The Relationship between the Hand Pattern Used during Fast Wheelchair Propulsion and Shoulder Pain Development

J Biomech, 2021 · DOI: 10.1016/j.jbiomech.2020.110202 · Published: February 12, 2021

Spinal Cord Injury Rehabilitation Biomechanics

Simple Explanation

This study investigates the relationship between hand patterns used during fast wheelchair propulsion and the development of shoulder pain in manual wheelchair users with spinal cord injuries. It looks at whether certain hand patterns are linked to shoulder pain and if shoulder adductor strength plays a role. The research analyzes data from two groups of wheelchair users: those who developed shoulder pain over time and those whose pain resolved. It examines the hand patterns they used during fast propulsion and their shoulder adductor strength. The findings suggest that while the specific hand pattern used during fast propulsion isn't directly correlated with shoulder pain, using more over-rim hand patterns might indicate weaker shoulder adductor muscles.

Study Duration

36 months

Participants

60 manual wheelchair users with spinal cord injury

Evidence Level

Prospective Cohort Study

Key Findings

1
The hand pattern used during fast wheelchair propulsion is not significantly correlated with shoulder pain development.
2
More over-rim hand patterns during fast propulsion may be indicative of weaker shoulder adductor strength.
3
Differences in handrim forces or cadence as a result of using a different hand pattern may not be large enough to avoid developing shoulder pain or to mitigate present shoulder pain.

Research Summary

This study aimed to determine if hand patterns during fast wheelchair propulsion correlate with shoulder pain development and if shoulder adductor weakness is linked to specific hand patterns. The results indicated no significant correlation between hand patterns and shoulder pain development. However, a trend suggested that more over-rim patterns might be associated with weaker shoulder adductors in one subset of the participants. The study concludes that while hand patterns may not directly cause shoulder pain, the use of over-rim patterns could potentially indicate underlying shoulder muscle weakness, warranting further investigation.

Practical Implications

Clinical assessment

Clinicians should consider assessing shoulder adductor strength in manual wheelchair users, particularly those who frequently use over-rim hand patterns.

Targeted interventions

Rehabilitation programs should focus on strengthening shoulder adductor muscles, which may help prevent shoulder pain development, regardless of hand pattern used.

Further Research

Future studies should investigate the robustness of the relationship between hand pattern and shoulder strength, considering factors like pain level and location.

Study Limitations

1
The study analyzed propulsion only at participants’ fastest comfortable speed.
2
The generalizability of these findings may be limited due to the small number of female participants and the focus on individuals with complete spinal cord injuries.
3
Pain was represented as a binary outcome.

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