Purpose: To determine whether pain, posture and satisfaction with life change in persons with spinal cord injury after improvement in sagittal plane alignment via customized orthotic wheelchair configuration. Methods: Prospective repeated measure study. Participants: Eleven men with T1-T10 motor complete spinal cord injury. Main Outcome Measures: Seated Height (SH), Wheelchair User's Shoulder Pain Index (WUSPI), Posture Scale for Wheelchair Users (PSWU), pain intensity, and Satisfaction with Life Scale (SWLS). Results: Increase in SH was significant (p=.03), mean change of 2.57 centimeters (1.01 inches); 95% C.I.: 0.33 to 4.82. At two weeks, participants reported significantly less pain (-9.6) on the WUSPI (p=.03); C.I.: -18.34 to -0.87, and significantly lower ‘worst pain’ intensity (-1.18) (p=.04); C.I.: -2.3 to -0.4. Remaining outcomes did not show significant change. Conclusion: The results of this study support the use of wheelchair configuration to provide orthotic stabilization in the sagittal plane to the paralyzed trunk. Improved postural alignment was shown to decrease shoulder pain and intensity of pain measured two weeks post intervention. Early orthotic postural support via wheelchair configuration may prevent the negative sequelae of postural deviations and promote improved health outcomes.