“As a manual wheelchair user, I’m used to looking after my shoulders but I started having neck problems out of the blue. I’m barely getting around, and I’m in pain even sitting at rest, or looking down at a book. I thought I was in reasonable shape and this is a real pain in the neck! Help!” —Tina in Northern BC
To answer Tina’s question, we turned to Andrea Bass, RPT, Physiotherapist, Inpatient Spine Program, GF Strong Rehab Centre.
Tina, you’re not alone—there are many reasons why neck pain can develop after spinal cord injury (SCI). It can be muscle related caused by posture or strain on the shoulders, positioning, and movement required for wheelchair use, or aging. Neck pain can also stem from surgery or even be caused by changes to the nerves. Addressing the underlying causes of neck pain is important for long-term relief.
Managing Underlying Causes of Neck Pain
After an SCI, many people need surgery to relieve pressure on the spinal cord or stabilize the spine. This surgery can affect nearby muscles and regaining strength in these muscles, along with those in the neck, shoulders, and upper back, is an important part of recovery.
Without proper rehabilitation, muscle weakness and imbalance can lead to long-term posture changes and ongoing pain. Even if your surgery occurred in the thoracic spine (the area from the base of your neck to the bottom of your ribs), it can still affect your neck posture and movement.
Posture and Muscle Balance
If you spend much of your day sitting in a wheelchair, it is common to develop tight muscles at the back of the neck and weakness in the deep muscles at the front of the neck. This imbalance can lead to a forward head posture, where the chin pokes forward and places extra strain on the neck and surrounding muscles.
A rehabilitation program that focuses on stretching tight muscles, strengthening the deep neck flexor muscles, and improving overall posture can help reduce strain.
Wheelchair Setup and Positioning
Your wheelchair setup plays an important role in your posture and neck health. The average human head weighs about 4.5 kg (10 lbs). When your head is positioned forward, the muscles in your neck and upper back have to work harder to support it. Optimizing your seating position can help reduce this strain.
An occupational therapist and physiotherapist can assess your wheelchair setup and recommend adjustments to support better posture.
Wheeling Technique
For manual wheelchair users, wheeling technique can also affect neck pain. Ideally, wheeling should minimize excessive shoulder shrugging between pushes. This shrugging motion, sometimes referred as shoulder hitching, can overwork muscles.
When these muscles become tight and overused, they can contribute to neck pain, shoulder pain, and headaches. A physiotherapist or occupational therapist can help you optimize your wheeling technique while a physiotherapist or registered massage therapist can help release muscle tension as well as develop a strengthening plan to optimise wheeling efficiency.
Neuropathic Pain
Not all neck pain is caused by muscles or posture. Some people experience neuropathic pain. This pain is caused by changes in the nervous system after injury, such as aging related changes or pinching of nerve roots leaving the spinal cord in your neck or back.
Neuropathic pain is often described as burning, electric, cold, or pins and needles. If your pain feels like this, it’s important to speak with your doctor, as medications and other treatments may help. Other health professionals can also support management by improving strength, movement, and posture.
Building Your Support Team
Managing neck pain after an SCI often involves a team approach. Healthcare professionals such as physiotherapists, occupational therapists, registered massage therapists, doctors, pharmacists, and psychologists can all play a role.
Peer support is also incredibly valuable. Speaking with others who have had similar experiences can provide practical ideas, encouragement, and reassurance. Neck pain after SCI is common, but with the right support it is possible to reduce pain, improve comfort, and support your long-term health.
If you need help connecting with healthcare professionals, a seating assessment, or peer support, contact the SCI BC InfoLine: call 1-800-689-2477, email info@sci-bc.ca or text 778-247-2477.
This article was originally published in the Spring 2026 issue of The Spin. Read more stories from this issue, including:
- Para pickleball
- Neurostimulation
- Cannabis
- Adaptive clothing
And more!
