C4 complete

Key muscles:

  • Upper Trapezius (shoulder shrug)
  • Accessory neck muscles (hold the head up, turn and lift the head)
  • Deep neck muscles (stabilise the neck, these need specific strengthening after injury to the neck)
  • Diaphragm (essential for breathing without a machine)

Not many muscles for moving are working at this level of injury. You will need help from other people for many movement tasks but you will be able to learn what needs to be done and how to direct someone to assist.

Balance strategies:

You will have some ability to shift your body position when you are in a sitting position by moving head and shoulders. Practice by loosening your chest strap and removing your head rest to allow your head to move backwards. Explore how changes in your head position can shift your weight. Make sure you have someone spotting you.

You will have limited ability to balance for safety and function and you will need some equipment to assist you. Make use of the tilt in space function in your wheelchair to rest back from upright. This allows gravity to push you back into your backrest rather than falling forward. You will also need good side supports to keep your body in alignment when you are sitting up. A chest strap is a good idea to help stop you from falling forward and good support for your arms when sitting can help with balance as well as reduce neck and shoulder pain (by supporting the weight of your arms).

Moving on the bed:

You will require assistance to change position on the bed. Use a slide-sheet to move up, down and across the bed and also to help with rolling. The people helping you will need to be careful to position your arms so they don’t get twisted or squashed when you are rolling.


You will use a hoist to transfer from your bed. Careful positioning of the hoist sling and adjustments to your posture once you are in your wheelchair are both very important. You can use a mirror to check your posture and then direct people helping you to re-position you if necessary.

Equipment to get around:

You will use a power wheelchair to get around independently. Most people with a C4 injury drive their chair with chin or head movements, there are other driving systems too so you can work out what is going to suit your abilities best.

Power wheelchairs can cover up to 25 kms per day but they will not get you everywhere you need to go. Most people travel in a modified vehicle that transports them sitting in their wheelchair. Some vehicles have lowered floors to drive the chair straight in, others have ramps and some have hydraulic hoists that can lift you and the chair up into the vehicle.

Equipment to exercise:

You can learn to use straps, foam blocks and your wheelchair to be positioned using your body weight for stretch. You will need assistance to move into the positions but should be able to remain in the stretch without someone helping. This will help you maintain flexibility in your body which can help reduce pain and spasm.

You have limited options for fitness training available because of the small number of muscles you have working. Many people do not undertake regular exercise for fitness and face the future problems of a sedentary life. FES cycling is one option that is effective for providing cardio-vascular exercise. The cycling equipment requires expert knowledge to set up and trial, it is also very expensive.