Have ever imagined how many strokes does someone need to propel a manual wheelchair in a single day? There is no exact figure, but what we can say is that it needs a lot of strokes to propel a wheelchair. It may take between 2,000 to 3,000 strokes per day. However, doing a repetitive activity as such can endanger the user and lead them to develop tendonitis, carpal tunnel syndrome as well as impingement.
Who is facing a risk?
In case you take your time and think about the stress that is being applied to your upper body part every day while propelling your wheelchair, you might end up wondering how lucky you are to have come this far without experiencing any other injury.
Using a wheelchair does not only involve repetitive hand and shoulder motions, but it involves other activities such as loading/unloading the wheelchair, wheelchair transferring and several other activities for your daily life. This puts your spinal cord at a greater risk due to the fact that your arms are operating in an entirely different manner to fill in the gap of your lower injured section.
Being in a wheelchair means that you have fewer muscles that you can rely on, hence those fewer muscles are always active hence having to undergo extreme stress than they should. For example, in order for someone who is suffering from a spinal cord injury along his/her wrist level or chest level, he/she will be using he/his arms to perform any activities that were supposed to be handled by the legs. This cause a lot of strain and stress upon the joints which were not meant to experience such amount of stress.
Normally the common repetitive use injuries are formed along the shoulder and wrist. Normally the wrist injury is the carpal syndrome which leads to tingling or numbness. Injuries that occur along the shoulder are normally tightening or impingement that is around the shoulder capsule.
You should not just blame only the wheelchair use for these injuries. In case you are using different muscles when it comes to dressing, transfer or bathing, that means that those muscles are being used as an alternative and they are being stressed beyond their normal use.
How is aging connected to injuries
Just think about the 2,000 stroke performed by a wheel chair user in each single day. Then think about the fact that as the number of strokes increases so does your risk of experiencing a repetitive use injury. This is why repetitive use injury poses a great concern as the wheelchair user ages. When you start to age, your flexibility as well as strength are compromised. Besides, there is a complete transformation that occurs in your body as you begin to age and this poses a great risk of having repetitive use injuries.
However, repetitive use injuries does not mean that you have to totally switch from using a manual to a power wheelchair. There is room for modifying your wheelchair so as to reduce the rate of transfer, and this can significantly reduce the amount of joint stress. For example, driving while sitting in your wheelchair can help in reducing the number of transfers needed in a single day. Besides, using a mechanical lift can simplify the transfer process while reducing the amount of work involved in the transfer process..
There are many manual wheelchair users who have managed to maintain high level of wellness and have remained being successfully throughout their lifetime. According to Dr. Ulmer, it all depends on someone’s lifestyle, goals as well as his/her personal preferences. Besides, any prior injuries before your SCI will affect your ability to propel your wheelchair for long term. Also, the age at which you were, when you underwent the SCI, how you were trained in using your upper extremities for your wheelchair propulsion and the nature of your daily activities will also account to your wellbeing.
But it is also normal for to opt for a power chair so as to conserve your energy and prevent any chronic pain. A power chair will help you to overcome many issues that arise from using a manual wheelchair. Besides, you will be able to maintain a certain level of freedom and independence.
In case you need a wheelchair, you can opt for a power wheelchair for outdoor movements especially when covering long distances and community outings, while retaining a manual wheelchair for indoors or when covering short distances.
Preventive measures
There are different ways that can help you to minimize the risk of experiencing repetitive use injuries while keeping yourself in a good healthy condition that will enable you to propel even when you are aged. These are as follows:
- Exercising program: Having an exercising program which involves balancing different shoulder muscles and enhancing flexibility is so important. These kinds of exercises are different from those offered by a trainer at a gym
But you have to be careful not to over strengthen the muscles needed for propulsion. Enhancing your balance must be your major focus when exercising.
- Enhancing your posture: Posture is a key factor when it comes to injury prevention, and it is possible for your therapist to identify poor posture by just taking a look at you propelling your wheelchair. Sunken chest or shoulders leaning beyond the head position will make pushing less efficient.
So make sure that you work on your posture as well as strengthening your muscles especially in your upper back so as to be able to sit upright.This will improve your push mechanics making the entire propelling process simple and efficient.
- Training on the proper use of your wheelchair: Getting proper training regarding your wheelchair propulsion is the most effective way to prevent a repetitive use injury.
Using your entire energy or force in making a single wheel revolution will cause a lot of damage to your joints after a long period of time. However, having an effective stroke, will enables you to conserve your energy, hence maximizing force that you apply upon the wheel with minimal effort. This will help you to preserve the ability to push for quite a long time.
- Consulting a rehab team: The rehab team is so important as it able to analyze the way you are propelling and make sure that your stroke is as efficient as it should be.
Advancement in technology has led to the invention of smart wheel technology which is used in analyzing the push forces, frequency and duration at the time of wheelchair propulsion. This technology is able to provide you with objective figures which include the extent of force that is being used and the angle at which is being applied. This information can enable the therapist determine type of wheelchair and seating that will enable you to maximize efficiency as well as prevent your shoulder or wrist from experiencing more injuries or complications.
Besides, an experienced wheelchair positioning and seating therapist will be able to offer you with some efficiency techniques.
In addition to that, the rehab team will be able to offer you with the right equipment such as push rims or ultra-weight wheelchair that are installed with a grip surface if necessary.
- Analyzing your lifestyle: You might have come across people carrying a 15-pound backpack upon the back of their wheelchairs throughout the day. This increases their risk of being injured. It is very important to emphasize on follow-up care together with your rehab team. The team will analyze every step of your activities and ensure that you have the right tools/equipment that will help you perform every task you need, while preventing your from any injuries and maintaining your level of independence.
- Examining your daily schedule and reducing any possible transfers: Cutting out any unnecessary transfers is a perfect idea. Avoid any activity that would make you experience stress along your shoulders and putting you at risk of having injuries. Besides, you have to pay more attention to the position of your wrist when making transfers and propulsion. Pressure relief is also important.
- Do not neglect your wheelchair: Make sure that you perform all the necessary maintenance and repair needed so as to maintain your wheelchair in good condition and extend its lifespan.
What can you do if you think you might have a repetitive injury?
Firstly, you will have to identify repetitive injuries during their initial stages and get them treated as quickly as you can. Besides, by performing the needed adjustments in your wheelchair and applying proper positioning you can prevent a lot of pain.