SCI Workout Consideration #6 – Muscles & Joints

Of course, all physical activity engages the muscles and joints. Everyone that exercises regularly eventually experiences some muscle soreness or joint pain or stiffness. Usually, these conditions are temporary and are easily treatable with a little rest and proper self-care; however, individuals with SCI need to be particularly aware of several conditions affecting muscles and joints that can be extremely painful and potentially debilitating.


Spasticity is due to increased tone in a muscle.

What Issues Are Posed With SCI? 

A spinal cord injury disrupts communication between the brain and the part of the nervous system responsible for muscle control below the level of injury. This disconnect can result in a common condition that individuals with SCI need to consider when exercising – spasticity.

Spasticity typically occurs in the muscles below the site of injury and can make it challenging to exercise since it can be very painful. It can lead to abnormal posture, cause deformities in the bones and joints, and can be further exacerbated by exercise.


Symptoms of spasticity include:

  • High muscle tone
  • Hyperactive stretch reflexes
  • Spasms: Quick and/or sustained involuntary muscle contractions
  • Clonus: A series of fast involuntary contractions
  • Contractures: A permanent contraction of the muscle and tendon due to severe lasting stiffness and spasms

Steps to Reduce Risk When Exercising

There are several steps that you can take to reduce spasticity and make exercise safer and more comfortable.

If you experience spasticity, try:

  • Regular stretching several times per day. This is the best way to reduce spasticity.
  • Aim to hold stretches for 10-30 seconds.
  • Use a partner to assist you in stretching of the non-functioning muscle.
  • If you take medication to control spasticity, try to coordinate the time you take the medication and the time of your exercise session to minimize spasticity during your workout.

To avoid further complications from spasticity:

  • Do not bounce or perform ballistic stretching.
  • Do not exercise when you are experiencing severe spasticity.  Work with your doctor or therapist to reduce spasticity before returning to exercise.
  • Do not exercise when you have an infection. Urinary tract and other infections can increase the risk of spasticity,
  • Do not exercise in cold temperatures, since cold air can increase spasticity.

Overuse Injuries

Individuals with SCI (particularly those that use a manual wheelchair) are susceptible to several overuse injuries. The repetitive motion of pushing a wheelchair puts significant stress on the muscles and joints of the upper body, namely the wrists and shoulders.  

Some of the most common overuse injuries experienced within the SCI community are carpal tunnel syndrome, rotator cuff strain, and shoulder impingement.

Carpal Tunnel Syndrome 

Carpal tunnel syndrome results from chronic pressure on the wrist that causes swelling.  The swelling compresses the nerve that runs through the wrist to the hand, the medial nerve, causing pain and weakness.

What Issues Are Posed With SCI? 

Manual wheelchair users are very susceptible to carpal tunnel syndrome because the act of the hand repeatedly gripping and pushing the wheels places a significant amount of force on the hands and wrists.  Studies show that as many as 90% of long-term manual wheelchair users suffer from carpal tunnel syndrome.


Symptoms of carpal tunnel syndrome affect the hand and wrist and may include:

  • Pain
  • Tingling
  • Numbness
  • Weakness

Steps to Reduce Risk When Exercising 

Like most overuse injuries, the best way to keep carpal tunnel syndrome from affecting your ability to exercise is through prevention.

Some steps you can take to reduce your risk include:

  • Wearing padded gloves.
  • Using good body mechanics when pushing your wheelchair.
  • Making sure your wheelchair is fitted properly and equipment is well maintained.
  • Using padding push rims to reduce pressure on the hands
  • Applying ice to the wrists for 20 minutes at the end of each day to reduce any swelling.
  • Incorporating a wrist flexibility and strengthening program into your routine.  

Rotator Cuff Strain & Shoulder Impingement 

The ball-and-socket structure of the shoulder joint makes it extremely mobile but also very vulnerable to possible injuries. For manual wheelchair users, the shoulder joint is the primary joint used during transfers and propulsion. This puts wheelchair users at particularly high risk for developing shoulder injuries.

Rotator cuff strain is most commonly caused by muscle imbalances in the shoulder.

The rotator cuff is a group of muscles and tendons around the shoulder joint that are responsible for moving and stabilizing the shoulder joint. The motion of pushing a wheelchair causes certain muscles of the shoulder to be used more than others, leading to muscular imbalances. These imbalances can result in injury to the rotator cuff.

Additionally, individuals with SCI tend to have weak internal and external shoulder rotators.  This weakness can also contribute to rotator cuff strain.

Symptoms of a rotator cuff strain include pain and/or an aching sensation in the shoulder joint.

An image of a man using a wheelchair and holding a dumbbell.

Shoulder impingement is another common injury among wheelchair users because the biomechanics of pushing a wheelchair creates a significant amount of pressure on the shoulder joint. This pressure is 2.5 times higher for wheelchair users than for non-wheelchair users!

Also, long periods spent in a seated position require that wheelchair users frequently reach overhead to grasp objects and perform tasks. Once again, the biomechanics of this movement put considerable stress on the shoulder joint.

Steps to Reduce Risk When Exercising 

You can reduce your risk of developing shoulder injuries by taking the following preventative measures:

  • Always use good body mechanics when pushing your wheelchair.
  • Try to balance out the time pushing in your chair with other types of physical activity that use different movements and muscles.
  • Make sure your exercise routines are well balanced, including stretching, aerobic exercise, and strength training.
  • Incorporate strength training exercises to help reduce muscular imbalances in the shoulder. Be sure to include exercises to strengthen the shoulder’s internal and external rotators!


