pushingthelimits.com

There’s no doubt that pushing yourself around by the arms is eventually going to wear down your shoulders, especially if you’re doing crazy stuff like climbing Kilimanjaro. Shoulders and arms simply weren’t designed to do the kind of work we force them to do so we can get around in a wheelchair. Not just pushing wheels, but transfers and everyday actions all combine to cause wear and tear on the shoulders, elbows and wrists.

It’s impossible to cancel out completely the added weight and workload we as wheelchair users put on our upper body, but it is possible to try to minimize the effects and preserve good function for as long as possible.

The Consortium For Spinal Cord Medicine has produced a paper addressing the issue: Preservation of Upper Limb Function Following Spinal Cord Injury, which outlines causes of damage and how to combat unwanted stress. Be sure to read the entire article for some really in-depth analysis and interesting statistics on wheelchair use.

Some points from the report that can easily be followed everyday to try and keep your upper body in good shape:

• Perform level transfers when possible.
• Avoid placing either hand on a flat surface when a handgrip is possible during transfers. 
• Adjust the rear axle as far forward as possible without compromising the stability of the user.
• Allow the hand to drift down naturally, keeping it below the pushrim when not in actual contact with that part of the wheelchair.
• Vary the technique used and the arm that leads when transfering.
• Perform stretching exercises of the neck, upper trunk, and limb a minimum of 2 to 3 times per week.
• Avoid strengthening exercises if they are painful to perform or if range of motion is significantly restricted.

Ultralight wheelchairs have been shown to last 13.2 times longer than depot wheelchairs and to cost about 3.5 times less to operate (Cooper et al., 1996). When compared to lightweight wheel- chairs, the ultralights were found to last 4.8 times longer and were 2.3 times less expensive to oper- ate (Cooper et al., 1997). When tested to failure, ultralight wheelchairs had the longest survival rate and had fewer catastrophic failures (Fitzgerald et al., 2001) and thus placed users at less risk for premature failure and possible injury. Although the initial cost of an ultralight chair is higher, the expense is more than made up in durability. 

Preservation Of Upper Limb Function After Spinal Cord Injury (PDF)