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Spinal Cord Injury, Paraplegia & Tetraplegia

An injury to the spinal cord can change movement, feeling, bladder, bowel, breathing and blood pressure below the level of the injury. Know the emergency signs, then learn how rehabilitation, daily self-care and the right equipment help people live well.

Suspected spinal injury: call 911. Think of it after a fall, a crash, a dive into shallow water or a hard blow to the head, neck or back, especially if the person has neck or back pain, weakness or loss of movement, numbness, tingling or burning, loss of bladder or bowel control, trouble breathing, or a twist in the normal curve of the spine (St John Ambulance). The NHS likewise advises emergency help for paralysis or weakness after an injury to the head, neck or back, and says not to drive yourself to the hospital (NHS).

  • Don’t move the person and don’t tell them to move, unless they are in immediate danger (St John Ambulance).
  • If you can, steady their head with your hands on either side, so the head, neck and spine stay in a straight line, and keep doing so until emergency help arrives. Keep watching their breathing and responses; if they are not breathing, start CPR (St John Ambulance).
  • Emergency crews place a rigid collar and carefully lay the person on a backboard to prevent further damage to the spinal cord (NINDS).

Autonomic dysreflexia is an emergency too. In people with an injury at or above the T6 level (mid-chest), pain or discomfort below the injury, even pain they cannot feel, can send blood pressure dangerously high. It can lead to stroke, organ damage, seizures and death (MSKTC). Watch for a pounding headache, a sudden rise in blood pressure (20 to 40 points above the person’s usual top number), sweating, flushing or goose bumps above the injury, a stuffy nose, blurred vision, restlessness, a slow pulse, and cold, clammy skin below the injury (MSKTC, NINDS).

  • Sit upright right away and loosen anything tight, including clothing, belts and leg-bag straps. Check blood pressure about every five minutes. Then look for the cause, starting with the bladder (a kinked catheter or a full bladder), the bowel and the skin (MSKTC, Reeve Foundation).
  • Call 911 if you cannot find and fix the cause, or blood pressure stays high (MSKTC). Carry the wallet card from your care team so responders know how to treat it.
  • Some episodes cause no symptoms at all, which is why blood pressure checks matter (Reeve Foundation).

Call your spinal cord injury team the same day for a fever, chills, cloudy or bad-smelling urine or changes in muscle spasms (MSKTC); a cough with thick mucus, chest tightness or shortness of breath (MSKTC); a red or discolored patch of skin that has not faded 30 minutes after pressure was removed (MSKTC); or new nerve pain, new numbness or new weakness, which can mean a new problem (MSKTC).

What is a spinal cord injury?

A spinal cord injury (SCI) is damage to the spinal cord, the bundle of nerves and nerve fibers that carries signals between the brain and the body. The damage, or damage to the bones and tissue around the cord, can cause temporary or permanent changes in feeling, movement, strength and body functions below the point of injury (NINDS). Most injuries don’t cut through the cord. Instead, pieces of broken or dislocated vertebrae (the bones of the spine) tear into cord tissue or press on the nerves (MedlinePlus). Paralysis can happen immediately, or develop over time from bleeding, swelling and cell death in the cord (NINDS).

Paraplegia and tetraplegia (quadriplegia)

  • Tetraplegia, also called quadriplegia, is paralysis from an injury in the neck (cervical) part of the spine. It involves some degree of paralysis in both the upper body (shoulders, arms, hands, fingers) and the lower body (chest, legs, feet) (MSKTC).
  • Paraplegia is paralysis from an injury in the chest (thoracic), lower back (lumbar) or sacral part of the spine. It involves some degree of paralysis in the lower body (MSKTC).
  • In general, the higher the injury, the more of the body it affects (NINDS). The level of injury is the lowest point on the body where muscle movement and feeling are still normal, found with strength and light-touch and pin-prick tests (MSKTC).