As you can see, being aware of a few common conditions associated with SCI that can impact exercise will help you take the necessary steps to minimize your risk so that you can exercise safely. Exercising with SCI doesn’t have to be intimidating or scary, and the benefits of exercise are well-worth the investment!

Looking for SCI-friendly exercise guides? Visit our website at to view our exercise videos, equipment, and training tips.

Further Reading 

NCHPAD – Overuse Injuries in Wheelchair Users

NCHPAD – Spinal Cord Injuries


SCI Workout Consideration #5 – Bone Loss

Having weak and brittle bones due to a loss of bone mass can be a significant risk factor for injury during exercise. In general, weak bones are:

  • More susceptible to fractures from forces generated on them during physical activity.  
  • More likely to break as a result of accidents during exercise, such as slipping and falling or injury from a piece of equipment.  Even minor accidents, such as twisting your leg can result in a broken bone.

What Issues Are Posed With SCI? 

Bone loss can impact anyone, however, individuals with SCI are affected at much higher rates than the general population. In fact, it is estimated that 80% of individuals with chronic SCI have bone loss significant enough to be diagnosed with osteopenia or osteoporosis and decreases in bone density of 30% to 40% in the legs is typical after SCI.

Most of the bone loss occurs below the level of injury; therefore, individuals with quadriplegia experience the greatest overall bone loss. Individuals with paraplegia also experience significant bone loss in the lower extremities but maintain bone density in the upper body.

The primary reason for bone loss after SCI is due to the lack of mechanical stress on the bones below the level of injury. This is because every time we move, and even when we are standing still, our muscles are working to support us. When a muscle contracts, it places a mechanical stress on the bone it is attached to and the body responds to the stress by creating more bone. When the muscle can’t contract, the bone-building process ceases and bone mass is gradually decreased over time.

Other factors that contribute to the loss of bone mass in individuals with SCI include:

  • Hormonal changes
  • Changes in metabolism and blood pH
  • Poor blood flow to the limbs
  • Altered gas and nutrient exchange at the bone.

How to Reduce Risk When Exercising

You can significantly reduce your risk of fractures during exercise by always taking the following steps:

  • Exercise in a safe environment. Since accidents are a common cause of fractures, the best way to avoid them is through prevention. This means exercising in a safe environment.  
  • Make sure that your training environment is safe and free from obstacles that may cause a fall.
  • Learn safe transfer techniques to minimize the possibility of injury while transferring from your wheelchair to equipment and back again.
  • Use straps or other adaptive devices to make sure that your trunk is properly supported on equipment and ensure that you can maintain your balance throughout the exercise.
  • Take the time to properly position and secure your wheelchair prior to each exercise.
  • Use appropriate equipment. For example, if you have limited hand function, using cuff weights or weights with straps will allow you to safely perform exercises without the risk of dropping the weight on yourself.  
  • Avoid movements with a high fracture risk. Some movements put excessive stress on the bones, which can lead to fractures.  

To avoid fractures, always:

  • Perform all movements in a slow, controlled manner and always within your range of motion.
  • Avoid movements that put excessive stress on the bones.  Movements to avoid include:
    • Twisting (especially twisting with a weight or other load)
    • Extensive flexion or extension
    • Overstretching can put significant stress on the bones, causing fractures. When performing assisted stretches (i.e. stretches with a partner), make sure your partner avoids extreme tension.

Finally, remember to always check your body after each workout for any signs of fracture, including swelling, redness, and bruising.

Next Up…

#6 Muscle & Joint Issues

Further Reading 

Osteoporosis and Fractures in Persons with SCI:  What, Why, and How to Manage


SCI Workout Consideration #4 – Skin Breakdown

Anyone participating in physical activity can expect to experience skin irritations and injuries, such as cuts, scrapes, and bruises, at one time or another.  For most people, these issues are unpleasant and annoying; however, skin breakdown and irritation can be a potentially serious condition for exercisers with SCI.

What Issues Are Posed With SCI? 

In general, the loss of sensation below the level of SCI can make it difficult to realize when skin breakdown occurs. You may not be able to feel when you have a new cut or sore.

Increased friction on the skin from physical activity can lead to skin breakdown. When moving, friction occurs during skin on skin contact and from contact with clothing and equipment. Friction can also occur on areas of the body in contact with prosthetics, assistive devices, and adaptive equipment.

It’s important to note that skin breakdown experienced below the level of SCI injury can put you at serious risk for developing Autonomic Dysreflexia (AD).

There are a number of types of skin breakdown that individuals with SCI need to be aware of when exercising:

Pressure sores, or pressure ulcers, are areas of skin that are damaged due to a lack of blood flow to the area. These lesions are caused when pressure is applied to the skin and not relieved on a regular basis. They can occur from:

  • Sitting or lying in one position for too long
  • Sitting or lying on hard surfaces
  • Improperly fitting prosthetics and adaptive equipment
  • A buildup of moisture on the skin

Untreated pressure sores will gradually worsen and can cause serious complications.

Blisters are raised areas of skin filled with fluid or blood.  Blisters result from friction on the skin when it repeatedly rubs against the body, clothing, or equipment.

Abrasions, or scrapes, are caused when the skin is scraped away when rubbed up against a rough surface.

Lacerations, or cuts, are the result of the skin being cut or torn open.

How to Reduce Risk When Exercising 

To prevent pressure sores:

  • Stay well hydrated. Make sure to drink water before, during, and after exercise.
  • Avoid sitting on hard surfaces and use a well-padded wheelchair cushion whenever possible.
  • Wear clothing that is well-fitting, moisture-wicking, and appropriate for the activity/exercise.
  • Consider taping or padding areas that are prone to skin breakdowns, such as feet and heels.
  • Make sure all prosthetics and adaptive equipment are properly fitted.
  • Perform pressure reliefs, such as wheelchair push-ups, every 20 minutes.
  • Change position on a regular basis.
  • Secure yourself to equipment to reduce friction.

