Wheelchair Propellers: Love Your Shoulders!

The human body is a resilient, adaptive, beautiful thing.

But when parts of our bodies are called upon to work in ways outside of their traditional “job descriptions,” trouble can result.

One example for wheelchair users: Shoulders.

They boast a tremendous range of motion and enable us to accomplish all sorts of tasks everyday. But when you propel your own wheelchair day in and day out, for months, years, decades, shoulders bear the strain. And that’s not to mention the other tasks shoulders have to carry out: transferring from wheelchair to bed, toilet, shower, etc. Performing push-ups and other weight-shift duties to maintain healthy skin. Reaching countless times a day, and perhaps frequently reaching overhead, depending on an environment’s accessibility.

Kristin Kaupang, a physical therapist with a neurologic specialist certification, is well aware of the hard work that wheelchair users’ shoulders put in. At the Harborview Medical Center at the University of Washington, Kaupang works with clients who have spinal cord injuries and propel their own wheelchairs.

Because of that, Kaupang knows first hand how common shoulder pain and discomfort can be for this active population.

“The shoulders of individuals who require a wheelchair for mobility are being used at a higher frequency and with greater force than for those individuals who can ambulate,” she explains. “For many, the shoulders take on the function of the legs, but our shoulders are not designed to withstand that kind of force. Therefore, it is not surprising that more than half of ultralight [wheelchair] users will experience shoulder pain/injury during their lives.”

TLC for Hard-Working Shoulders

Shoulder pain and injuries can greatly hamper a wheelchair user’s independence. Taking care of your shoulders and extending them some tender loving care can go a long way toward preserving their health for the long term.

“A seating/mobility professional can analyze the wheelchair user's body mechanics, posture, and shoulder mobility in relation to the wheelchair as well as during activities of daily living,” Kaupang says. “The seating/mobility professional will educate the individual [on] how to minimize forces, strengthen muscles to protect from injury, and make recommendations about posture and positioning that allow for optimal use of the shoulder during activities.”

Ideally, good shoulder habits start early in the rehab process – but it’s important, Kaupang says, to make shoulder care a priority throughout your life.

“Training and education about shoulder injury prevention should start early and be re-iterated often throughout the continuum of care,” she explains. “Even prior to in-patient rehabilitation, the acute care clinicians will work with individuals to start introducing shoulder health strategies. The education is certainly the most intensive during the inpatient rehabilitation setting, as establishing good mechanics from the start is easier than adjusting positions down the road. Reinforcement certainly occurs in outpatient therapy visits, as well as visits with rehab physiatrists.”

And as life happens, you should be on the lookout for changes that could impact you shoulders.

“Anytime that there is a change body size or any change in function, it is important for the individual to apply the strategies and techniques that they have learned,” Kaupang says of maintaining healthy shoulder habits. “Returning to see a rehabilitation professional and/or seating/mobility professional may also occur throughout the aging process of aging with a disability.”

Watching for Red Flags

If you are propelling your wheelchair one day and notice something different – a twinge, an ache, a spasm in your shoulder – does that mean you’ve been injured? And what should you do?

“There are certainly many different types of pain, such as sharp pain, aches or pinches,” Kaupang says. “Any pain that is new should be a red flag. Any pain that limits an activity that was previously able to be achieved is a red flag. If you experience these pains, it is important to find the root cause of them.”

The good news is that your occupational or physical therapist, or your wheelchair/assistive technology provider, might be able to adjust your seating & mobility equipment as part of the solution.

“It may be as simple as changing your back angle or wheel position,” Kaupang says. “A seating/mobility professional will be able to help you optimize your push mechanics and wheelchair positioning to best protect and utilize your shoulders.”

One thing is for sure, Kaupang says: Don’t just hope that the pain will go away on its own.

“It is important,” she says, “not to let the pain persist. Pushing through pain often makes the problem worse.”

Save Your Shoulders: Watch and listen to Kristin Kaupang’s excellent presentation on caring for your shoulders by understanding what causes shoulder strain, and what you can do in your daily routine, your exercise regimen, your home and work environment and even in your sleep (!) to love your shoulders.