Can You Walk Again After a Spinal Cord Injury? Key Factors

It is completely understandable that “Will I walk again?” is often the first question asked after a spinal cord injury. Because every injury is unique, there is no single percentage or guarantee that applies to everyone. However, doctors can provide a prognosis (expected outcome) based on your early clinical examinations.

These predictions primarily apply to traumatic spinal cord injuries (caused by an impact or accident). The chances of walking again depend on several factors, with the most important being your neurological level of injury and whether the injury is classified as “complete” or “incomplete” ^[1][2]. People with incomplete injuries have a much higher likelihood of regaining the ability to walk compared to those with complete injuries ^[3][4].

Understanding the ASIA Impairment Scale (AIS)

To classify your injury, a trained clinician will perform a standardized physical exam and assign an ASIA Impairment Scale (AIS) grade. It is important to know that an early exam (within the first few days) might change as swelling, spinal shock, or other acute medical issues resolve ^[5].

The AIS grades range from A to E, and they are one of the most reliable early predictors of walking recovery ^[1]:

• AIS A (Complete Injury): This means there is no preserved sensory or voluntary motor (muscle) function in the lowest sacral segments of the spinal cord (S4-S5, at the base of the spine). Importantly, “complete” is a neurological classification and does not mean the spinal cord was physically severed or cut in half. While statistically people with an AIS A grade have the lowest likelihood of walking again ^[3][4], some individuals do see their grade improve over time ^[6].
• AIS B (Sensory Incomplete): Sensation is preserved below the injury level (including the sacral segments), but there is no voluntary muscle movement. The chances of walking again are highly variable ^[3]. Preserved sensation, such as feeling a pinprick in the legs, is a strong positive sign ^[7].
• AIS C and D (Motor Incomplete): There is some degree of voluntary muscle movement below the injury level. People with AIS C or D injuries have the greatest likelihood of regaining useful walking ability ^[3][4].
• AIS E (Normal): Sensory and motor functions are normal.

The Timeline of Recovery: What Often Happens

Recovery from a spinal cord injury is generally “front-loaded,” meaning the fastest neurological changes happen early on ^[5][8]. However, these are population averages, not strict deadlines:

• The First 3 Months: This is typically when the fastest motor recovery (return of voluntary muscle movement) takes place ^[5].
• 3 to 9 Months: Meaningful neurological recovery often continues, with most changes in an individual’s AIS grade occurring within the first six to nine months ^[5].
• Beyond 9 Months: Neurological recovery (the healing of the nervous system) generally slows down ^[8]. However, functional recovery—improving your strength, balance, use of braces, and walking skills—can continue for much longer through rehabilitation ^[9].

Other Factors That Matter

While your AIS grade is crucial, your care team will also look at:

• Neurological Level and Specific Muscles: Walking depends on the pattern of strength across multiple lower-extremity muscles. For instance, preserved strength and sensation in specific spinal segments (such as those tested at the L3, L5, and S1 levels in the lower back and sacrum) strongly predict the ability to walk outdoors independently ^[10].
• Age and Overall Health: Older age may reduce the likelihood of walking again ^[7]. Medical complications like diabetes or severe infections can also delay rehabilitation and impact functional outcomes ^[11].
• Individualized Rehabilitation: Participating in supervised, task-specific therapy (like locomotor training, which focuses on practicing walking motions) can help maximize your functional mobility ^[12]. The timing and intensity of this therapy must be carefully tailored to your medical stability, bone health, and energy levels.

Defining “Walking” for You
“Walking” can mean different things: independent community walking, short-distance indoor walking with braces and a walker, or relying mostly on a wheelchair while standing for transfers. Clarifying your specific goals with your team will help guide your rehabilitation.

(Note on Symptoms: If you notice new muscle twitches or spasms, report them to your care team. These are often reflexes or spasticity rather than purposeful, voluntary muscle control, and your doctor can help you understand the difference through a standardized neurological exam.)