To prevent blisters, abrasions, and lacerations:

  • Use talcum powder, petroleum jelly, or another type of skin lubricant to reduce friction.
  • Make sure all prosthetics and adaptive equipment are properly fitted.
  • Wear gloves to protect the hands.  
  • Use plastic wheel-guard covers on wheelchairs.
  • Use caution when transferring on and off equipment.

Remember: always check your body during and after your workout for new sites of skin breakdown and pay close attention to areas that are more prone to skin breakdown, such as the hips, sacrum, feet, and heels.

Next Up…

#5 Bone Loss

Further Reading 

NCHPAD – Overuse Injuries in Wheelchair Users

Human Kinetics – Medical Conditions in Athletes With Spinal-Cord Injuries

Exercise After Spinal Cord Injury

SCI Workout Consideration #3 – Heart Rate

An increase in heart rate is a normal and typical response to exercise. Your heart rate will increase with exercise intensity until it reaches a maximum heart rate based on a number of factors (including age and gender); however, the magnitude of the heart rate response during exercise can vary significantly among individuals with and without SCI.

What Issues Are Posed With SCI? 

Your heart rate response to exercise is directly related to the level of the spinal cord injury.

T7 Injury or Below: Individuals with SCI at T7 or below, typically display heart rate responses similar to individuals without SCI.

Paraplegia: The maximum predicted heart rate for individuals with paraplegia is suppressed. Current guidelines from NCHPAD recommend keeping exercise intensity at or below 70% of your maximum heart rate.

Quadriplegia: The maximum predicted heart rate for individuals with quadriplegia is 100 to 125 bpm. Current guidelines from NCHPAD recommend keeping exercise intensity between 50-70% of your maximum heart rate.

How to Reduce Risk When Exercising 

The most effective way to make sure that you are training in a safe range based upon your injury is by monitoring your heart rate during exercise using an electronic heart rate monitor or by taking your pulse.

The rate of perceived exertion (RPE) scale is another way to gauge if you are working at an appropriate level of intensity. The RPE scale can be used alone or in conjunction with heart rate monitoring and is based upon how hard you feel you are working, on a scale from 7 (Easy) to 20 (Very, Very Hard).  The goal is to exercise at an intensity of about a 10-14, depending on your level of SCI.

Next Up…

#4 Skin Breakdown

Further Reading 

Get Moving: Exercise and SCI

NCHPAD – Spinal Cord Injuries

SCI Workout Consideration #2 – Blood Pressure

Blood pressure (BP) is another factor that is directly affected by exercise.  As with temperature, your body has a series of automatic mechanisms that work to keep your blood pressure in a safe range during and after exercise.  

What Issues Are Posed With SCI? 

Spinal cord injury, however, affects your body’s autonomic responses and its ability to regulate blood pressure.  There are two conditions that individuals with a SCI need to be aware of during exercise – orthostatic hypotension and autonomic dysreflexia (AD).  

Orthostatic Hypotension 

Orthostatic hypotension is a drop in blood pressure when in an upright position.

Orthostatic hypotension occurs most frequently when:

  • Changing from a lying position to a sitting position,
  • Changing from a sitting position to a standing position, or
  • Sitting or standing for long periods of time.

It occurs in these positions because blood pools in the legs. Furthermore, loss of nervous system control and muscle function in the lower body and trunk (typically associated with SCI) make it difficult for the body to pump blood from the legs to the brain.


Symptoms of orthostatic hypotension include:

  • Dizziness
  • Lightheadedness
  • Nausea
  • Fainting

If you experience any of these symptoms, lay on your back with your feet elevated until your symptoms go away.

How to Reduce Risk When Exercising 

To reduce the risk of orthostatic hypotension when exercising you can:

  • Gradually increase the pace and intensity of exercise to avoid sudden drops in blood pressure.
  • Get up slowly. Avoid quickly moving from lying to sitting or from sitting to standing.
  • Stay well hydrated before, during, and after exercise.
  • Wear an abdominal binder and/or compression stockings to help move blood from the legs and trunk to the brain.
  • Compression garments increase blood flow to the brain by increasing pressure in the trunk and lower extremities and “pushing” the blood towards the head.

Autonomic Dysreflexia (AD)

Autonomic Dysreflexia (AD), or autonomic hyperreflexia, is an extremely dangerous condition that results in very high blood pressures (up to 190 – 250 mm Hg systolic and 130 – 150 mm Hg diastolic) and is caused by an irritating stimulus, such as a full bladder, urinary tract infection, or pressure sore, below the level of injury. Individuals with a complete SCI at T6 or higher are most susceptible to AD since these individuals lack sensation in the lower extremities.

When irritation occurs below the level of SCI, the body reflexively responds by causing spasms and narrowing blood vessels, resulting in a rise in blood pressure. The body attempts to send signals to the brain about the increase in blood pressure; however, these signals are carried only as far as the spinal cord lesion and stop before reaching the brain.

Since the SCI lesion interrupts communication between the lower body and brain, the brain is unable to detect and respond to the increase in blood pressure. Unless treated, the blood pressure will continue to rise until it reaches potentially fatal levels.


Symptoms of Autonomic Dysreflexia include:

  • High blood pressure (hypertension)
  • Profuse sweating
  • Headache
  • Nausea
  • Goosebumps
  • Shortness of breath

How to Reduce Risk When Exercising 

To reduce the risk of autonomic dysreflexia when exercising:

Do not exercise if you:

  • Have a urinary tract, kidney, or other infection.
  • Have a known injury (e.g. broken bone) or wound (e.g. pressure sore) below the level of SCI.
  • Are constipated.

