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Living Well with Spinal Cord Injury: Understanding Spasticity, Stretching and Maintaining Movement

  • Writer: Ben Proctor
    Ben Proctor
  • 20 hours ago
  • 10 min read

"Should we still be stretching if they can't move the limb themselves?" The answer is often yes.


While every person is different, maintaining joint range, soft tissue flexibility, comfort and positioning can make a significant difference to quality of life. Stretching is not about "fixing" paralysis. Instead, it is about helping someone remain comfortable, maintain posture, make personal care easier and preserve as much movement as possible.


Why Does Spasticity Happen After a Spinal Cord Injury?


Following a spinal cord injury, communication between the brain and body is disrupted. Normally, the brain constantly sends messages to the muscles, telling them when to contract and when to relax. After a spinal cord injury, some of these control signals are interrupted. As a result, muscles can become overactive and develop increased tone, commonly known as spasticity.


Spasticity can appear as:


  • Muscle stiffness

  • Involuntary spasms

  • Limbs pulling into certain positions

  • Difficulty moving joints

  • Resistance when stretching


Although spasticity can sometimes be helpful by providing a degree of muscle bulk or assisting transfers, excessive spasticity can interfere with positioning, sleep, comfort, dressing and hygiene.

It is also important to remember that spasticity can fluctuate. Illness, infections, pressure sores, pain, constipation, poor positioning and even emotional stress can sometimes make muscle tone worse.


Why Stretching Still Matters


When muscles remain in shortened positions for long periods, they gradually become less flexible. Over time, joints can become stiff and movement becomes increasingly difficult.

Regular stretching can help:


  • Maintain joint range of movement

  • Improve comfort

  • Support better posture

  • Reduce pressure areas

  • Make dressing and personal care easier

  • Improve wheelchair positioning

  • Reduce the risk of long-term contractures


One of the biggest benefits is often comfort. Sometimes a successful stretching session is not measured in degrees of movement but in whether someone sits more comfortably afterwards, rests more easily in bed, or finds day-to-day care less challenging.


Maintaining movement is not about chasing perfect range of motion. It is about preserving comfort, posture, ease of care and quality of life.


Bed Stretching Versus Wheelchair Stretching


People often assume stretching should always be performed in bed. In reality, both bed and wheelchair stretching have advantages, and the best choice depends on the individual, their goals and the person assisting with the stretches.


Thinking About the Carer Too


One important consideration that is often overlooked is the wellbeing of the person providing the stretches. Family members and carers may be helping with stretching programmes every day, sometimes for many years. If the position is uncomfortable, places excessive strain on their back, shoulders or joints, or requires awkward postures, it becomes much harder to maintain consistently.

For this reason, equipment such as adjustable profiling beds, height-adjustable care beds and appropriately configured wheelchairs can make a significant difference. A stretching programme should work for both the person receiving treatment and the person providing it.

Sometimes the most effective position is simply the one that allows both individuals to remain comfortable and safe.


Stretching in Bed


The bed often allows the body to be fully supported and relaxed.


Benefits include:


  • Better trunk support

  • Easier access to both sides of the body

  • Easier positioning with pillows

  • Less risk of losing balance

  • Easier to achieve larger movements in some joints

  • Greater opportunity to position the body symmetrically


For more significant stretching sessions, the bed is often the ideal environment.


Stretching in a Wheelchair


However, wheelchair stretching should not be overlooked. For some people, sitting upright allows gravity to assist positioning. In individuals whose shoulders tend to pull forwards or whose arms rest across their lap, the wheelchair can encourage a more open posture.


Wheelchair stretching can also be more functional because it addresses the position in which the individual spends much of their day.


One advantage of seated stretching is that it can provide better access to movements around the shoulder girdle. Scapular mobilisation and shoulder extension are often easier to facilitate in sitting than in lying. This can be particularly useful when trying to improve arm positioning, sitting posture and comfort in the wheelchair.


For some individuals, stretching in sitting may help the shoulders rest more comfortably on the wheelchair armrests afterwards, improving posture and comfort throughout the day. In some cases, improvements seen in the wheelchair transfer directly into improved sitting posture and arm positioning afterwards.


The best environment is the one that is safe, comfortable and allows the individual to achieve their goals.


How to Stretch Limbs Affected by Spasticity


One of the biggest mistakes is stretching too quickly.

Fast movements often increase muscle tone.

Instead, think: Slow. Gentle. Sustained.

Move the limb gradually until resistance is felt. Rather than pushing harder, hold the position and allow the muscle time to relax. Many therapists describe feeling the muscle gradually "melt" or soften during a sustained stretch.


Support the Whole Limb


When performing passive movements, it is important to support the limb throughout the movement.

Rather than moving a hand, wrist or foot in isolation, support the joints above and below. For example, when moving the shoulder, support the arm and elbow. When stretching the hand, support the wrist. When moving the ankle, support the lower leg.


Supporting the limb well reduces unnecessary strain on joints and soft tissues and allows movement to feel smoother and more comfortable. Passive movement should never feel forced. The aim is to guide the limb through available movement, working with the body rather than against it. Slow sustained movements are often far more effective than pushing harder against resistance. When resistance is encountered, it is often better to pause and hold the position rather than force the movement. Many people find that the muscles gradually relax and allow a little more movement naturally.


