunk extension, do this in front of a bed first if you have spasms)

• Supine: Bend knees and rotate knees to one side while keeping shoulders flat.

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UPPER BODY & NECK STRETCHES

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1. Shoulder Rolls

• Roll shoulders in a circular pattern (clockwise x10-20, counterclockwise x10-20). Move slowly and try to make a circle with your shoulders that is as big as possible (try to push shoulder as far as you can in each direction, up, forward, down and backward).

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2. Upper Trap/Neck Stretch

• Push shoulders/scapulas down toward the ground

• Tilt ear toward shoulder gently while keeping opposite shoulder down.

• Use opposite hand to increase stretch (optional).

• Reduces neck stiffness and tension headaches.

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3. Chest/Shoulder Stretch (Doorway or Corner)

• Sit or stand in a doorway, place forearms on doorframe, lean forward gently.

• Or clasp hands behind back and lift chest.

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4. Wrist & Forearm Stretch

• Extend one arm, palm facing down.

• Use the other hand to gently pull fingers down and back.

• Repeat with palm facing up.

• Helps prevent and treat tendonitis around elbow.

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ASSISTED STRETCHES (If You Can’t Stretch Independently)  - Always communicate during assisted stretching—pain = stop. These can be done by a caregiver, family member, or trained aide. They should always move slowly and listen for discomfort or tightness.

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If you feel sharp pains or Autonomic Dysreflexia symptoms, stop stretching immediately. If no further pain or discomfort, try to gently stretch area again. If the problem persists, talk to a medical provider about the issue. If your spasticity increases during stretching, try deep breathing or wait until tone subsides. It is very likely stretching will cause increased spasticity or tone in the short term, but in the long term, joints should become looser and more flexible.