Prior to your exercise session, always:

  • Examine your body below the level of SCI for signs of injury or other potential irritants. Look for things such as pressure sores, bruises, blisters, and ingrown toenails.
  • Empty your bladder and bowels.
  • Make sure your urinary catheter is unobstructed and working properly.

If you begin experiencing any symptoms of AD during your workout, immediately:

  • Stop exercising.
  • Determine the source of the irritant and remove it, if possible.
  • Sit upright to reduce blood pressure.
  • Loosen any tight clothing.

If your symptoms do not get better right away after taking these steps, contact emergency medical services!  Remember, AD is a very serious condition and getting medical care as soon as possible could be the difference between life and death.

Next Up…

#3 Heart Rate

Further Reading 

Complications of Spinal Cord Injury: Orthostatic Hypotension

Factsheet: Autonomic Dysreflexia

SCI Workout Consideration #1 – Thermoregulation

Maintaining a safe and consistent core body temperature is critical for our bodies to function properly. In general, the human body is very effective at maintaining a safe internal temperature because it has a series of involuntary mechanisms to regulate temperature.  

For example, if your body temperature rises too high, the body attempts to cool itself by sweating and dilating blood vessels (vasodilation). If your body temperature drops too low, the body attempts to warm itself by constricting blood vessels (vasoconstriction), increasing metabolism, and shivering. These processes of regulating and maintaining a stable core temperature are called thermoregulation.  

As we exercise, our bodies respond to a variety of internal and external factors that impact our core body temperature. The temperature of the external environment, the heat generated by the working muscles, and increased respiratory functions all put stress on our thermoregulatory processes.  

Most of the time, our natural heating and cooling systems are up to the task and our body stays in a safe temperature range; however, certain circumstances, such as exercising in extreme temperatures or certain medical conditions, can result in your body’s natural heating and cooling systems to become “overloaded”. In fact, if your body temperature rises too high (hyperthermia), or drops too low (hypothermia) you can experience consequences such as cardiac arrest, brain damage, and death.

What Issues Are Posed With SCI? 

If you have a spinal cord injury, you are particularly susceptible to hyperthermia and hypothermia during exercise.

A person with a SCI has limited autonomic control (i.e. control of involuntary bodily functions) below the level of injury. Since temperature regulation is controlled by involuntary mechanisms, the mechanisms that your body relies on to regulate temperature, such as sweating dilation/constriction of the blood vessels, and shivering do not occur or are limited. This might also limit the ability to perceive changes in body temperature as well as an individual without SCI, putting you at additional risk for injury.


Symptoms of hyperthermia (overheating) include:

Symptoms of hypothermia (low body temperature) include:

  • Shivering
  • Slurred speech or mumbling
  • Slow, shallow breathing
  • Weak pulse
  • Clumsiness or lack of coordination
  • Drowsiness or very low energy
  • Confusion or memory loss
  • Loss of consciousness

How to Reduce Risk When Exercising 

There are several steps that you can take before, during, and after exercise that can help maintain a safe body temperature throughout your workout.

To reduce the risk of hyperthermia (overheating):

  • Stay well hydrated. Make sure you drink water before, during, and after exercise.
  • Wear lightweight clothing designed for use in warm-weather activities.
  • Dress in layers so you can remove clothing as needed.
  • In extreme heat and humidity conditions, exercise indoors.
  • Make use of fans and air conditioning.
  • Use a cold towel or spray bottle to help you stay cool during exercise.

To reduce the risk of hypothermia (low body temperature):

  • Stay well hydrated. Make sure you drink water before, during, and after exercise.
  • Refrain from exercising in the extreme cold.
  • If you do exercise in the cold, dress in layers and bring extra clothing.
  • Remember that the extremities (such as your arms, hands, feet, and legs) lose heat quickly.  Make sure to protect your extremities with appropriate apparel such as gloves and warm socks.  

Next Up…

#2 Blood Pressure

Further Reading 

Hypothermia: Causes, Symptoms, and Treatment

Understanding Heat-Related Illness – Symptoms

The Top 6 Considerations for a Safe and Effective SCI Workout – Introduction

September is Spinal Cord Injury (SCI) Awareness month.  As the month comes to a close, we will focus on the importance of exercise for individuals with SCI and take a look at 6 common conditions to be aware of when exercising to stay safe during your workout.

Benefits of Exercise with SCI

To many individuals with a SCI, the thought of exercising can seem overwhelming and downright scary.  Although exercising with SCI does pose its challenges, regular exercise is very important for the overall health and well-being of these individuals.  Of course, exercise provides numerous benefits to both physical and mental health and offers the additional benefit of improving independence and the ability to perform day-to-day activities.

Research in the SCI population has shown that exercise improves:

  • Respiration (breathing)
  • Muscle strength
  • Circulation
  • Immune system function
  • Body composition
  • Self-esteem
  • Mood
  • Independence and ability to perform activities of daily living (ADL’s)

Likewise, exercise also helps prevent:

  • Urinary tract infections
  • Respiratory infections
  • Loss of muscle mass
  • Obesity

And finally, exercise reduces:

  • Depression
  • Anxiety
  • Constipation
  • The risk for diabetes
  • The risk for heart disease

Fortunately, most individuals with SCI can exercise safely, as long as they are familiar with a few common conditions.

Our Top 6 Considerations When Exercising with SCI

Being aware of a few common conditions associated with SCI that can impact exercise will help you take the necessary steps to minimize your risk so that you can exercise safely.

