Many believe using a manual chair benefits them by providing cardio exercise while keeping weight down. While this can indeed be true, too often the repetitive motion of pushing body weight plus the weight of even the lightest, most advanced (and costly) rigid wheelchair can lead to short- and long-term secondary injuries to shoulders, tendons, and joints.
These injuries often require surgery to correct and can be further debilitating, taking away much-needed independence and causing chronic pain and reduced quality of life issues which negate any positive benefits achieved from using a manual chair.
Carpal Tunnel Syndrome
In a study by Aljure et al., 27 percent of folks who were 1 to 10 years post-injury had carpal tunnel syndrome. For people who had been on wheels 11 to 30 years, that number climbed to 54 percent. But fully 90 percent of those who had spent 31 years or more on manual wheels had carpal tunnel.
Rotator Cuff Strain and Shoulder Impingement
For those with a manual wheelchair, the shoulder joint is number one when it comes to transfer and propulsion. Long-term repetitive use (referred to as “overuse syndrome”) can lead to muscle strain, rotator cuff tears, and shoulder impingement – with devastating consequences. After all, even a minor shoulder injury can impair a person’s ability to achieve and maintain independence.
According to the National Center on Health, Physical Activity and Disability (NCHPAD), the rotator cuff is the common site of trauma even among non-athletic wheelchair users. They cite a study by Burnham et al., which found that the pattern of imbalance caused by wheelchair propulsion was unique, and very different from swimmers and baseball pitchers. It turned out that weak shoulder adductors were the culprit, and could cause rotator cuff impingement syndrome. But that was just the tip of the iceberg. According to NCHPAD, “People with paraplegia also demonstrated a significant weakness of external and internal rotation.”
The answer? Perform exercises that strengthen the shoulder adductors, as well as internal and external rotators. In other words, a person uses one set of muscles to propel themselves
forward while in a chair; strengthening the opposite muscles can help correct the imbalance.
Prevention Is Key
If you’re choosing to use a manual chair in order to exercise your arms, hands and shoulders, it may be time to find other ways to stay fit. Heed the latest advice from therapists and orthopedic doctors alike by adopting a new motto: “Save your arms.”
Think of the times when you’re most challenged by a manual chair. Maybe you need to get up the hills of San Francisco. Perhaps you’re literally and figuratively in the weeds trying to cross the grass terrain at an outdoor festival. It could be something as mundane as enjoying a sunset on the beach.
What happens when you’re traversing teeth-rattling bumpy boardwalks or European cobblestones, or facing the daunting prospect of managing a conference center’s long carpeted corridors and banquet areas?
Then there are the nagging worries…. You’re moving hand-in-hand with your love but focusing on ensuring that your chair doesn’t end up in a crevice that will stop your manual dead in its tracks and throw you forward onto the pavement. Or you’re not able to join your friends on a walking tour or stroll around town, as you won’t be able to keep up without asking for help. Or you’re anxious about going somewhere new, as you’re not sure if the ramp is too steep to make it up alone or while carrying anything on your lap.
Then there’s the worst: wearing a great new outfit and transferring street soot onto it from your hands.
If these scenarios are real to you, consider putting your manual chair in a safe place and take it out only when you want to push for exercise, enjoyment or for crowd surfing!
Instead, imagine the benefits of non-manual controlled POWER. True, you’ll need to find fun and healthy ways to achieve your health goals, but that’s doable.
There are several ways to ensure that weight gain doesn’t prevent you from living your healthiest life – without the risks of losing function from debilitating shoulder, tendon, and joint injuries.
The pool is a great option no matter what your disability. Check out Ali’s video as a C6 complete quadriplegic.
Most local city recreational center pools, YMCA pools, and apartment and condominium community pools now have lifts (thanks to the ADA). You can also find private clubs that deliver accommodations (like the Denver Athletic Club).
If you love the idea of owning your own pool but don’t have the space, an Endless Pool system may be the answer.
There are a number of “sit and be fit” programs that incorporate aerobic and anaerobic exercises, some of which are weight bearing and some of which use exercise bands.
Every Body Fitness offers monthly fee-based programs ranging from $25 to $65 per month, as well as free videos. NCHPAD’s exercise guideprovides information about various forms of exercise and safety considerations.
You can work with a trainer to design a program specifically for your needs and then continue to implement that program on your own. You may be able to take advantage of centers like SCI-FIT, which focuses on recovery from paralysis and spinal cord injuries. Or you can DIY with a Wheelers Paramill, a treadmill for wheelchair users that allows both forward and backward propulsion. (They’re currently offering a $500 incentive program!)
You can use your manual or a specialty chair to play table-tennis, rugby, ski, bike, or lacrosse. An increasing number of communities are offering more single, group, and team sporting opportunities than ever before. The Christopher and Dana Reeve Foundation can help you find resources near you.
Hippotherapy, also known as horse therapy, is a growing trend. It can help improve your balance, core strength, and upper body strength. The Professional Association of Therapeutic Horsemanship (PATH) International has a directory of 870 member centers and 4,900 certified professionals.
The Bottom Line?
Move! Standers, get up every 15 minutes – and set a timer as a reminder. If you’re sitting, you can do the same. Whatever you’re capable of: chair push-ups, stretching, arm circles, dancing, punching the air…just move.
Instead of being tired from pushing your chair around, enjoy your fitness routines. While you’re at it, you’ll benefit from a well-rounded fitness program that will not cause repetitive injuries.
* The dumbbells pictured above are lightweight and therefore do not adversely affect the stability of the wheelchair.
* The Model M should be powered off during workouts.