Complete and incomplete injuries

With a complete injury the cord can’t send signals below the level of injury, so there is no feeling or movement there; with an incomplete injury some signals still get through and the person keeps some feeling or movement (MedlinePlus, NINDS). Doctors grade this on the ASIA Impairment Scale. The dividing line is whether you can feel the anal area or tighten the anus: if not, the injury is complete (grade A); if so, it is incomplete (grades B to D, depending on how much feeling and movement remain below the level of injury) (MSKTC).

Nobody can promise how much function will return. As rules of thumb, many people with complete injuries regain one or two levels, people with incomplete injuries are more likely to regain muscle movement, and chances are better while gains are still showing up (MSKTC). If little or no nerve cell death occurs, a person can make an almost complete recovery (NINDS).

Causes and how common it is

  • Vehicle crashes and serious falls are the most common causes in the U.S. Others include violence (mostly gunshot wounds and assaults), sports injuries, medical or surgical injuries, workplace accidents and diseases (NINDS). Diving into shallow water is another way the spine is injured (St John Ambulance).
  • Risk factors include age (16 to 30, or over 65 for dangerous falls), alcohol use, and not wearing a seat belt or protective sports gear (NINDS).
  • Numbers: the National Spinal Cord Injury Statistical Center estimates about 18,000 new injuries a year and roughly 302,000 people living with SCI in the U.S. About 79% of new cases are male, and the average age at injury has risen from 29 in the 1970s to 43 since 2015 (as reported by the Reeve Foundation).

This guide is about injury to the spinal cord itself. For everyday back or neck pain, see our Back Pain and Neck guides. Because falls and crashes can injure the head as well, see also Head Injury, Concussion & TBI, and Amputation & Limb Loss if an injury involved the loss of a limb.

Emergency and hospital care

In the emergency room, doctors check breathing, movement and feeling, and use MRI, CT and X-rays to see the damage. The spine is realigned and stabilized with a brace or mechanical force as soon as possible, and surgery may remove bone fragments or relieve pressure on the cord; in some cases, earlier surgery is linked to better recovery of function (NINDS). Early care also watches closely for unstable blood pressure, abnormal heart rhythms and blood clots, which are treated with blood thinners and compression stockings (NINDS). Unfortunately, there are at present no known ways to reverse the damage to the spinal cord itself (NICHD).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A spinal cord injury center or rehabilitation team led by a rehabilitation physician (physiatrist), with therapists, nurses, psychologists and social workers. Care covers stabilizing the spine, rehabilitation, bladder and bowel programs, skin care, spasticity and pain treatment, breathing care, equipment and lifelong follow-up. Hospital and rehabilitation costs: cost estimate being researched. Medicare Part B covers medically necessary wheelchairs, hospital beds and outpatient physical therapy (you pay 20% after the deductible). Eligible veterans can use the VA Spinal Cord Injuries and Disorders System of Care. State vocational rehabilitation is free for people with a significant disability. Recovery and rehabilitation continue for life. There is no cure, but many people regain some function, and the daily care routines in this guide help prevent many complications.
Chiropractic Spinal manipulation and adjustments. Not a treatment for spinal cord injury. About $55–$100 for a self-pay follow-up visit; first appointments about $90–$200. We found no research showing chiropractic helps spinal cord injury. After an injury the spine may be braced or fused, bones are often thin, and numb skin hides warning signs, so any hands-on spinal care needs your SCI doctor’s clearance first.
Acupuncture Fine needles, tried for nerve pain, bladder problems and recovery of function. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Reviews of small trials report encouraging but limited results, with weak study quality. Promising for nerve pain, not proven. Tell your acupuncturist about your level of injury.
Herbal medicine No herb has been shown to repair the spinal cord or reliably treat its complications. Cost estimate being researched. Research on cranberry for urinary infections is mixed, and cannabis has not been shown to relieve pain after SCI. Many people take several medicines, so check herbs with your pharmacist.
Massage therapy Gentle therapeutic massage for muscle tightness and musculoskeletal pain, by a therapist who understands SCI. At one national chain, about $125–$160 for a 60-minute massage for non-members, or a membership of about $70–$90 a month. Listed as an option for musculoskeletal pain after SCI, though research is limited to case reports. Needs a light touch, especially over numb skin, healing skin and a fragile spine.
MBHA Wellness Coach Daily habits: pressure reliefs and skin checks, bladder and bowel routines, exercise, nutrition, fluids, not smoking, mood and peer support, and emergency preparedness. Cost estimate being researched. Peer support through your rehabilitation center is often free. Supports — never replaces — your SCI team and the care plan they design with you.