Staying Safe When Exercising with SCI Infographic
Click on the Image to View Larger

Here are our top 6 considerations when exercising with SCI:

#1  Thermoregulation

#2  Blood Pressure

#3  Heart Rate

#4  Skin Breakdown

#5  Bone Loss

#6  Muscles & Joints

Each day over the next week, we will take a look at one of these 6 common conditions associated with SCI.  We will see how they can impact exercise and outline the steps that you can take to minimize risk and make exercise both enjoyable and safe.

Remember, exercising with SCI doesn’t have to be intimidating or scary, and the benefits of exercise are well-worth the investment!

Next Up…

#1 Thermoregulation

Get a Grip: 4 Essential Pieces of Equipment for Resistance Training with Grip Pain & Weakness

It’s estimated that over 1 in 4 adults in the United States experiences some degree of difficulty gripping objects due to pain or weakness in the hands. While gripping difficulties can be due to a number of conditions including fibromyalgia, stroke, paralysis, multiple sclerosis, cerebral palsy, and Parkinson’s disease, arthritis is by far the most common cause of gripping difficulties, and the Centers for Disease Control and Prevention estimates that it affects more than 54.4 million adults in the USA. In fact, arthritis is currently the leading cause of adult disability in the US.

Luckily, there are ways for those affected to alleviate pain in the fingers, hands, and wrists, as well as increase grip strength. One of the best ways to reap these benefits is by following a regular resistance training program. 

Though a resistance training program might seem counterintuitive, it can be incredibly effective and only requires a few versatile pieces of equipment. Best of all, this method doesn’t require a lot of money spent on equipment or gym memberships, and can even be completed in the comfort of your own home!

What is Resistance Training?

According to the American College of Sports Medicine, resistance training (also known as strength training or weight lifting) is “a form of exercise designed to improve muscular fitness by exercising a muscle or a muscle group against external resistance.”

Applying external resistance to a muscle will cause it to contract, leading to increases in muscular size, strength, endurance and tone. External resistance can come in a variety of forms, including dumbbells, barbells, kettlebells, resistance bands, or even your own body weight.

What are the Benefits of Resistance Training?

Over and over, research has shown that resistance training has numerous positive effects on both physical and mental health for participants of all ages and ability levels.  

According to the Mayo Clinic and a recent study in the American Journal of Lifestyle Medicine, some of the general benefits of resistance training include:

  • Retention of lean muscle mass with age
  • Improved balance
  • Decreased risk of heart disease
  • Reduced resting blood pressure
  • Increased bone mineral density
  • Alleviation of the symptoms of anxiety and depression
  • Increased functional independence and enhanced quality of life

As if the benefits listed above weren’t enough, studies also suggest that resistance training provides even more benefits for individuals with arthritis, fibromyalgia and other conditions causing grip pain and weakness.

The Mayo Clinic and an article by Wayne Westcott in the Current Sports Medicine Reports state that those additional benefits of resistance training include:

  • Increased range of motion
  • Decreased joint pain
  • Reduced lower back pain

How do I Resistance Train When I Can’t Hold a Weight?

To fully reap the rewards of resistance training, the American College of Sports Medicine (ACSM) recommends performing resistance training a minimum of two days per week. The ACSM also states that “exercise sessions should be performed on non-consecutive days and each session should target each of the major muscle groups.”

This all sounds great in theory, but, in reality it can be difficult to perform strength training exercises when you experience grip pain and weakness. Typical resistance training equipment such as barbells and dumbbells requires significant gripping strength!

Fortunately, there are plenty of other equipment options available that will allow you to strength train with grip pain and weakness. Below, we’ll examine 4 essential pieces of resistance training equipment that will allow you to safely adapt and perform resistance training workouts.

Looking for exercises?  Want tips on selecting and using equipment?  Visit our website at to view our exercise videos, equipment, and training tips.

Essential Pieces of Equipment for Resistance Training

Let’s explore 4 essential pieces of resistance training equipment that you can use to get a safe and effective resistance training workout– all from within the comfort of your own home!

1. Medicine Balls

A medicine ball is simply a weighted ball. They are a great tool for developing upper body strength, as well as performing a variety of functional movements for the upper body and core.

Medicine balls are versatile and are available in a variety of sizes (from the size of a softball to the size of a beach ball) and weights (from 1 pound to 50 pounds).

Traditional medicine balls are firm and covered with a nylon, leather, polyurethane, or rubber exterior.  Frequently, the ball’s exterior is tacky or textured to make it easier to grip. However, even traditional medicine balls with these features can be impossible to use if you suffer from grip pain and weakness.

Luckily, there are several medicine ball options that give those with grip pain and weakness all of the benefits of a traditional medicine ball, without the need for a strong grip.

Let’s explore these options in more detail…

Medicine Balls with Handles or Straps

This style of medicine ball is similar to a traditional medicine ball, but it has either one or two handles or straps. Generally, these medicine balls have a hard, texturized shell.

The user’s hands slide into the straps or handles, making the ball easy to grip and cause less fatigue in the arms and hands, which allows you to exercise longer. These medicine balls provide the option of gripping with one or two hands to allow for both one arm and two arm exercises (if the ball is small).

An image of a medicine ball with handles.
Medicine Ball with Handles

Medicine balls with handles or straps are ideal for:

  • Upper body exercises
  • Abdominal training
  • Exercises involving rotational movement

Soft Grip Medicine Balls

Soft medicine balls have a soft, pliable exterior shell and are typically filled with sand, gel, or a similar flexible material. An added bonus – because soft medicine balls are squishy, they also develop grip strength!

