Thomas Jefferson University Hospital Protocol for Muscle Strengthening of Patients

with unstable spinal cord injury

Upper Extremitas Lower Extremitas
Lesion PROM AROM Resisted PROM AROM Resisted
Level
Cervical • Stabilize scapula • To elbow and • Wrist only • Stabilize pelvis • Stabilize pelvis • Isometrics if
and shoulder girdle wrist only • Isometrics can • Gentle stretch • Gentle stretch applicable
• Shoulder flexion & be done to
abduction limited shoulder
to 90°
• No stretch
Thoracic • Stabilize scapula • To elbow and • Wrist only • No stretch of • Stabilize pelvis • Isometrics if
1-6 and shoulder girdle wrist only • Isometrics can hip flexion > • Hip flexion applicable
• Shoulder flexion & be done to 90° limited to 90°
abduction limited shoulder
90°
• No stretch
Thoracic • Stabilize scapula • Shoulder, • No resisted • Stabilized • Stabilize pelvis • Isometrics if
7-12 and shoulder girdle elbow and shoulder pelvis • Hip flexion applicable
• Shoulder flexion & wrist flexion > 90° • Hip flexion limited to 45°
abduction limited • Shoulder • Bilateral limited to 45°
90° flexion & resistance • SLR limited to
• No stretch abduction only 30°
limited to 90°
Lumbar • Shoulder flexion & • Shoulder • No shoulder • Stabilize pelvis • No hip motion • Isometric if
abduction limited flexion limited flexion > 45° • Hip flexion • Only ankle applicable
90° or to pain to 45° or abduction > limited to 45° motion
• Shoulder 90° • SLR limited to • The knee only
abduction • Minimal 30° in side lying
limited to 90° bilateral
resistance