Approach 1 of 6

Conventional medicine (AMA)

Care for spinal cord injury is best led by a team that knows it well. A rehabilitation physician (physiatrist) usually leads, with social workers, physical and occupational therapists, rehabilitation nurses, psychologists, vocational counselors, nutritionists and others (NINDS, MSKTC). You are the most important member: you work with the team to set personal goals, learn how to care for yourself and how to direct others who help you (MSKTC). The topics below each have their own section further down this page.

What the team treats

What it costs

  • Hospital and rehabilitation stays: cost estimate being researched.
  • Medicare: Part B covers medically necessary durable medical equipment, including wheelchairs and hospital beds, when your doctor orders it for use at home. After the deductible you pay 20% of the Medicare-approved amount, and the supplier must be enrolled in Medicare (Medicare.gov). Part B also helps pay for medically necessary outpatient physical therapy, with no yearly limit, and you pay 20% after the deductible (Medicare.gov).
  • Veterans: the VA’s Spinal Cord Injuries and Disorders System of Care serves Veterans with SCI even when the injury happened after military service. Veterans separated under conditions other than dishonorable may qualify (VA).
  • Work-related help: state vocational rehabilitation programs provide free services to people with a significant disability that limits their ability to work, and workers’ compensation programs do the same for people injured on the job (MSKTC).

What to expect

Early on, you may be in the hospital, then inpatient rehabilitation, then outpatient therapy while you build strength and stamina. Most people adjust well over time, and everyone has bad days (MSKTC, MSKTC). The MSKTC advises a checkup with your provider every year to look for health problems common to your age and type of injury (MSKTC).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care does not treat spinal cord injury, and we found no research showing that it does. The question for most people is whether it is safe, and it needs more care than usual.

Why caution matters after SCI

  • Healing and fixed spines. In the early weeks the spine is realigned, braced or surgically fused to keep it stable (NINDS, NICHD). Nobody should push on an injured spine until the surgeon says it is stable.
  • Fragile bones. Bone loss occurs in almost everyone with SCI, mostly below the level of injury, and about half of people injured 10 years or more have a broken bone at some point. In more severe cases even stretching, dressing or rolling over in bed can cause a fracture (MSKTC).
  • Hidden warning signs. A fracture or any other source of pain below the injury can trigger autonomic dysreflexia in people at or above T6, even if the pain can’t be felt (MSKTC, MSKTC).
  • Neck manipulation. Serious problems from spinal manipulation, including serious spinal or neurological problems and strokes from tears in neck arteries, are very rare but have been reported, and the chance may be higher in people with underlying health problems (NCCIH). A 2022 report in Neurology is titled “Spinal Cord Injury, Vertebral Artery Dissection, and Cerebellar Strokes After Chiropractic Manipulation” (case report, PubMed). A single report can’t show how often this happens.

Taking these together, high-force adjustments (especially in the neck, or below the level of injury) are a poor fit for most people with a spinal cord injury. If you want chiropractic care for an ordinary ache, ask your SCI physician first, tell the chiropractor your level and type of injury, and ask about gentler techniques. For routine back or neck pain in people without SCI, see our Back Pain and Neck guides.

What it costs

  • Without insurance: about $55–$100 for a follow-up visit; a first appointment commonly runs about $90–$200 (The Pricer).
  • Medicare: Part B covers qualifying manipulation of the spine, but not routine chiropractic X-rays, massage or many other office services; after the deductible you generally pay 20% of the approved amount (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is used in some rehabilitation settings. The MSKTC lists it among treatments for musculoskeletal pain after SCI, explaining that some believe it stimulates the body’s pain-control system (MSKTC).