An image of a soft medicine ball.
Soft Medicine Ball

Some soft grip medicine balls are filled with air. The firmness of air-filled balls can be adjusted by increasing or decreasing the air. The more air, the firmer the ball. The less air, the more pliable the ball, making it easier to grasp.

If the ball is small, soft medicine balls give you the flexibility of gripping with one or two hands, allowing for both one arm and two arm exercises.

Soft grip medicine balls are ideal for:

  • Upper body exercises
  • Developing grip strength

Ergonomic Medicine Balls

An ergonomic medicine ball has all of the advantages of both a medicine ball with straps and a soft grip medicine ball. Double bonus!

The ergonomic design fits the natural shape of the hand, leading to less fatigue and easier grip, but this style of medicine ball also has a soft, pliable surface like a soft medicine ball. This allows you to use it like a dumbbell but is much easier to hold onto.

The user’s hand slides into the strap, making the ball easy to grip. The strap can be adjusted to fit securely around the hand, which requires minimal gripping strength from the user.

Red, soft ergonomic medicine ball with adjustable strap.
Ergonomic Medicine Ball with Strap

Ergonomic medicine balls are ideal for:

    • Upper body exercises
    • Any exercise that you would use a dumbbell to perform
    • Individuals with severe hand pain and weakness since minimal gripping is required
    • Training one arm at a time
      • Note: If you want to work both arms at the same time, you simply need a second weight and use them just like you would use a pair of dumbbells

2. Soft Hand Weights

Soft hand weights are used much like a dumbbell but are much easier and more comfortable to hold onto. They consist of a soft, pliable shell that’s filled with sand or similar material, and are particularly great for individuals with larger hands that find light dumbbells too small to grip.

Man's hand holding a blue, soft hand weight.
Soft Hand Weight

Soft hand weights are ideal for:

    • Upper body exercises
    • Any exercise that you would use a dumbbell to perform
    • Training one arm at a time
      • Note: If you want to work both arms at the same time, you simply need a second weight and use them just like you would use a pair of dumbbells.

3. Cuff Weights

A cuff weight is typically a nylon sleeve that is wrapped around the wrist or ankle and secured with a Velcro strap. They are most often filled with sand or other similar materials and come in a range of weights (from 0.25 pounds to 25+ pounds).

Cuff weights can be used alone or in pairs and provide a great way to add resistance to almost any exercise without having to hold a weight. They are great for users with conditions such as tetraplegia and cerebral palsy who are unable to grasp because cuff weights don’t require any gripping!

Cuff weights are most often sized in a way that allows the wearer to place them on either the ankle or the wrist. This allows for use in both upper and lower body exercises. Larger sized cuffs are also available to use on the thigh, or with larger individuals, and pediatric sized cuffs are available for children and smaller adults.

Cuff weights are available in both fixed and variable (adjustable) weight versions. Here’s a little more information about each of these options…

Fixed Weight Cuff 

Fixed weight cuffs refer to cuffs that have a specific and unchanging weight.

Black and blue fixed weight cuff with adjustable strap.
Fixed Weight Cuff

The Pros & Cons of Fixed Weight Cuffs

Pros Cons
  • Often less expensive per cuff than variable weight
  • Many users find them more comfortable and conform better to the wrist or ankle than variable weights
  • If you want to increase or decrease weight, you must purchase other cuffs to expand your selection

Fixed weight cuffs are ideal for:

  • Upper and lower body exercises (wrist & ankle)

Variable Weight (Adjustable) Cuff

Variable weight cuffs (or adjustable weight cuffs) allow the user to adjust the weight of the cuff in small increments. The weight is adjusted by adding or removing weighted inserts.  

2 images of red, variable weight cuffs with adjustable straps and metal inserts.
Variable Weight Cuff

These inserts are typically small metal rods or small pouches filled with sand, and can range from 0.1 to 5 pounds each, depending upon the total weight of the cuff.

The Pros & Cons of Variable Weight Cuffs

Pros Cons
  • Variable weight cuffs have the benefit of providing a range of weight options without having to purchase several individual cuffs
  • Often more expensive per cuff than fixed weight
  • Many users find them less comfortable and do not conform as well to the wrist or ankle as fixed weight cuffs

Variable weight cuffs are ideal for:

  • Upper and lower body exercises (wrist & ankle)

4. Cuff Attachments & Handles

Resistance bands and resistance tubing are a terrific way to resistance train and are available in a variety of sizes, lengths, and strengths.

Resistance bands and resistance tubing offer the following advantages:

  • Lightweight and portable. You can use them anytime, anywhere. They are particularly great when you are travelling.
  • Cost-effective. Bands are relatively cheap compared to other fitness equipment. You can typically get a set of 4-6 foot bands or tubing for less than $20.
  • Good for any fitness level. Resistance bands come in a variety of resistances (from XX-Light to XXX-Heavy). There are options that are light enough for beginners or heavy enough for experienced exercisers.  
  • Easily adaptable. The level of resistance is easily adjustable, even in the middle of an exercise. Too much resistance? Just give the band or tube more slack. Too little resistance? Choke up on the band to make the exercise harder.  
  • Versatile. Resistance bands and tubes can be used for an effective full-body workout that challenges every part of the body – upper body, lower body, and core. The possibilities are endless!

With all of those benefits, working out with bands and tubing seems like a no-brainer. Unfortunately, it can be difficult to hold bands and tubes if you experience grip pain and weakness. Fortunately, there are several attachments that will allow you to safely and effectively use bands and tubing without discomfort or pain.  

Here are two great options…


A variety of handle attachments have been designed for use with resistance bands and tubing. Handles are typically covered with a foam padding, which makes the handles more comfortable and easier to grip. Using handles also reduces fatigue in the hands and forearms.

