The outcome of this study is an integrated theoretical framework for understanding friendship processes following spinal cord injury (SCI). A constructivist grounded theory approach was adopted to inductively explore the challenges that friendships faced following injury and how, within the context of hospital and community settings, people with SCI and their friends met these challenges. A total of 60 interviews formed the basis of this study. The sample consisted of 19 people with a SCI, 8 of their friends and 3 family members (1 wife, 1 sister and 1 mother) as well as 10 hospital and community-based rehabilitation staff. Written documents from published and internet sources were also analysed. Simultaneous data collection and analysis was utilised to develop the theoretical framework presented (Glaser & Strauss, 1967). The primary concern identified for friendships following SCI was the divergence of life paths for injured individuals and their friends. Diverging life paths were defined by the concepts of enforced separation and priority drift. Specifically, following injury, friendships were separated at a physical, social and cognitive level through processes of environmental separation, role separation, identity separation and interactional separation. From the time of injury, friendships started to experience priority drift, in that friendships declined in priority because of immediate need, the vulnerability of the new world, facing the unknown and reality shifting over time. The diverging life paths presented an ongoing challenge for friendships. To address the challenge of diverging life paths, people with SCI, their friends, family members and rehabilitation staff employed a variety of strategies (including working and redefining the friendship) aimed at reconnecting life paths. The purpose of these strategies was to reduce enforced separation and realign the priorities of the friends. Working consisted of behavioural strategies that were principally aimed at reducing enforced separation by breaking the ice, negotiating old and new roles and responsibilities, moulding the environment, and recruiting peer and staff helpers. Redefining consisted principally of cognitive strategies aimed at changing perceptions of self, others and friendship through the concepts of redefining friendship and priority setting. The processes of diverging life paths and reconnecting life paths occurred on a continuum for different friendships. Although some friendships experienced extreme divergence of life paths, others only experienced subtle divergence. Thus, some friendships did not utilise the processes of reconnection to a large degree whereas others required substantial transformations through working and redefining. Previous research has typically explored social support and friendships in terms of network size, type of support and adjustment outcomes. The current study extends previous research through its focus on friendship processes, providing a basis on which to design future research and clinical practice.