What the research says

  • Nerve pain: a 2022 meta-analysis of six trials (286 people) found acupuncture reduced SCI-related nerve pain, with electroacupuncture looking better, but it noticed publication bias and concluded the role of acupuncture “remains to be determined” (meta-analysis, PubMed).
  • Recovery of function: a 2015 review of 12 trials found possible benefit for neurological recovery, but the studies were generally of poor quality and favored positive results, so the benefit was “by no means definitive” (meta-analysis, PubMed).
  • Overall: a 2013 review of 16 trials called the evidence for function, bladder problems and pain “encouraging albeit limited,” with two pain trials giving conflicting results, and asked for better sham-controlled trials (systematic review, PubMed).

In short, acupuncture is a reasonable, low-risk thing to discuss with your team for pain, but it is not a proven way to restore movement.

Safety

Complications are uncommon when acupuncture is done with sterile, single-use needles; problems have come from non-sterile needles and poor technique (NCCIH). Because SCI can hide pain and anything uncomfortable below the injury can set off autonomic dysreflexia (MSKTC), tell the acupuncturist your level of injury, have your blood pressure cuff handy if you are at or above T6, and ask them to be careful in areas where you can’t feel.

What it costs

  • Private sessions about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found no herb or supplement that has been shown to repair the spinal cord, restore movement or reliably treat its complications. Plants do play small roles in standard care, and a few popular ones deserve a warning.

  • Cranberry: many people with SCI believe it prevents urinary infections, but the MSKTC says research on the benefits is mixed; a daily cranberry pill avoids the sugar in juice (MSKTC).
  • Cannabis: studies so far have not shown cannabis products effective for pain after SCI, more research is needed, and smoking it is not recommended because of the risks of inhaling smoke (MSKTC).
  • Fiber: psyllium, a plant fiber, is one of the bulking laxatives that bowel programs sometimes use, under a doctor’s direction (MSKTC).
  • Vitamins and minerals: the MSKTC says some may support the immune system, but to ask your health professional before taking supplements (MSKTC).

Safety. Many people with SCI take medicines for spasticity, pain, mood, bladder and blood pressure. Herbs can interact with medicines, and for some there are theoretical reasons to suspect interactions with sedatives (NCCIH). Check with your pharmacist or doctor before taking any supplement, and don’t stop or change a prescription on your own.

Approach 5 of 6

Massage therapy

Therapeutic massage is listed among the physical treatments for musculoskeletal pain after SCI, where muscle tightness and imbalance are the cause (MSKTC). Shoulder, arm and back pain from pushing a wheelchair, transfers and pressure reliefs are common (MSKTC).

What the research says

We found little research. One 2022 case study followed a 26-year-old man who received eight one-hour massage sessions over five months after surgery involving his spinal cord. His numbness and stiffness eased slightly and he found it helpful, but one person can’t show that massage works (case study, PubMed).

Safety

  • Be gentle. Massage is generally low-risk, but serious problems have occasionally been reported, particularly with vigorous or deep work (NCCIH). One 2012 case report describes tetraplegia after a neck massage in a man who had ossification of a spinal ligament and a herniated disc, and urges extra caution with manipulation, including massage, in such patients (case report, PubMed).
  • Bones and skin. Bones can break with little force after SCI (MSKTC), and skin that can’t feel can be damaged without warning. Pressure injuries can run deeper than they look (MSKTC), so keep massage away from red, discolored or broken skin.
  • Tell the therapist about your level of injury and autonomic dysreflexia if you are at or above T6, and stop if you notice a pounding headache or sweating (MSKTC).