Pair of Handles
Pair of Handles

Handles are typically attached to the band or tube by one of two ways:

  1. Tying the band or tube to a metal D-ring on the handle. However, this method can be challenging to securely tie the tube or band if you have limited dexterity and/or finger, hand, or wrist pain.
  2. Threading the band or tube through a special “easy-load” mechanism. Handles with the “easy-load” mechanism allow the user to loop the band or tube through the handle and secure it without tying. This attachment method is best for anyone with limited dexterity and finger or hand pain.

Handles are ideal for:

  • Upper body exercises
  • Individuals with only slight grip pain or weakness


A cuff attachment is an adjustable, padded strap that is wrapped around the wrist or the ankle and secured with a Velcro strap. This attachment is a great way to use resistance bands and tubes without having to grip. Cuffs are particularly helpful to those that are unable to grasp and for those with conditions such as tetraplegia and cerebral palsy. The cuff is used just like a handle — but no gripping is required!

Cuff attachments come in a variety of sizes for use on the wrist, ankle or thigh. This versatility allows for use in both upper and lower body exercises. There are also larger sized cuffs available to use by larger individuals and pediatric sized cuffs are available for children and smaller adults. The variety of cuff sizes allows for use in upper and lower body exercises, giving you virtually unlimited exercise options. 

Adjustable cuff attachment on a green resistance band.
Band with Cuff Attachment

Just as with the handle attachments, cuff attachments are typically attached to the band or tube by one of two ways:

  1. Tying the band or tube to a metal D-ring on the cuff. However, this method can be challenging to securely tie the tube or band if you have limited dexterity and/or finger, hand, or wrist pain.
  2. Threading the band or tube through a special “easy-load” mechanism. Cuffs with the “easy-load” mechanism allow the user to loop the band or tube through the handle and secure it without tying.  This attachment method is best for anyone with limited dexterity and finger or hand pain.

Cuffs are ideal for:

  • Upper and lower body exercises (wrist, ankle, thigh)
  • Individuals with little or no grip strength
  • Individuals experiencing severe finger, hand, or wrist pain


The good news?

You can exercise with grip pain and weakness, you just need the right equipment!

With just a few key pieces of equipment, you can get an effective, full body workout at home without spending a lot of money or joining a gym. Best of all, developing a workout plan that includes resistance exercise will help you manage and alleviate symptoms of arthritis, fibromyalgia, and other conditions that cause grip pain and weakness.

So, what are you waiting for?  Don’t let grip pain and weakness stop you from being your best!


Finding Your Personal “Whys”

Congratulations!  You’ve started the journey to better health.  You are working hard to eat healthier and exercise more.  You may even be starting to see results in terms of weight loss.  You are riding a wave of adrenaline, determined to persevere this time around.  Then it starts to happen…the weeks pass, the initial excitement begins to wear off, and it gets harder and harder to stay motivated.  What can you do to keep your momentum and maintain it for the long-term?  The answer lies in finding your personal “Whys”.

What are your personal “Whys”?

Ask yourself the following question – “Why do I want to be healthier?”  Most people respond to that question with something like the following:

“I want to lose weight.” or “I want to get fit.”  Those are all reasonable objectives, but they don’t answer the question of “Why?”.  Losing weight, getting fitter, building muscle may be the outcome of adopting a healthy lifestyle, but they don’t address the underlying reasons that motivate you to get and stay healthy.  Your personal “Whys” are the true reasons that you want to be healthier.

Some examples of personal “Whys” include:

  • I want to sit in an airplane seat without using a seat belt extender.
  • I want to get my diabetes under control without medication.
  • I want to carry my groceries into the house without assistance.
  • I want to ride a bicycle with my children.
  • I want to walk up a flight of stairs without getting winded.

Why is knowing your personal “Whys” important?

Research shows that individuals that identify the things that they want to do/have/experience when they are healthy are more successful in achieving and maintaining a healthy lifestyle.   When times get tough and motivation begins to wane, focusing on your personal “Whys” can give you the push you need to achieve your goals.

Woman ThinkingHow do I find my personal “Whys”?

A good way to determine your personal “Whys” is simply sitting down and by making a list.  Brainstorm all of the things that you want to do/have/experience when you are healthy.   Once you have your list, post it somewhere you can see it everyday.  Keeping these “Whys” in the forefront of mind keeps you focused on the things that are truly important to you and sustain you in the long run.

6 Practical Tips for Starting an Exercise Program and Sticking to It

Beginning an exercise program can be the start of an amazing transformation in your physical and mental health and overall wellbeing. Studies show that regular moderate physical activity has numerous benefits including:

  • Achieving and/or maintaining a healthy weight and body composition.
  • Reducing the risk of diseases such as stroke, metabolic syndrome, type 2 diabetes, depression, certain types of cancer, depression, and arthritis.
  • Improving mood by stimulating brain chemicals that make you feeling happier and more relaxed.
  • Increasing energy levels.
  • Improving the quantity and quality of sleep.

With all of these benefits, it is hard to make an argument not to include exercise in your daily routine. However, once you make the commitment to begin an exercise program, it is important to have a plan and adhere to some basic advice when getting started. Even with the best intentions, exercise can quickly become a painful and frustrating experience if you jump in too quickly without having the proper tools for success. Here are some practical tips to make the transition to regular physical activity as pleasurable and pain-free as possible.

#1 Start Low and Slow

The easiest and quickest way to fall off the exercise bandwagon is to begin to fast and push too hard. Start off slowly, work at a low intensity, and build up gradually. It takes time for your body to adapt to exercise so be kind to yourself and give your body time the time it needs to adjust. Trying to do too much too soon will inevitably result in frustration, fatigue, and injury.

