Manual Wheelchairs Cause Health Problems
Manual wheelchair push propulsion is a strenuous activity that has been linked to the development of upper limb pain and dysfunction. Wheelchair (push) propulsion places high demands on the upper extremities and over time negatively impacts upper extremity health.
The shoulder is the most common site of upper extremity pain in manual wheelchair users, with reported prevalence of pain ranging from 32% to 78%. A range of pathological conditions at the shoulder have also been documented including impingement syndrome, adhesive capsulitis, recurrent dislocations, rotator cuff tears, and tendinitis. To cite as an example, supraspinatus tendinopathy was detected in 100% of non-dominant shoulders. in 49 manual wheelchair users with SCI participating in the National Veterans’ Wheelchair Games in 2005 and 2006. Further, 92% of participants had evidence of supraspinatus impingement indicating that nearly all persons demonstrated evidence of shoulder joint pathology.
Because individuals who use a manual wheelchair are dependent on their upper extremities for mobility and daily activities, shoulder dysfunction and pain present an additional loss of independence and decreased quality of life. The onset of pain or injury greatly interferes with activities of daily living (ADLs), reduces quality of life and increases financial burden on the user and family.
Push propulsion relies primarily on two muscles (the anterior deltoid and pectoralis major) for most of its propulsive power and those muscle often, become much stronger than the posterior back and shoulder muscles, whose job it is to stabilize the shoulder girdle. This leads to protracted shoulders with tightened anterior and overly stretched/weak posterior muscles (upper thoracic kyphosis and protracted scapula). Multiple clinical studies link manual wheelchair push propulsion to the development of shoulder imbalance and impingement generating forces, leading to multiple upper extremity pathologies.
The typical approaches employed in mitigating shoulder related injuries in manual wheelchair users involve trying to reduce the amount of effort. This is attempted through the reduction of wheelchair and wheelchair wheel weight as well as promoting more efficient propulsion techniques. In all these cases the goal is to reduce not eliminate the problem, which always comes down to the poor ergonomics involved in push propulsion. Even with these approaches implemented, and knowledge of the clinical problem identified in the scientific literature since the 1980s and 90s its prevalence remains high today.
In cases where users are demonstrating signs of shoulder injury and pain, clinicians often suggest the use of power assist wheels or power chair alternatives. Dependency upon power add-ons and fully powered wheelchairs could be deleterious to the user’s health and well-being. Performing cardiopulmonary exercise is challenging for most wheelchair users due to a myriad of barriers. For this reason, physical exercise in the form of self-propulsion is preferred whenever possible and paramount to reducing secondary disabilities such as obesity, diabetes, and cardiovascular disease.
Clinically Proven Health Benefits of ROWHEELS
Rowheels’ pull propulsion design directly addresses the issue of shoulder pain and injuries by activating upper back and posterior shoulder muscles and promoting better shoulder and trunk postures. The biomechanics of Rowheeling (pull propulsion) eliminates or substantially reduces the forces that lead to upward migration of the upper arm (humerus) into the shoulder joint (acromial arch) (4). This makes the risk of shoulder impingement related pain and injury markedly less likely. Exercise interventions that are designed to reduce shoulder dysfunction involve increasing muscle development of the scapular retractors and external rotators. This is the main idea behind the Rowheels system, to increase posterior scapular retractor muscle activation and facilitate trunk postures that support normal glenohumeral and scapulothoracic function. Furthermore, this function
is accomplished through daily self-propulsion activity, lessening the burden on individuals to rely on access to and routine engagement in a strength training program to combat the effects of overuse. Prolonged use of Rowheels can leads to a stronger and stable shoulder joint and this can help protect or limit the degree to which other weight-bearing activities such as transfers and weight shifts could damage the shoulder structures.