What it costs

  • At one national chain, a 60-minute massage costs about $125–$160 for non-members, and memberships run about $70–$90 a month (The Pricer).
  • When this work is part of physical therapy, Medicare Part B helps pay for medically necessary outpatient therapy; you pay 20% after the deductible (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Most of the problems that land people with SCI in the hospital can be prevented with daily habits. An MBHA Wellness Coach can help you build and keep them, working alongside your SCI team and never replacing it.

Daily skin routine

  • Check your skin, or have a caregiver check it, at least twice a day, morning and bedtime, using a mirror for hard-to-see areas (MSKTC).
  • Do pressure reliefs on the schedule your therapist teaches you; in a wheelchair that is generally every 15 to 30 minutes (MSKTC).

Bladder, bowel and fluids

Move your body

Adults with SCI should work up to at least 20 minutes of moderate to vigorous aerobic exercise twice a week plus strength training for each major muscle group twice a week. If you can’t reach that, any activity beats none (MSKTC). Exercise also eases pain, improves sleep and mood and helps keep weight healthy (MSKTC). A coach can help you find activities you enjoy, at a pace your doctor approves.

Protect your lungs

Don’t smoke or vape, stay up to date on flu, COVID-19 and pneumonia vaccines, and see your provider promptly for signs of a chest infection (MSKTC).

Mood, pain and connection

  • Stress, boredom and low mood can make pain worse; distraction, relaxation, breathing exercises, mindfulness and enjoyable activity can help you cope (MSKTC).
  • Peer support helps. People with SCI who have been through rehab can offer practical advice, and your team can often arrange a visit (MSKTC).

Be ready for emergencies

Keep at least a week of medicines and supplies such as catheters, copies of your medical information, a lightweight manual chair as a backup if you use a wheelchair, and a network of people who know how to help (MSKTC).

Another approach

Levels of injury and what they affect

Each section of the spine controls different parts of the body: neck (cervical) nerves control the back of the head, neck, shoulders, arms, hands and the diaphragm; chest (thoracic) nerves control the chest and back muscles and many organs; lower back (lumbar) nerves control the lower abdomen and back, buttocks and parts of the legs; and sacral nerves control the thighs, lower legs, feet, genitals and the area around the anus (NINDS). The MSKTC describes what people with a complete injury at each level can usually expect as a minimum. People with incomplete injuries, or new equipment, often do more (MSKTC):

  • C2–C4: limited head and neck movement (shoulder shrugs at C4). At C2–C3 a ventilator is needed; at C4 a ventilator may be needed at first, but most people adjust to breathing without one. Full help is needed with self-care. A power wheelchair can be driven with head, chin or sip-and-puff controls, and voice-controlled technology allows independent use of phones, computers and home devices.
  • C5: adds bending the elbows. After setup, eating and brushing teeth can be independent, and a power wheelchair is likely. Some people can drive a modified van.
  • C6: adds wrist extension. Feeding, grooming, and upper-body bathing and dressing can be independent; transfers over level surfaces and driving with adaptive controls are possible.
  • C7: adds straightening the elbows. An ultralight manual wheelchair is used, and many people manage skin checks, bowel and bladder care with devices.
  • C8–T1: adds precise hand and finger movement. Independent in all self-care.
  • T2–L1: adds trunk control. Independent in self-care, driving, and manual wheelchair use on all surfaces and curbs.
  • L2–S1: adds hip, knee, ankle and toe movement. Higher levels may use a manual wheelchair, but many people can walk short distances with braces and walking aids; lower levels often walk with few or no aids.

Breathing deserves special mention: injuries between C1 and C4 can stop breathing because those nerves move the diaphragm (NINDS). Injuries at or above T6 also carry the risk of autonomic dysreflexia (MSKTC); the Reeve Foundation adds that some people with injuries at T10 and above have reported symptoms (Reeve Foundation).

Another approach

Autonomic dysreflexia: what to do

After a spinal cord injury at T6 or above, the body’s automatic “fight or flight” response to pain or discomfort below the injury can run out of control, because the calming signal from the brain can’t get through. Blood pressure can then climb to dangerous levels (MSKTC). It is a life-threatening emergency, but it usually resolves when the cause is found and fixed.

