Importance of Coughing

This article contains a video
a woman smiling
Curated by
Kristen Sachs
Content via Christopher & Dana Reeve Foundation
Christopher & Dana Reeve Foundation
Curated by
Kristen Sachs

Many people with spinal cord injuries at the chest level and higher experience difficulty coughing and moving secretions. Dr. Spine of the Christopher & Dana Reeve Foundation explains the importance of understanding the anatomy surrounding the diaphragm and chest muscles, and offers cough techniques to help keep the lungs clear and healthy.


The diaphragm is an elastic membrane responsible for filling and emptying the lungs of air. It is controlled by the phrenic nerve that originates high in the cervical area around C3, C4, and C5. Individuals with injuries below the C5 level typically have pretty good control of their diaphragms. “But if you move further up, diaphragmatic control gets weaker and weaker,” explains Dr. Spine.

The chest muscles are also important when it comes to coughing. These muscles are controlled from the T1 level down. And “if you can’t tighten up your chest muscles, you don’t have the ability with a cough to add that squeeze of the chest to push on the lungs and get those fluids out,” says Dr. Spine.

But there are some techniques that can help prevent secretions from building up, which could potentially lead to an infection. 


Deep Breathing

Sit up as straight as you can, and take several deep breaths. Deep breathing helps aerate the lower portions of the lungs. Dr. Spine recommends you do this exercise every day if you are able, especially when you have an infection or suspect you might deep within the lungs.


graphic depicting a quad cough technique

Quad Cough

“A quad cough is putting pressure on the abdomen during forced exhalation.” The technique often helps quadriplegics cough up secretions, and it can be performed either by yourself or with assistance from someone else.

Insufflator/Exsufflator (CoughAssist)

The insufflator/exsufflator machine, commonly referred to as the CoughAssist) helps someone take a deep breath followed by a rapid exhalation or cough. “You can image your diaphragm coming down by its own volition but extra pressure pushing down and opening your lungs all the way up. As parts of those lungs are opened up, secretions are reduced and are easier to expectorate.”

Watch the video below as Dr. Spine discusses anatomy and techniques surrounding the all-important cough.

While coughing may be difficult with a compromised diaphragm and chest muscles, these techniques may be what you need to help keep your lungs clear. Share this post with someone who could benefit from this information!

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