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Upper Extremity Care

If you’re pushing a wheelchair, you are not alone. About half of those with spinal cord injury eventually experience upper extremity pain as a result of pushing a wheelchair. However, with knowledge, the right equipment, exercise and care, you can preserve your arms and shoulders long-term, and avoid pain.

Many individuals push a manual wheelchair their whole life without issue, but weight gain, aging, and pain can force a person to switch from a manual to a power wheelchair.

There are a number of reasons to prompt a person to switch – power chairs are faster and can be fitted with a tilt-in-space seat that provides the best pressure relief – but it can be a tough decision. Psychologically, some may feel more ‘disabled’ in a power chair, and the need for a van is an expensive factor to consider since transfers from a power chair to a car seat are not practical.

Power-assist devices are available to transform a manual chair into a hybrid power unit. The advantage is they are less expensive than a full power unit, but add quite a bit of weight to a manual chair, making it more difficult to load into a car.

Before you make any decisions: Always work with a team of seating specialists.

Seating specialists know that correct positioning is vital to preventing pain, and they can help with medical equipment reimbursement issues.

When it comes to changing your wheelchair, the key decision is based on maximizing independence. The choice of moving to a power chair cannot and should not be made alone. There are many factors involved in selecting the right chair and accessories to match your specific needs.

Video: Preventing Shoulder Issues

Is your wheelchair set up for maximum efficiency? You could be working too hard to get around and setting yourself up for shoulder pain.

Tips to Minimize Upper Limb Problems

If you’re sticking to your manual chair, here are a few tips to consider:

  • Adjust rear axles as far forward as possible without feeling too tippy. You might want to add anti-tippers if you can’t hold on to a wheelie; these will keep you from falling over backward.
  • For a smooth, low-impact push, hand motion should be around and around — not back and forth. It’s best to drop your hands when you release the rims. Bring them back low, as if you are going to touch the axles. The path of your hands should be a little circle inside the big circle of the rim.
  • Transfers are tough on the shoulders. Don’t transfer unnecessarily.
  • Seat height affects the efficiency of a rim push. If your wheel axles are too high or too low, it makes for harder work. Sitting low is better. Set the axle height so the fingertips extend just past the axles when you lean back with arms relaxed.
  • Tires that are not properly inflated are harder to push. Keep a gauge handy and keep the tires fully filled.
  • The current crop of lightweight chairs, especially those made of titanium, can make a huge difference in one’s mobility. Lightweights require less force to propel, they are fully adjustable and cost less to operate than the heavy hospital-type units.
  • Consider modifications to the home environment to reduce stress on the upper extremities. This would include transfer equipment, lifts, or hospital beds.
  • Remember to treat acute pain right away and try to maintain optimal range of motion.

Along with the proper chair settings and modifications, exercise and stretching are an important part of shoulder health. The shoulder is an amazing joint but since it’s held together by a complex set of tendons and soft tissue, it needs to be moved through its range. It is advised you work with a physical therapist to best know what you should do to stretch the shoulder.

Maintaining shoulder strength and flexibility requires exercise. For example, use a pair of light dumbbells or an elastic band for resistance training. Again, get advice before you begin any exercise program, and take it at your own pace. You can hurt yourself if you try to do too much too fast.

The above information is derived from the Clinical Practice Guidelines developed by the Consortium for Spinal Cord Injury, of which the Reeve Foundation is a steering committee member. The primary guidelines are targeted to healthcare professionals. A consumer guide, “Preservation of Upper Limb Function: What You Should Know” was recently released. The publications are available from the Paralyzed Veterans of America.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $9,447,037 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.