When your legs don't work your upper body becomes crucially important. People with mobility impairment use their upper bodies to propel a wheelchair, transfer, and all other activities of daily living. Our hands, arms, and shoulders were never intended to endure the overuse that happens to paraplegics and quadriplegics. Physical therapists are an important resource for people with disabilities. People with mobility impairments may find themselves consulting a physical therapist due to shoulder pain caused by years of propelling a wheelchair. In celebration of October being physical therapy month, I interviewed two physical therapists who provide tips for wheelchair users to maintain good shoulder health. I have been in a wheelchair for 33 years and I have experienced shoulder pain at times. I have used many of these tips over the years with great results.

Cathy Carver, PT, ATP/SMS, and Katie Fitzgerald, PT, DPT, NCS are both in clinical practice at the University of Alabama at Birmingham working in adult neuro-rehab and the outpatient wheelchair clinic. They both understand the importance of the preservation of shoulder health for wheelchair users. They have shared their thoughts on ways that wheelchair users can protect themselves from a shoulder injury while aging with a disability.

Here are some of the risk factors for increased complaints of should pain for wheelchair users.

1. The number of years spent as a wheelchair user? The longer a person has been using a wheelchair and the older the person gets the more upper body pain they will experience.
2. Female gender: Males often have a more muscular upper body and therefore have fewer complaints of pain in comparison to females.
3. Higher body-mass index: The more you weigh the more difficult it is to propel a wheelchair and perform transfers. I have noticed a significant increase in shoulder pain when I gain just 10 pounds.
4. Low trunk control: People with higher-level injuries and poor trunk control report more shoulder pain.
5. History of participating in wheelchair sports: People who enjoy participating in wheelchair sports subject their upper bodies to even more wear and tear.

Shoulder Preservation Techniques

1. Avoid excessive overhead maneuvers: Minimize the number of times in a day that you lift your arms over your head. Reaching over the head can cause a repetitive strain injury. Keep items in level or lower cabinets as much as possible.
2. Properly fit Wheelchair: You physical therapist and Assistive technology Professional (ATP) with configuring your wheelchair to keep your center of gravity directly over the center of the wheelchair. The seat height can't be too high or too low to get the most efficient push. A wheelchair user arms should directly hand down and hit the exact center of the tire if the wheelchair is fit properly.
3. Using the lightest weight wheelchair possible: Lifting the wheelchair in and out of the car frequently and transfers necessitate choosing the lightest wheelchair possible. Choosing materials like titanium, aluminum, and carbon fiber are ideal for ordering a new wheelchair. Although, depending on the type of insurance you have, lightweight materials are not always possible.
4. Performing level or downward transfers: Transfers from high and low surfaces cause' undue strain on a person's shoulder.
5. Using a power assistive device (Example: Smart Drive): Minimizing the number of pushes per day by using a power assistive device will significant reduce shoulder damage.
6. Avoid doing the same motion over and over again: If you normally use the right are for reaching things, make an effort to use the left arm. If you normally transfer from one side, make an effort to use the opposite side.
7. Create a routine of exercise you back muscle by doing a rowing motion: Pushing the wheelchair requires a forward motion. To balance activities start and exercise routine that requires the opposite motion. Use a theraband hooked to a door hand pull the theraband backward repetitively to strengthen your back muscles and counterbalance the forward wheelchair pushing motion. Adaptive rowing is a great sport that will strengthen  

Cathy Carver, PT, ATP, SMS, and Katie Fitzgerald, PT, DPT, NCS recommend seeing your physician if you are experiencing should pain or you want to strengthen your shoulders. Once your doctor has cleared you to start and exercise routine get an order for a physical therapy evaluation. Your PT will then design an exercise routine that is right for you. Here are a few of the exercises that Cathy and Katie recommend once you have been seen your physician make sure you are safe to workout.

The “I” shoulder exercise: Hold your arms out straight in front of you and hold your hands together. Then holding your hands together, lift them over your head and repeat that motion in sets of 10. Start with one or two sets and increase the number of sets as tolerated.

The “T” shoulder exercise: Put both of your arms straight out in front of you and then move them out to your side in the shape of a “T” and then back to the center in front of you. Do this in sets of 10 and increase the number of sets as you can tolerate it.

The “Y” shoulder exercise:  Start with arms down by your side with your thumbs up and then lift them over your head to the point where your hands' touch and then back down and out to each side. Repeat this motion in sets of ten. Increase the number of sets as tolerated. If you are a beginner with shoulder exercises start with your arms down by your side with your thumbs up, but lift them over your head.

Manual wheelchair users often experience should pain due to repetitive strain injuries over the years. In addition to strengthening exercises, Cathy and Katie recommend rowing type motion. That will strengthen the muscle that is opposite to the wheelchair pushing muscles. Physical therapists also recommend switching up the way you perform tasks. Use your left hand for tasks if you usually use your right hand. Transfer to the opposite side of the bed half of the time. Give your dominant side a break as often as you can to prevent injury and to strengthen your non-dominate side. Remember to consult your doctor before starting any type of exercise program. Take care of your shoulders and remember to say thank you to your favorite physical therapist!