A gentle pulling sensation is usually acceptable, but stretching should not be painful. Sharp pain, pinching sensations or significant discomfort should always be respected.

The goal is not to force a joint through resistance but to encourage comfortable movement, maintain available range and optimise positioning.


Common Upper Limb Stretching Areas


People with spinal cord injuries often develop increased tone in:


  • Shoulder internal rotation

  • Elbow flexion

  • Forearm pronation

  • Wrist flexion

  • Finger flexion


This can cause the arms to pull in towards the body and the hands to close. Treatment often focuses on:


  • Shoulder opening and external rotation

  • Elbow extension

  • Forearm supination

  • Wrist extension

  • Finger and thumb extension


Maintaining hand opening is particularly important for skin care, nail care and comfort.

Sometimes improving movement in one area can positively influence another. Opening the hand, extending the elbow or improving shoulder positioning may help reduce overall upper limb tightness and improve posture.


Positioning Is Just as Important as Stretching


A 15-minute stretch may be helpful.

The position someone spends the next 23 hours and 45 minutes in is often even more important.

Good positioning can help maintain the benefits achieved during stretching.

Examples include:


  • Supporting the arms on wheelchair armrests

  • Using pillows to support shoulders in bed

  • Avoiding prolonged positions where limbs remain tightly flexed

  • Encouraging symmetrical sitting where possible

  • Supporting the hands in a more open position where appropriate


Good positioning starts long before a stretching session. The way someone sits in their wheelchair, the support provided to their arms, and the way they are positioned in bed all influence muscle tone and joint comfort. Sometimes a simple change in arm support, cushion setup or seating position can achieve more than an extra ten minutes of stretching.


Medications Commonly Used for Spasticity


Stretching and positioning are important, but medication can also play a role.


Common medications include:


Baclofen


Baclofen acts on the spinal cord to reduce excessive nerve activity and muscle tone.

Potential side effects include:


  • Drowsiness

  • Weakness

  • Fatigue

  • Dizziness


Tizanidine


Tizanidine works through the central nervous system to reduce muscle spasm and tone.

Potential side effects include:


  • Sleepiness

  • Dry mouth

  • Dizziness

  • Low blood pressure


Botox (Botulinum Toxin)


Botox is injected directly into specific muscles. It temporarily weakens overactive muscles and can make stretching easier. Effects often begin within days to weeks and may last several months.

Many people find that stretching programmes are more effective after Botox treatment, as muscles can be easier to lengthen and position.


Understanding Heterotopic Ossification


One condition sometimes seen after spinal cord injury is heterotopic ossification (HO).

HO occurs when bone develops in soft tissues where bone should not normally exist.

This can happen around joints such as:


  • Hips

  • Knees

  • Shoulders

  • Elbows


The exact cause remains unclear, but it appears related to abnormal healing responses following neurological injury.

Signs may include:


  • Increasing stiffness

  • Reduced movement

  • Swelling

  • Warmth around a joint

  • Pain


In established HO, movement may become mechanically restricted because bone is physically blocking movement. This is why stretching should always be gentle and comfortable. You cannot stretch through bone. The goal becomes maintaining available movement and comfort rather than forcing range.


Splints and Orthotics


Sometimes positioning equipment can help maintain movement and posture.

Examples include:


Hand Splints

Can help:


  • Maintain hand opening

  • Reduce finger flexion postures

  • Improve hygiene access

  • Improve comfort

  • Support positioning overnight or during rest periods


Ankle Foot Orthoses (AFOs)

May help:


  • Maintain ankle position

  • Reduce contractures

  • Support standing programmes where appropriate

  • Improve lower limb positioning


Any splint should be individually prescribed and regularly reviewed to ensure it remains comfortable and appropriate.


Wheelchairs and Specialist Equipment

Modern wheelchairs are highly sophisticated pieces of equipment.

Features may include:


  • Tilt in space functions

  • Recline functions

  • Pressure-relieving cushions

  • Custom seating systems

  • Powered positioning

  • Alternative control systems such as chin, head or neck controls

  • Specialist arm supports

  • Custom headrests and lateral supports


The right seating system can significantly influence posture, comfort and long-term joint health. Good seating is often one of the most effective forms of preventative therapy. Similarly, specialist beds, pressure-relieving mattresses, standing frames and positioning equipment can all play an important role in maintaining comfort, posture and long-term health.


Spinal Cord Injury Support and Useful Resources


A spinal cord injury affects far more than physical health. It can impact family life, work, finances, housing, mobility, mental wellbeing and confidence.


Fortunately, there are many excellent organisations providing support, advice and practical assistance for individuals living with spinal cord injury and their families.

This page contains some of the organisations and resources I commonly recommend.


Cornwall and South West Support


REMAP Cornwall

REMAP is a fantastic charity that creates custom-made equipment and adaptations for people with disabilities when there is no suitable commercial solution available. Their volunteers include engineers, technicians, carpenters and occupational therapists who work together to solve practical everyday challenges.

