Long Time Wheelchair Use Messes You Up, You Need “Correctives” – Erik Kondo

The typical manual wheelchair user suffers from a wide variety of health problems. Shoulder pain is a common complaint. The popular explanation for this pain seems to be straightforward. Manual wheelchair users apply their upper body for wheelchair propulsion. Wheelchair propulsion is the result of repetitive movements throughout the day. Therefore, the shoulder pain must be the result of the repetitive movements of wheelchair propulsion. And if self-propulsion is the cause of shoulder pain, then wheelchairs will benefit from doing less of it. So says the theory (promoted by the manufacturers of power-assist devices).

It is important to recognize that this Cause-and-Effect relationship is NOT a proven fact. It is a theory of a possible cause of shoulder pain for (some) people. There are plenty of examples of manual wheelchair users, who self-propel much more than the typical wheelchair user and don’t have shoulder pain. And there are many examples of wheelchair users who self-propel very little during the day and also have shoulder pain. Therefore, it is possible that other factors of manual wheelchair usage could also be causes of shoulder pain.

It is important to recognize that wheelchair users do other activities during the day besides self-propelling their wheelchairs, such as transfers, and lifting awkward/heavy objects. They also don’t engage in a lot of actions and bodily movements that are done by able-bodied people throughout the day.

A manual wheelchair user is not like a typical able-bodied person who just happens to be self-propelling a wheelchair. If you use a wheelchair for self-propulsion, a physical reason has necessitated that you use a wheelchair. This physical reason also means you don’t engage in the same regular activities engaged in by nonwheelchair users. In other words, it is not just what you do, it is also what you don’t do, that could be a contributing factor to shoulder pain.

While a wheelchair is a device for enhancing mobility for a person in their environment, it is also a restrictive (supportive) device for much of person’s body. In terms of the upper body and torso, the higher the backrest, the more the wheelchair user’s overall movement is restricted. This restriction means that many wheelchair users move their upper body in a limited fashion because they are seated in a wheelchair with a high (contoured) backrest and in many instances, also armrests. Therefore, their movements are unbalanced in terms of their overall range of motion and muscle usage.

The manner in which a person sits also has a large effect on their movement patterns. Many wheelchair users slump in their wheelchairs (seeking upper body stability). This slumping (forward head) posture restricts their upper body movement. Along with promoting imbalances, it also creates other postural problems (not addressed here).

In this case, engaging in less self-propulsion does nothing to reduce this imbalance. The imbalance remains, even if the aggregate amount of movement decreases. On the other hand, an able-bodied person doesn’t have these restrictions of movement, and hence, the resulting imbalance. Research has shown that muscular imbalances are a potential cause of shoulder pain by causing shoulder impingement syndrome and more.

How can this imbalance be addressed? Theoretically, if you completely stopped moving, then you would no longer have this imbalance. Given that wheelchair users are already the most inactive demographic and suffer from lack of activity/exercise-based health problems, this is not an advisable solution. The opposite solution is to purposely engage in “corrective” movements that reverse this imbalance. Now instead of doing less movement overall, you are doing more of certain movements in addition to your existing movement patterns.

Simply stated, if you have been doing primarily “push” movements, you now add “pull” movements to create “equality”. If you have been primarily working your chest and shoulder muscles, you explicitly start working your back muscles. If your range of motion has been “closed and forward”, you add “open and backward” to your range of motion. You self-propel backward. These opposite movements are known as corrective exercises.

Since sitting in your wheelchair has created a restriction of movement, it is likely that some of the corrective exercises will have to be performed out of your wheelchair. If the manner in which you sit in your wheelchair has created a muscular imbalance due to restricting your movements, then continuingly sitting in the same wheelchair with the exact same setup is not an effective way to reverse this imbalance. Something has to change.

You have to acknowledge that long time wheelchair use is likely to mess you up by creating muscle imbalance, reduced range of motion, and postural problems, unless you actively address these issues.

Fortunately, it is never too early or too late to get started!