Preserving Shoulder Health

For Your Clients: How They Can Take Shoulder Health Into Their Own Hands

Preserving Shoulder HealthMaintaining shoulder health is an ongoing challenge for clients who propel their own wheelchairs — and their independence and mobility are at stake. While consumers can’t always predict or control how far they’ll have to propel in a day, or how far they have to push to find a wheelchair ramp or elevator, they definitely can take steps to lower the risk of shoulder injury.

Mobility Management asked Kristin Kaupang, PT, NCS (Neurologic Certified Specialist), University of Washington’s Department of Rehabilitation Medicine, about how seating & wheeled mobility clinicians and assistive technology professionals can help their self-propelling clients to establish good habits, as well as advice for consumers that will help them to care for and love their shoulders.

Q: What training or education can seating & wheeled mobility professionals give to clients regarding how they can positively impact shoulder care and health? For example, what kinds of daily activities and skills need to be emphasized regarding transfers, propulsions, lifting/reaching, etc.?

Kristin Kaupang: The shoulders of individuals who require a wheelchair for mobility are being used at a higher frequency and with greater force than for those individuals who can ambulate. For many, the shoulders take on the function of the legs, but our shoulders are not designed to withstand that kind of force.

Therefore, it is not surprising that more than half of ultralight [wheelchair] users will experience shoulder pain/injury during their lives.

Training and education about shoulder injury prevention should start early and be reiterated often throughout the continuum of care. A seating/mobility professional can analyze the wheelchair user’s body mechanics, posture and shoulder mobility in relation to the wheelchair as well as during activities of daily living. The seating/mobility professional will educate the individual [on] how to minimize forces, strengthen muscles to protect from injury, and make recommendations about posture and positioning that allow for optimal use of the shoulder during activities.

Q: What’s the most effective delivery method for this advice? Should clinicians seek to present it during, for instance, inpatient rehabilitation, but also reinforce it during subsequent outpatient visits?

KK: Training and education about shoulder injury prevention should start early and be reiterated often throughout the continuum of care. Even prior to inpatient rehabilitation, the acute care clinicians will work with individuals to start introducing shoulder health strategies.

The education is certainly the most intensive during the inpatient rehabilitation setting, as establishing good mechanics from the start is easier than adjusting positions down the road. Reinforcement certainly occurs in outpatient therapy visits, as well as visits with rehab physiatrists.

Anytime that there is a change in body function, body size or any change in function, it is important for the individual to apply the strategies and techniques that they have learned. Returning to see a rehabilitation professional and/or seating & mobility professional may also occur throughout the process of aging with a disability.

Q: What “danger signs” do you suggest consumers watch out for regarding shoulder strain or injury? Is any sort of shoulder pain a sign of trouble that should be investigated? Do certain types of feelings — fatigue or a dull ache or a sharp pain — typically manifest first when a shoulder is under strain?

KK: There are certainly many different types of pain, such as sharp pain, aches or pinches. Any pain that is new should be a red flag. Any pain that limits an activity that was previously able to be achieved is a red flag.

If you experience these pains, it is important to find the root cause of them. It may be as simple as changing your back angle or wheel position. A seating/mobility professional will be able to help you optimize your push mechanics and wheelchair positioning to best protect and to utilize your shoulders. It is important not to let the pain persist: Pushing through pain often makes the problem worse.

Editor’s Note: Go to to view and listen to Kristin Kaupang’s presentation called “Protecting Your Shoulders & Staying Active After Spinal Cord Injury.” The hour-long session gives consumers a terrifically empowering overview of what they can do to reduce shoulder strain, including adopting optimal positioning (even while sleeping!), using shoulder-friendly pressure-relief techniques, optimizing their propulsion strokes, and changing their environments to reduce the kinds of reaching that can put shoulders under unwanted pressure.

This article originally appeared in the June 2015 issue of Mobility Management.

Rolling Dynamics, Rolling Resistance &  Optimizing Wheeled Prosthetics