Shoulder Preservation: An End-User Perspective – Mal’s Story
In 1980, when I acquired my SCI, there was very little talk about preservation of shoulders. The focus was on strength, lots of weights and pushing. The adage “if you don’t use it you lose it” was strongly endorsed. In those days, I thought that shoulder pain was a good thing, it meant I had been working my shoulders and therefore strengthening them. In my mind it was “a badge of honour” to have sore shoulders. I didn’t know the difference between “good” pain and “bad” pain. In the early 1990s, I started playing competitive wheelchair basketball. Here I began to learn more about how to look after my shoulders – resistance bands, stretching, warming up, warming down, backwards pushing rotator cuff strengthening, etc… I also started handcycling and concentrated on the “pull” of the hand cranks to work the back of my shoulders. But, to tell the truth, my focus was so much on being competitive I often played with injuries, which I am sure has caused problems for me now. Hindsight is a great thing, and I wish I had of thought more about the long-term impact of the stresses I put on my shoulders, elbows, and wrists. Pain, loss of strength, loss of range and carpal tunnel syndrome are things I have experienced and continue to work against. At 39 years post injury, I am still mobile, and the past several years I have put into place strategies to maintain and improve the health of my upper limbs.
Apart from the obvious negative of pain, why is upper limb health so important to me? There are many reasons, but for the sake of this blog here are three of my main ones
Independence: A friend of mine often says that “if it goes without saying, it is worth saying”. My shoulders are fundamental to my independence. Being able to push my wheelchair, transfer, lift my chair in and out of the car, kayak, complete pressure reliefs – just about every activity of daily living (ADL) I do requires my shoulders.
Wellbeing: Being able to do all the things I can do independently has a huge impact on my wellbeing. My SCI has cost me a lot of independence as it is, so I treasure every bit I have. Loss of independence is, quite frankly, depressing! As well as that, pain is a stressful thing, so minimising pain is really important.
Pressure Care: My shoulders are directly linked to my pressure care. In the past 39 years I have had only 2 pressure injuries which caused me to spend time in bed. One was post operation, the second was a stage 2 pressure injury caused by a bad transfer. The better my shoulders are the better my transfers are, and the less risk I have of a pressure injury.
So, as I race into my sixties and hopefully beyond, what are my strategies for looking after my shoulders? Here are some of the things I have done, and am now doing
My wheelchair is super light-weight and custom built around me. I have minimal adjustment and folding parts in my chair. After 39 years I pretty much know what I want out of my wheelchair, so a fixed back and fixed front to rear height is my preference. Even these simple things shave a noticeable amount of weight off my chair. I have the rear wheels as far forward as I feel safe with which makes it easier to push.
I restrict my pushing to areas that do not cause a lot of shoulder pain. I have been using a power assist device, the SmartDrive, for many years now and love it. I use it for any steep hills or really long pushes. I still push, but not as much and on less challenging slopes.
I have a set of strengthening and stretching exercises that I do regularly. Most of these involve resistance bands or a medicine ball, and are low weight with higher reps. The important thing is for me to concentrate on technique! They are exercises recommended by my physiotherapist. As part of my NDIS Capacity Building, I have linked my goals of maintaining independence and function to the cost of the physiotherapist.
For cardio exercise, I rely on kayaking and handcycling. Both these activities allow me to focus on working the back of my shoulders, in the “pull” stroke.
I have been using an ergonomic hand rim for about 15 years now. These significantly improved my carpal tunnel issues. There are a number of these available, including the Natural Fit™ and the Flex Rim™ (my favourite).
This is a little left field, but it has been an important change for me. Up until about 10 years ago I did not have wheel locks on my chair. With the improvement in design, specifically scissor locks, I finally decided to try them. It amazed me how much easier my transfers became!
The conversations I have with a lot of my peers these days centre around what we are doing to maintain shoulder strength and the impact long-term wheelchair propulsion is having on us now. If I could have a chat with my 20 year old self I would stress the importance of looking after his shoulders (not that he would have listened). In my mind the old adage of “use it or lose it” has been changed to “use it, don’t abuse it”. There is a lot of great Assistive Technology and resources to help wheelchair users maintain upper limb health, so why not take advantage of it all!