Caring for your shoulders after Spinal Cord Injury
By Yvonne Hsieh, Senior Physiotherapist, estara
Shoulder pain can be a common and frustrating issue for many people living with spinal cord injury (SCI). There are some really simple things you can do to maintain your shoulder health and maintain your independence.
Why is shoulder pain prevalent for people living with SCI?
Shoulder pain affects between 30% and 70% of people with SCI. The shoulder joint is particularly vulnerable, with most pain linked to overuse injuries of the rotator cuff muscles. This is because after SCI, the upper limbs take on a much bigger role in daily life.
Tasks like:
Transferring from bed to wheelchair
Propelling a manual wheelchair
Performing pressure reliefs
Reaching from a seated position
are all done using the arms and shoulders. Sometimes this happens with poor posture or alignment. If you live with SCI you also unfortunately can’t simply “rest” your shoulders when they hurt and your limbs are essential for getting you around and managing daily tasks.
If left untreated, shoulder pain can make it harder to:
Transfer independently
Use a wheelchair
Participate in social or work activities
Why surgery isn’t usually the answer
Surgical treatment for shoulder injuries often requires complete rest of the arm for at least six weeks. For someone with SCI, this would mean being confined to bed. This just isn’t practical or safe for most people. That’s why conservative (non-surgical) management is the recommended approach. And the good news? There are many effective strategies that can help.
What you can do: evidence-based strategies for shoulder health
1. Exercise smartly
A tailored exercise program can:
Strengthen and stabilise shoulder and neck muscles
Improve flexibility
Build endurance to meet the demands of daily life
Research shows that stretching and strengthening programs designed for people with SCI can significantly reduce shoulder pain*. Ask your physiotherapist or exercise physiologist for a program that suits your needs.
*Van Straaten MG, Cloud BA, Zhao KD, Fortune E, Morrow MMB. Maintaining Shoulder Health After Spinal Cord Injury: A Guide to Understanding Treatments for Shoulder Pain. Arch Phys Med Rehabil. 2017;98(5):1061-1063.
2. Review your transfers
Transfers are one of the biggest sources of shoulder strain. Here’s how to reduce the impact:
Have your technique reviewed by a physiotherapist or occupational therapist.
Use assistive equipment like height-adjustable beds to make transfer surfaces level and therefore causing less strain on your shoulders.
Plan your day to reduce the number of transfers—your shoulders will thank you!
3. Check your wheelchair setup
Your wheelchair should support your posture and movement, not work against it:
Have your seating and posture assessed by a physio or occupational therapist.
Learn and use the semi-circular propulsion technique—it reduces the number of pushes and lowers the strain on your shoulders.
4. Explore assistive technology
Assistive devices can make a huge difference in preventing and managing shoulder pain. Don’t wait until pain sets in—prevention is key.
Some helpful tools include:
Power-assist devices: these attach to manual wheelchairs to reduce pushing effort.
Transfer boards: to help bridge the gap between surfaces, reducing lifting.
Electric lifters: to take the load off your arms during transfers.
Electric height-adjustable beds: to reduce the strain on your shoulders.
Shoulder pain doesn’t have to be an inevitable part of life after SCI. With the right strategies, support, and equipment, you can protect your shoulders, stay mobile, and maintain your independence.
If you’re experiencing shoulder pain, or want to prevent it, talk to your estara team. Small changes can make a big difference and we are here to help.