Common triggers

A checklist, as the MSKTC lays it out

  1. Check your blood pressure. Everyone at risk should own a home blood pressure monitor and know how to use it, and know their usual numbers (MSKTC, Reeve Foundation).
  2. Sit upright and loosen tight clothing (MSKTC).
  3. Check the bladder, then the bowel, then the skin, fixing what you find (MSKTC).
  4. If your doctor has prescribed a medicine for these episodes, use it as taught (Reeve Foundation). We don’t list doses; your team will tailor them.
  5. If you can’t find the cause or control blood pressure, call 911 and show the responders your wallet card (MSKTC).

Good routine care is the best prevention: consistent bladder and bowel programs, daily skin checks and pressure reliefs, loose clothing and shoes, and safe transfers (MSKTC).

Another approach

Rehabilitation: team, therapy and technology

Rehabilitation helps you reach the best possible health, independence and quality of life (MSKTC). The first phase usually focuses on regaining communication skills and arm and leg strength, and on learning to use adaptive devices (NINDS).

  • Physical therapy builds strength and stamina; occupational therapy rebuilds fine motor skills and teaches daily tasks such as getting in and out of bed, hygiene, eating and using the toilet, and coping with spasticity, autonomic dysreflexia and nerve pain (NINDS).
  • Recreation therapy helps you return to sports, arts and leisure; vocational and educational training support a return to work or school (NINDS).
  • Devices may include braces, a wheelchair, electrical stimulators, assisted walking training, neural prosthetics and computer adaptations (NINDS).
  • Peer advice: people who have been through rehab say to trust your team, be patient, take advantage of peer support, ask questions, and keep a balanced mindset: hope for recovery, and learn the skills you need either way (MSKTC).

Another approach

Bladder and bowel management

After SCI, the signals that control the bladder and bowel often don’t work properly. For general background, see our Bladder Problems and Bowel Problems guides; this section covers what is different with SCI.

Bladder

  • An SCI can leave you unable to stop urine (incontinence) or unable to release it (retention). High pressure in the bladder can cause bladder and kidney infections, kidney stones and kidney damage (MSKTC).
  • Common options are intermittent catheterization (emptying the bladder with a catheter several times a day), indwelling catheters (urethral or suprapubic), and external collection devices. Each has pros and cons, and your doctor, often with a urodynamics test, helps you choose (MSKTC). Don’t plug a catheter, because an overfull bladder can cause infection or autonomic dysreflexia (MSKTC).
  • Urinary tract infections are common. Empty the bladder fully when needed, drink enough water and keep clean before and after bladder and bowel care (MSKTC). It is common for people with SCI to have bacteria in the urine, so antibiotics are usually only needed when symptoms appear (MSKTC).

Bowel

  • A bowel program is a customized plan for regular, planned bowel movements. It has four parts: timing, diet and fluids, medicines and emptying techniques (MSKTC).
  • Above about T11/T12, tight muscles tend to cause constipation; at or below it, loose muscles tend to cause stool incontinence (MSKTC).
  • Some pain, bladder and spasm medicines can worsen constipation, so tell your doctor (MSKTC). A full bowel is a common trigger of autonomic dysreflexia.

Another approach

Skin and pressure-injury prevention

Up to 80% of people with SCI will have a pressure sore in their lifetime, and about 30% will have more than one (MSKTC). The good news is that most are preventable (MSKTC). Without feeling, there’s no warning to shift position (MSKTC). For the basics of pressure injuries, see our Bed Sores guide.

