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).

Various propulsion techniques

Various techniques are used to move the manual wheelchair forwards:

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