BACKGROUND: Spinal cord injury (SCI) refers to damage sustained by the spinal cord due to direct or indirect external factors, resulting in a variety of motor, sensory, and sphincter dysfunctions. Suspension exercise training (SET), which utilizes neuromuscular activation techniques, has demonstrated lasting benefits for musculoskeletal disorders. The objective of this systematic review and meta-analysis was to rigorously evaluate the safety and effectiveness of SET as an intervention for SCI. METHODS: The authors conducted a comprehensive search across eight databases to identify all relevant randomized controlled trials (RCTs) on October 20, 2024. Data were extracted, the literature was reviewed, and the methodological quality of the included trials was evaluated. This meta-analysis was performed using Stata version 14.0. RESULTS: Thirteen studies involving a total of 883 patients were included. OUTCOMES: Lower extremity motor function score of the lower extremity motor function score of the American Spinal Injury Association Motor Score (ASIA-LEMS) (weighted mean difference (WMD) 3.653, 95% confidence interval (CI) 2.351 to 4.956, p < 0.05), the gait parameters (step length standardized mean difference (SMD) 0.655, 95% CI 0.462 to 0.849, p < 0.05; step speed SMD 1.057, 95% CI 0.533 to 1.582, p < 0.05; step frequency SMD 1.000, 95% CI 0.512 to 1.489, p < 0.05), the Berg Balance Scale score (BBS) (WMD 6.154, 95% CI 5.019 to 7.289, p < 0.05). The Modified Barthel Index score (MBI) (WMD 12.475, 95% CI 5.855 to 19.094, p < 0.05), and the Modified Ashworth Score (MAS) (WMD 0.756, 95% CI 0.879 to 0.632, p < 0.05). Significant improvements were observed in all of the aforementioned outcome indicators, suggesting that SET is likely to be effective in restoring function in patients with SCI. CONCLUSION: This study has demonstrated that SET is likely to improve motor and balance functions, as well as activities of daily living, in patients, while also contributing to a reduction in muscle tone. However, this meta-analysis is limited by the quality of the studies included; therefore, further high-quality research is essential to validate these findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO; identifier: CRD42024606161. CLINICAL TRIAL NUMBER: Not applicable.

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