  • Pressure reliefs: in a wheelchair, lift or shift weight every 15 to 30 minutes for at least 30 to 90 seconds; if you can’t, a caregiver should reposition you regularly (MSKTC).
  • Skin checks at least twice a day, concentrating on skin over bone: the tailbone, sitting bones, hips, heels, ankles, elbows and back of the head (MSKTC).
  • In bed: turn on a schedule, anywhere from every 2 to every 6 hours at night depending on your skin; use pillows and foam pads to protect bony areas; lift rather than slide (MSKTC).
  • Seating: get a seating evaluation at least every two years or sooner if your health or skin changes (MSKTC).
  • Keep skin clean and dry, eat a balanced diet with enough protein, avoid smoking, avoid burns and sunburn, and check shoes and clothing for tight spots (MSKTC).
  • If a red patch doesn’t fade after pressure is off for 10 to 30 minutes, a pressure sore has begun: stay off the area and call your provider if it hasn’t gone away in 2 to 3 days (MSKTC).

Another approach

Spasticity

Spasticity, or stiff, tight muscles and sudden spasms, affects about 65% to 93% of people with SCI. It is more common with neck injuries and with incomplete injuries (MSKTC). It isn’t always bad: it can help with standing or transferring and preserve muscle, and a change in spasticity can be an early warning of a problem such as a urinary infection, a fracture or a pressure injury (MSKTC).

  • Common triggers: skin irritation, pressure injuries, a full bladder or infection, constipation, injuries, tight clothing, stress and extreme temperatures (MSKTC).
  • Physical treatments: stretching or range-of-motion exercises at least twice a day, cycling, weight-bearing, splints or braces, and electrical stimulation or vibration (MSKTC).
  • Medicines and procedures: oral medicines (such as baclofen or tizanidine), injections into specific muscles, and, when other treatments haven’t worked, a surgically implanted baclofen pump, which needs regular refills and follow-up (MSKTC). Side effects such as drowsiness can be significant, so work with your provider to find the best fit.

Another approach

Pain after spinal cord injury

Most people with SCI have pain that doesn’t go away, from nerve damage or from muscles and joints (MSKTC). The pain is real, and chronic pain and distress make each other worse (MSKTC).

  • Neuropathic (nerve) pain is burning, stabbing or electric, can be felt in areas with little feeling, and is often resistant to treatment, so combinations work best (MSKTC). Treatments include medicines and electrical stimulation, but none is completely effective long-term (NINDS). See also our Nerve Damage guide.
  • Musculoskeletal pain often comes from overusing shoulders and arms for wheelchair pushing, transfers and pressure reliefs. Fixes include changing technique or equipment, strengthening, and a seating evaluation (MSKTC).
  • Visceral pain in organs can be confusing, because SCI may hide the usual symptoms, so new belly pain needs a doctor who knows SCI (MSKTC).
  • Psychological tools such as relaxation, biofeedback, mindfulness, imagery and counseling can reduce pain’s impact (MSKTC).
  • New nerve pain years after injury is unusual and may signal a new problem such as a fluid-filled cavity in the cord (syrinx), so tell your doctor (MSKTC).

Another approach

Breathing and lung health

About a third of people with SCI need temporary or permanent help with breathing, and breathing complications, usually pneumonia, are the leading cause of death (NINDS). Injury level matters: the diaphragm is controlled by nerves at the third to fifth neck levels, and coughing depends on the abdominal muscles, which higher injuries weaken (MSKTC).

  • Equipment: a cough-assist machine, suction, a ventilator or a diaphragm pacing system, depending on the injury (MSKTC).
  • Prevention: don’t smoke or vape, stay hydrated, keep a healthy weight, avoid sick contacts, and get recommended vaccines (MSKTC).
  • Sleep apnea is common, especially with neck injuries; ask about a sleep study if you snore or wake tired (MSKTC).

Another approach

Sexual health and fertility

Spinal cord injury can change arousal, orgasm and fertility, depending on the level and completeness of the injury (MSKTC). A urologist and other specialists can suggest options (NINDS). In brief (MSKTC):

  • Most people with SCI can be aroused by touch and can still have orgasms, though it may take longer and feel different.
  • Medicines for spasticity, pain or mood can reduce desire, so ask your doctor about alternatives. If your injury is at or above T6, stop and check your blood pressure if a headache or other signs of autonomic dysreflexia appear.
  • Men and women of all injury levels have had children. Many men can’t get a partner pregnant through intercourse, but urologists experienced in SCI offer treatment options.
  • Women usually have a brief pause in periods after injury, then can become pregnant, carry and deliver; a pregnancy has a higher risk of SCI complications, so find an obstetrician who understands them.
  • Condoms are considered the best birth control for most people with SCI; the pill is usually not recommended because of blood-clot risk.

