Study design <p>Retrospective case-control.</p> Objective <p>To evaluate if early resistance training in the context of gunshot spinal cord injury is associated with neurologic decline or need for secondary surgery for a new neurological deficit or spinal deformity correction.</p> Setting <p>A rehabilitation center in&#xa0;southern California.</p> Methods <p>A retrospective review of 114 patients from a national spinal cord injury rehabilitation center was conducted. Patients were allocated to two groups: those who initiated resistance training exercises (e.g. free weight or weight machine exercises, resistance band exercises, or ergometer use on a resistance setting) within three weeks of date of injury and those who began after three weeks. Primary endpoints included change in American Spinal Injury Association (ASIA) grade and need for spinal surgery for any reason following resistance training exercises completed during the acute inpatient rehabilitation stay.</p> Results <p>Mean follow up interval was 2.5 ± 0.3 years for the entire study population. No patients sustained a neurologic decline or required secondary surgery for late deformity correction or any other reason regardless of time to resistance training initiation. There was no difference in ASIA grade improvement rates across either group.</p> Conclusion <p>Immediate resistance training as part of a rehabilitation regimen for gunshot spinal cord injury appears safe.</p>