#2 Take a Load Off

If you are new to exercise, particularly if you are significantly overweight, stick to exercises that are low impact. Low impact exercises are activities that are either non-weight bearing or minimally weight bearing. Low impact activities are easier on the joints and are generally more comfortable for overweight individuals. Examples of low impact exercises include cycling, swimming, water aerobics, and rowing. You may also include moderate impact activities such as walking or using an elliptical machine, in your exercise program as long as you do not experience discomfort or pain. Once you have developed a good foundation of fitness, you can begin to slowly incorporate short bouts of high impact activities such as running and plyometrics (jumping) into your routine.

#3 Dress for Success

Having the proper shoes and clothing is a must when beginning an exercise program. Purchasing high-quality clothing and footwear that is appropriate for the activities you are performing may be pricey up front, but I promise you it is worth the investment in the long run.

Shoes should fit well and provide good support. If possible, have a professional measure and fit you for shoes, particularly if you plan to engage in a lot of weight bearing activities like walking or running. Many running stores offer free fitting services. Having properly fitted shoes is critical in reducing the risk of painful conditions such as blisters, shin splints, and injuries to the joints.

Clothing should fit well and be made of high-performance synthetic fabrics that wick sweat away from the body. Fabrics such as cotton absorb sweat and interfere with the body’s natural heat regulation processes and can promote chafing.

Chafing is a common (and very uncomfortable!) side effect of starting an exercise program. Chafing most frequently occurs as a result of exercise that consists of repetitive motion of the limbs, such as walking, running, and cycling. When the skin continually rubs against clothing or other skin, friction builds and the skin becomes irritated. The most typical sites of chafing are the thighs, underarms, and groin.

The best way to deal with chafing is to prevent it in the first place. There are a number of options for minimizing chafing from exercise. The first step, as mentioned above, is to make sure that you are wearing synthetic fabrics that wick sweat away. Second, wearing compression garments can significantly reduce friction during movement and therefore chafing. Athletic apparel companies, such as Under Armour, have extensive lines of compression clothing designed specifically for exercise. Finally, several anti-chafing balms (e.g. Body Glide) and creams are available to reduce chafing. These products are applied directly to the skin and provide a protective layer that helps to minimize friction during movement.

#4 Get Fueled Up

In order to get the most from your exercise program, it is critical to make sure that your body is properly fueled by plenty of water and nutritious foods. In order to function efficiently, burn fat, and build muscle, the body needs the macronutrients, vitamins and minerals found in whole foods such as fruits, vegetables, lean meats, low-fat dairy and whole grains.

Minimize empty calories by reducing added sugar and salt in your diet. Processed and packaged foods are the most common sources of added sugar and salt. Reducing or eliminating processed foods and replacing them with a balanced diet of whole foods will ensure that your body is appropriately fueled for exercise and has the building blocks necessary to build muscle and burn fat.

Eating real, whole foods is the best way to fuel your body for exercise. Using supplements is a tempting way to easily get vitamins and minerals; however, the body generally does not absorb and use vitamins and minerals from supplements as effectively and efficiently as it does from food. Also, unlike other drugs, supplements are not regulated by the government and therefore do not have any controls on contents or the quality of the product. Companies making and marketing these supplements are not required to verify the ingredients in the product, prove any claims of health benefits, or disclose potential dangers or side effects. Unless you have a specific vitamin or mineral deficiency that your doctor has prescribed a supplement to treat, it is always better to save your money, skip the supplements and choose healthy, whole foods.

Finally, if one of your goals is to lose weight, do not replace the calories you burn during exercise! It is easy to justify eating more by telling yourself that your body needs the extra calories because you worked out. However, this is rarely the case. Unless you exercise for over an hour at a moderate to high intensity (e.g. running 6 miles in an hour) you do not need to replace any of the calories your burned.

#5 Have a Backup Plan (or 2 or 3!)

Starting an exercise plan is the easy part – sticking with it in the long run is the hard part! One of the best things you can do to set yourself up for long-term success is to plan ahead. I suggest sitting down at the start of each week and creating a weekly plan that answers each of the following questions.

  • When will I exercise this week?  What days?  What times?
  • What exercise(s) will I do?
  • Where will I exercise?
  • How long will each exercise session last?
  • Who will I exercise with?

By making a detailed plan for the week, you have blocked off the appropriate time on your schedule to exercise. It also allows you to identify and deal with any obstacles that may prevent you from exercising. Inevitably, life happens and unexpected events occur that can potentially sidetrack us from our exercise plan. Brainstorm all of the possible reasons you can come up with that would prevent you from meeting your exercise goals and then determine what you can do to bust those excuses. Have a list of exercise options you can do inside, outside, in a small space, with little or no equipment, etc. Be prepared and don’t let the unexpected sneak up on you and get in the way of meeting your exercise goals.

#6 Get in Touch

Pay attention to how their body feels during and after exercising. At first, even minimal amounts of exercise can feel uncomfortable and unpleasant if you are new to exercise. However, as you continue to exercise consistently, you will begin to notice a change in how you feel both during and after exercise. Your breathing will become less labored; you can work longer and go farther with less fatigue, and you will begin to savor the feeling of accomplishment when you finish your workout. You will also begin to notice subtle changes in your everyday life. You may find you are less stiff when you get out of bed in the morning, you have more energy, walking a flight of stairs is no longer a challenge, and overall you are feeling happier and healthier. Pay attention to these feelings! When you are feeling down or tired and want to skip a workout, remember how exercise makes you feel and focus on the positive effects that it has had on your life. This will give you the motivation to stay focused and keep on moving!