Another approach

Depression and adjusting to life after injury

Feeling sad, angry or afraid at times is natural, and most people do find happiness over time (MSKTC). But major depression is common: an estimated 12% to 40% of people experience it in the first year, and about 15% to 30% of those living in the community (MSKTC). Depression isn’t weakness, and it is treatable: counseling and antidepressants work about equally well, and combining them is better than either alone (MSKTC). Exercise and support groups help too (MSKTC). Adjustment goes better when you stay connected, solve problems one at a time and look for purpose (MSKTC).

See our Depression guide. If you are having thoughts of suicide, call or text 988 (988 Lifeline).

Another approach

Bone health and safe transfers

Bone loss starts immediately after injury and is most severe in the first two years, and it continues for life at a slower rate. Fractures most often occur just above or below the knee, usually during transfers or falls from a wheelchair (MSKTC). A loud snap, redness, swelling or a low-grade fever may signal a fracture, and autonomic dysreflexia can be a sign too (MSKTC). Anyone who touches your body — helpers, therapists, bodyworkers — needs to know your bones may be fragile.

Another approach

Equipment, home, driving and work

Wheelchairs and seating

Choose a clinic with a team: you, your caregivers, a rehabilitation doctor, a therapist experienced in wheelchair evaluation and a qualified supplier. Many therapists and suppliers hold Assistive Technology Practitioner (ATP) certification, which Medicare requires of at least one specialist at the wheelchair vendor (MSKTC). MBHA plans a separate Wheelchair Users guide.

Home

The MSKTC’s level-by-level chart lists equipment such as transfer boards, bath benches, reachers, power lifts and smart-home controls for different levels of injury (MSKTC).

Driving

Many people can drive again. Your doctor can refer you to a Certified Driver Rehabilitation Specialist for a full evaluation, and vehicles can be fitted with hand controls and other adaptations (MSKTC).

Work

The Americans with Disabilities Act prohibits discrimination against qualified people with disabilities and requires reasonable accommodation, and state vocational rehabilitation programs help people find and keep jobs (MSKTC).

Another approach

Research, stem cells and unproven clinics

Be careful with promises. The MSKTC states that, despite any claim that there is a cure, there is currently no cure or proven way to completely reverse paralysis from SCI (MSKTC).

Real research

NINDS funds research on protecting nerve cells, helping the cord repair itself, cell-based therapies including stem cells, and retraining nerve circuits with rehabilitation, electrical stimulation, robot-assisted training and brain-computer interfaces. It is also studying stimulation of the cord below the level of injury (NINDS). Systematic reviews of stem-cell studies report signs of benefit, but call for caution because evidence is limited and long-term safety is unknown. A 2023 review of 22 studies of mesenchymal stem cells found improvements in some scores and no significant adverse events in the short and medium term (systematic review, PubMed); a 2024 review of 72 studies in chronic injury, with 1,144 treated people but only 186 controls, reported gains with various cell types (systematic review, PubMed). Studies like these are why trials continue, not proof that a treatment works. Ask your SCI doctor about legitimate clinical trials.

Beware of unproven stem-cell clinics. The FDA has received reports of blindness, tumor formation and infections from unapproved regenerative products (stem cells, fat-derived cells, cord blood, exosomes and more), and lists life-threatening blood infections among the risks. The FDA also says these therapies have not been approved to treat any neurological disorder. If you are being charged for such a product outside a clinical trial, you are likely being deceived and offered a product illegally, and a listing on ClinicalTrials.gov does not mean a product is legal. You can report problems to the FDA (FDA).

Member stories

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