Examples might include:


  • Bespoke wheelchair adaptations

  • Specialist seating solutions

  • Adapted equipment for hobbies and leisure

  • Personal care adaptations

  • Home-based equipment solutions


One of the greatest strengths of REMAP is their ability to create highly individualised solutions that simply do not exist commercially. Many services are provided free of charge.


Disability Cornwall

Disability Cornwall provides advice, advocacy, information and support for disabled people and their families across Cornwall. They can often help signpost individuals towards local services, support groups and funding opportunities.


Cornwall Mobility

Cornwall Mobility is a local charity supporting people with mobility difficulties. They offer advice regarding mobility equipment, accessible transport and maintaining independence.


Access Cornwall

Access Cornwall provides information and support around accessibility, inclusion and independent living within Cornwall.


Cornwall Voluntary Sector Forum (Cornwall VSF)

Cornwall VSF can help individuals connect with local support organisations, community groups and charitable services throughout Cornwall.


National Spinal Cord Injury Charities

Spinal Injuries Association (SIA)

The Spinal Injuries Association is the UK's leading user-led spinal cord injury charity. They provide support from the point of injury onwards and offer advice, advocacy, peer support, healthcare guidance and practical information for both individuals and families.


Services include:


  • Advice line

  • Peer support

  • Healthcare guidance

  • Family support

  • Benefits and advocacy advice

  • Educational resources


Back Up Trust

Back Up Trust helps people rebuild confidence, independence and skills following spinal cord injury. Their services are highly regarded within the spinal injury community and include mentoring, wheelchair skills training, courses and family support. Many of their staff and volunteers have lived experience of spinal cord injury themselves.


Services include:


  • Peer mentoring

  • Wheelchair skills training

  • Family support

  • Courses and workshops

  • Support for children and young people

  • Online community events

Website: Back Up Trust


Aspire

Aspire supports people with spinal cord injury in rebuilding independence after injury. They provide practical support around housing, employment, assistive technology and independent living.

Website: Aspire


SPIRIT

SPIRIT focuses on improving treatment, education and care for people with spinal cord injury. They support research, education and professional development whilst also helping improve standards of care.


WheelPower

WheelPower promotes sport and physical activity for wheelchair users and provides opportunities for people of all ages and abilities to become more active.

Website: WheelPower


Online Information and Education

SIA Knowledge Hub

One of the best sources of reliable UK information about living with spinal cord injury.

Topics include:


  • Bladder management

  • Bowel management

  • Pressure care

  • Wheelchairs

  • Equipment

  • Benefits

  • Relationships

  • Returning to work


Back Up Trust Resources

Back Up provides practical information on wheelchair skills, independent living, family support and adjusting to life after spinal cord injury.


Peer Support and Community


One of the most powerful resources available is connecting with others who have lived experience of spinal cord injury.


Many people report that speaking with someone who has experienced similar challenges provides reassurance, practical advice and hope for the future. Community recommendations frequently highlight organisations such as Back Up Trust and Spinal Injuries Association because of their mentoring and peer support programmes.


If you are newly injured or supporting a family member following injury, I would strongly encourage exploring:


  • Back Up Trust mentoring

  • SIA peer support services

  • Local support groups

  • Online communities and forums

  • Regional spinal injury centre events


Financial Support and Grants


Many charities can help identify grants for:


  • Wheelchairs

  • Specialist seating

  • Home adaptations

  • Assistive technology

  • Holiday and respite opportunities

  • Education and employment support


The Spinal Injuries Association, Back Up Trust, Aspire and local disability organisations are often good starting points when exploring available funding and support options.


A Final Thought


No two spinal cord injuries are the same, and everyone's journey is different.

Over the years, one of the most important lessons I have learnt is that success is not always measured by strength, movement or independence alone.


Sometimes success means:


  • Sitting more comfortably

  • Sleeping better

  • Easier dressing

  • Better hand hygiene

  • Improved posture

  • Less pain

  • More confidence

  • Making care easier for family members and carers


Small changes often make a big difference.


For people living with spinal cord injury, maintaining comfort, flexibility and positioning is not just about movement. It is about supporting independence, wellbeing and quality of life.


Progress is not always measured by what someone can do for themselves. Sometimes it is measured by comfort, dignity, participation in family life and being able to enjoy the things that matter most.


While physiotherapy, equipment and medical care are important, one of the most valuable things many people gain is connection with others who understand their experiences. Whether through family, friends, carers, support groups or spinal injury charities, having the right people around you can make an enormous difference.


Whether you are newly injured, supporting a family member, or adapting to life years after injury, there is support available and you do not need to navigate the journey alone.


At Physio at Home, we understand that travelling to appointments is not always easy following a spinal cord injury. Home-based physiotherapy allows rehabilitation to take place where it matters most – in the person's own environment. Whether the focus is maintaining joint range, managing spasticity, improving positioning, reviewing mobility equipment or supporting family members and carers, treatment can be tailored to the individual's goals and daily routine. Our approach is calm, practical and focused on helping people maximise comfort, confidence, independence and quality of life at home. More information https://www.physioathome.uk/

 
 
 

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