This article provides tips for wheelchair users to consider which may help in reducing pain and discomfort. Therapists are people that can help you do this along with your treating doctor or medical/health service too.
Using a Wheelchair (defining the issue of pain or contributing issues/limitations)
- Repetitive pushing of wheel rims is a major problem activity causing musculoskeletal pain. Consider obtaining a power or power-assist wheelchair if you:
- Have significant upper limb (shoulder, elbow or hand) pain.
- Have tetraplegia (quadriplegia).
- Have a prior injury to an upper limb.
- Are overweight.
- Are elderly.
- Live in a challenging environment, such as on a steep hill or near very rough terrain.
- If you use a manual wheelchair, make sure it is the lightest model (made from aluminium or titanium) you can afford or the NDIS/other scheme will pay for. Lighter models give you less weight to push around and can often be customised to make it easier for you to propel the chair.
- If you do use a manual wheelchair, reduce the number of strokes you use per distance travelled. Rather than quick short pushes, use long smooth strokes.
- If you use a manual wheelchair, make sure it is in good repair and set up in a way that allows you to get around with minimal effort. Ask your therapist to check whether your seat is in the right position relative to your rear axle. Also have him/her check that the chair and cushion together give you good stability.
- Get your wheelchair seating, posture and pushing technique evaluated by a occupational therapist periodically since your needs, habits or activities may change over time (and so will your support requirements).
- Keep your tires well-inflated to minimise rolling resistance.
- Wheel your chair over concrete and linoleum rather than through sand, grass or heavy carpeting. The reduced resistance to your wheels lessens the load on your arms.
Finally, if you are a manual wheelchair user, and the above are not helping you to manage pain and discomfort and be safe, you may wish to talk with an OT to determine if you could use a device fitted to your manual chair to provide powered support (e.g. to reduce the need for pushing), or may need to consider a power-assisted wheelchair (which has a small battery and motor and can operate both manually and in powered mode for around 20km/charge - often helpful for community visiting to reduce exertion) or whether you may need to use a fully powered wheelchair, in future.
Shoulder health can be a major contributor to wheelchair uses suffering with pain and discomfort. To stay well and reduce pain, think about options like:
- Minimising the frequency of arm/hand tasks, especially tasks that involve lifting heavy loads higher than your shoulder. Let someone else get that book off a high shelf for you.
- If possible, do not do tasks repetitively that require you to bring your hand higher than your shoulder. This may require reorganising your house. Talk with your occupational therapist about ways to do so.
- Minimise lifting heavy loads. If you cannot get someone else to do the heavy lifting, hold whatever you need close to your chest rather than at the end of an outstretched arm.
- Avoid doing push-up pressure reliefs (weight shifts), which can harm your shoulder joint. Instead, perform side-to-side or forward-lean pressure reliefs. Note: you should work with a therapist to learn the proper technique for these methods.
Transfers are an inescapable issue as a wheelchair user. But are sources contributing to pain discomfort and injury which can impact your use of a wheelchair. Think about the following, or get help from a therapist, to help you work through them to avoid problems and injuries:
- The heaviest thing you lift generally will be yourself. Reduce the number of transfers you do each day, and do them in a way that minimises risk of injury.
- Transferring from a high point to a lower one is not as hard on your wrists, elbows and shoulders as transferring from a low to a higher point. It is better to make two level transfers, rather than one downhill transfer followed by one uphill transfer.
- Use sliding boards and other assistive devices (such as lifts) in making transfers.
- When transferring, use a handgrip if available, rather than putting your hand on a flat surface.
- When transferring, don’t spread your hand flat and rest on it. Make a fist, and rest on your knuckles.
- When transferring, position your hands as closely to your body as possible so that your arms are straight up and down and your weight hangs between them.
- Alternate which one of your arms is the lead arm in transferring. Different muscles are used by the lead and trailing arms during transfers, and alternating the arms keeps muscles balanced.
- Maintain your ideal weight. Being overweight is hard on your shoulders, arms and wrists when you do transfers or push your wheelchair.
Have you had a recent injury?
If you have encountered an injury then medications may help relief pain and discomfort. You may need to also consult with a therapist to ensure your injured body part is OK and get help for it to heal quickly. The worse thing to do is to keep pushing through pain when an injury occurs... remember pain after an accident/problem is your bodies way of saying something is wrong. Getting help early can avoid long term injury and pain issues.
An OT may be good to talk with if you've had an injury. They can help you access equipment (if required), like from a loan pool or rental scheme, so your injury is not made worse and can heal quicker. Examples might be, an assistive power device to add to your wheelchair, a powered wheelchair for a while (e.g. 3 months), using a mobility scooter instead, or even obtaining a different wheelchair more suitable for you while an injury or problem is addressed or heals.
