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Daily Life & Mobility

Basics of shoulder physiology

Performing all the movements in the shoulder joint requires the interplay of various muscles in the shoulder, the cervical spine and the torso. Five different joints are involved in the process. The interplay of all these muscles and joints enables people to bear weight on their hands and shoulders and to carry out activities of daily living and overhead activities. Great pressure is placed on the shoulder joints when sitting up and during transfers. Frequent signs of wear and tear are found in tendons (supraspinatus tendon, subscapularis tendon, bicep tendon) and joints (shoulder joint and acromioclavicular joint).

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Various propulsion techniques

Various techniques are used to move the manual wheelchair forwards:

arc

Arcing

Arcing uses short fast strokes on the push rim. This technique is suitable for going uphill or over kerbs. The disadvantage here is that a great deal of propulsion is required, that forward movement is slow and that the shoulder experiences numerous jerky movements.

single loop

Single Loop Over Propulsion

Single loop over propulsion consists of a forward movement on the push rim with a circular movement backwards above the push rim. In this case, the same muscles are always active, which soon leads to overloading.

semi circular

Semi Circular

With the semi-circular technique, the arm is swung backwards in a relaxed stretched stance after the forward propulsion. This smooth circular movement allows a relaxed phase for activated muscles, requires fewer strokes and allows faster forward movement. This technique is suitable for moving over smooth terrain and is extremely energy-efficient and gentle on the shoulder.

double loop

Double Loop Over Propulsion

The double loop over propulsion technique looks like a figure 8 from above and also consists of a smooth circular movement It is usually used by extremely experienced wheelchair users over long distances.

Risk factors for shoulder issues:

  • Physical risk factors associated with shoulder pain:
    • Being overweight
    • Level of paralysis (tetraplegia)
    • Spasticity
    • Wheelchair user of many years
    • “Age”
    • Shoulder pain from the spinal cord injury
    • Limited mobility of the shoulder joints
  • Day-to-day risk factors:
    • You perform numerous transfers
      Transfers put a great deal of pressure on the shoulders. Use an aid (transfer board and / or sliding pad) if you are unable to hold your whole body weight. Practise a good transfer technique with your therapist. Do not pull on the bed gallows when performing a transfer. Try and minimise or avoid transfers that involve long distances, e.g. during a car transfer, or different heights. You do a lot of overhead work
    • You do a lot of overhead work
      Performing frequent overhead work puts a lot of strain on the shoulders and is a risk factor for shoulder pain. Overhead activities can result in trapped tendons, which in turn can lead to small injuries and possibly even inflammation. A poorly adapted residential or work situation, sport, such as basketball, and poorly adapted hand bikes can all lead to this kind of overload.
    • You are not very physically active
      Regular training is extremely important to ensure that the shoulder muscles remain well trained. In addition to shoulder exercises, hand crank training and riding a hand bike are activities that strengthen the shoulders without putting them under excessive strain. Preventive strength training is essential in terms of sport.
    • Try and avoid falls!
      Avoid falls as far as possible as they can cause damage to the structures of the shoulder. Preventing falls also includes a wheelchair that has been carefully adapted to your individual needs.
  • Risks in your surroundings with your aids
    • Wheelchair setting
      Depending on how your wheelchair is set, using your wheelchair can be more or less strenuous for the shoulders. It is important that the centre of gravity of the arms is directly above the hub of the wheel. This results in a tilted wheelchair set-up. If the wheelchair is set in a less tilted manner, the drive wheel is positioned further back. This, on the other hand, makes it harder to propel the wheelchair ergonomically, which can cause shoulder pain. In this case, it is necessary to look for optimal solutions on a case-by-case basis (anti-tip wheels, auxiliary electric devices and wheelchair loading systems).
    • Living conditions
      Living conditions should be adapted to your abilities and aids should be used as required.
  • Recommended complementary types of sport:
    • Archery
    • Swimming
    • Riding a hand bike
    • Specific strength training
    • Programmes for at home with strengthening, stretching and mobility exercises

 

Frequently asked questions

Why should I never allow anybody to pull me by my hands to help me sit up?

This movement is equally damaging to your health and the health of your carer. It places great strain on your shoulders, which can cause serious long-term damage, and could result in back problems for your carer. In addition, when sitting up this way, you are not able to assist, which means that you cannot control your movements. Pulling yourself up on bed gallows is similarly detrimental.

When I am being transferred while travelling, people always lift me by putting their arms under my shoulders, which causes me shoulder pain. What can I do?

There are situations where being lifted under the shoulders cannot really be avoided.
This is frequently the case during transfers in an aeroplane. It is important that you press down your shoulders in order to stabilise them. If you cannot do this or already have problems with your shoulders, a transfer belt may help. This is a wide belt with lifting loops that is attached tightly around your waist and enables the people assisting you to lift you up without putting strain on your shoulders.

What can I do in terms of the wheelchair to take pressure off my shoulders?

  • Pump up the tyres (the required tyre pressure is indicated on the tyre)
  • Clean the casters
  • Practise propulsion techniques
  • Lowest possible wheelchair weight

Which propulsion technique is gentle on the shoulder?

The circular and regular movement of the semi-circular technique allows the activated muscles to go through a relaxation phase. You need fewer strokes and move forwards more quickly. The technique is gentle on your shoulders and extremely energy-efficient.

What should I do in the case of acute shoulder pain?

  • Look for the cause and take shoulder pain seriously.
  • Apply hot / cold packs
  • Protect your shoulder, possibly reduce the number of transfers
  • Use aids, e.g. a transfer board
  • See a doctor / therapist

 

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