Shoulder Preservation Part 3: The Recommendations for Shoulder Preservation with Manual Wheelchair Propulsion
Did you know that the average number of pushes per day for a full-time manual wheelchair user is 2,000 to 3,000! Take a second and let this number sink in: 2,000 to 3,000 pushes every day. Now, go ahead and use that great technique we talked about last week and just take your arms and shoulders through 10 pushes. That was 10 pushes and without any bodyweight, weight of the wheelchair, friction of the chair across the ground, etc…. If we are not ourselves a wheelchair user, we cannot fully understand how our shoulders would feel propelling every day, but we can gain an understanding on the amount of work that the shoulders go through on a daily basis and what steps we can take to help in preserving the shoulder long term.
2. Adjust the rear axle as far forward as possible without compromising the stability of the user.
3. Position the rear axle so that when the hand is placed at the top dead-centre position on the pushrim, the angle between the upper arm and forearm is between 100 and 120 degrees.
4. Educate the patient to:
a. Use long, smooth strokes that limit high impacts on the pushrim.
b. Allow the hand to drift down naturally, keeping it below the pushrim when not in actual contact with that part of the wheelchair.
5. Promote an appropriate seated posture and stabilization relative to balance and stability needs.
6. Incorporate flexibility exercises into an overall fitness program sufficient to maintain normal glenohumeral motion and pectoral muscle mobility.
7. Incorporate resistance training as an integral part of an adult fitness program. The training should be individualized and progressive, should be of sufficient intensity to enhance strength and muscular endurance, and should provide stimulus to exercise all the major muscle groups to pain-free fatigue.
Next week, we will continue our discussion on shoulder preservation and deep dive into the recommendations.
Preservation of upper limb function following spinal cord injury: A clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005; 28 5: 434–470.