| THIS MONTH: SHOULDER HEALTH |
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Photo courtesy of Erik Mathy. |
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One day last fall, I was out mountain biking, and my dog stopped in front of me on a sloped turn. I flipped my bike trying to avoid her, fell to the bottom of the bank and landed hard on my left shoulder. After a string of expletives, another rider helped flip me upright and I limped down the rest of the trail on adrenaline. When I got back to my truck, the pain really hit. It felt like something was broken or torn. My wife had to help transfer me out of the bike and into the truck.
I’ve been a wheelchair user for more than 20 years and this was the first major shoulder issue I’d had, despite a Paralympic wheelchair rugby career, multiple long-distance handcycle trips and my inclination to constantly push my physical limits. The sudden shoulder injury was as deflating as it was painful and made me wonder if my shoulders had been living on borrowed time.
After a couple of days struggling around my house, I went to my physiatrist to assess the damage, and the news was surprisingly good. I had a separation in my AC joint, which, though painful, would heal on its own and hadn’t compromised the structure of my shoulder. For the next few months pain would be my limiter, but otherwise I could keep pushing and transferring and living my life.
The second piece of good news came as he explored the rest of my shoulder: He couldn’t find a single tear or sign of damage in the rotator cuff muscles. He was so shocked that he checked my right shoulder as well. Same result. “Well, I know you haven’t been taking it easy, but whatever you’ve been doing, keep doing it,” he said.
The experience offered one piece of validation and one cautionary lesson. Validation: Activity isn’t the enemy for our shoulders. It is possible to be out, pushing your wheelchair, doing difficult transfers, competing in adaptive sports and whatever else you want to do without inevitably blowing your shoulders out. Lesson: Even when you’re doing things right, unexpected damage can come in the form of an awkward cattle dog, a crack in the sidewalk or any other random accident. Knowing that, let’s look first at how to keep our shoulders healthy for the long haul, and then at what to do when damage does happen. |
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The Next Generation of Wheelchair Seating, Powered by Carbon
The right wheelchair cushion can make all the difference—for comfort, health, and independence. Traditional foam, air, and gel cushions often force compromises: they can break down over time, trap heat and moisture, or demand constant maintenance. With Carbon’s lattice technology, those trade-offs don’t have to be part of the equation. |
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A BALANCED SHOULDER IS A HEALTHY SHOULDER
I have no definitive answers as to why, after decades of wheelchair rugby and generally subjecting my body to more daily abuse than most, my shoulders have managed to stay healthy. But I have a couple of ideas that are echoed by other long-time wheelchair users.
First, if your primary means of activity is pushing your wheelchair, you need to add some variety. I’ve long felt that the basis of my shoulder health is balanced shoulder strength. For me, that means lifting weights and making sure that I focus equally on the pulling movements that build strength in the plethora of muscles in my upper and mid back.
Jerod Warf, an athletic trainer with over a decade of experience working with wheelchair users, says that the shoulder “should move in many directions, horizontally and vertically, or you’re not giving them what they need. Ask yourself: ‘When I’m out pushing my chair, what am I doing to re-lengthen those pushing muscles?’ You can be highly active, you just need to do supplemental shoulder routines, they’re like your daily vitamins that fill in the gaps of what you can’t get enough of on a daily basis.”
Warf offers a couple of shoulder health routines that can be done sitting in your wheelchair, either independently or assisted, depending on your level of function in “DeBunking the Shoulder Blowout Myth.”
Bob Vogel, our longtime expert on all things shoulder-related, recommends regular handcycling on a stationary trainer, where you’re focusing on the pull motion as a way to keep your shoulders balanced. His other go-to: wheeling backward up hills, which works the backs of your shoulders and saves the front of your shoulders from the high-force movements that can lead to damage. For more details and other tips, including how to improve your biomechanics and rest your shoulders while staying active, read his article “Ways to Help Prevent Shoulder Damage.”
An underdiscussed aspect of shoulder health is seating position. I sit with a lot of dump, which gives me enough stability to lean over my wheels when pushing up hills. The subtle change in pushing position transfers much of the propulsive force to my chest and triceps. If I have something on my lap so I can’t bend over, I notice my shoulder straining on even a slight incline. For more on getting your wheelchair seating dialed in, check out “How to Get the Best Wheelchair Setup for Your Lifestyle.” |
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FUNCTIONAL FITNESS
Top Upper Back Exercises for Wheelchair Users
Wheelchair user and certified personal trainer Ben Clark shares tips and techniques for strengthening your back and improving shoulder stability. |
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WHAT TO DO WHEN YOU'RE HURTING
If you have damaged your shoulders, whether through long-term wear or in a sudden accident, it’s time to start assessing treatment options.
The easiest way to categorize them is by level of intrusiveness. On the least intrusive end of the spectrum is physical therapy, followed by injections and finally, surgery. Vogel goes through how he considered the pros and cons of each along with other wheelchair users’ experiences of different treatments in his article “My Search for the Best Treatment Option When My Shoulders Went South.”
Physical therapy can take many forms — from targeted exercises to strengthen supporting muscles and get your shoulders back in proper alignment, to ultrasound therapy that can help promote your body’s natural healing response. PT won’t heal muscle or ligament tears, but it can provide relief for strains and inflammation while reducing pain and improving range of motion. Though often performed by a physiatrist instead of a PT, shockwave therapy is a newer treatment that shows promise in reducing pain and promoting healing of some shoulder issues. My physiatrist performed three shockwave sessions on me following my AC separation. Though I have no objective data on whether the therapy improved healing, it did give instantaneous relief to the tight muscles in my upper shoulder and neck, like a massage turned up to 11.
For years, the next option for relieving shoulder pain was to try cortisone (steroid) injections. They can provide pain relief but the relief is often temporary and the injections can cause further damage if used regularly. Newer “orthobiologic” treatments — including Platelet Rich Plasma, Microfragmented Adipose Tissue and stem cells — involve injecting biologic substances typically derived from your own body into your injured shoulders to promote healing and reduce pain. While they don’t work for every injury, some wheelchair users have had success returning to active lifestyles using orthobiologic therapies combined with PT. Read more at “Orthobiologics: Biological Shoulder Repair Instead of Surgery?”
Shoulder surgery is usually the last option to consider because of the expense, low odds for success, long recovery times, and the fact that for wheelchair users, a loss of an arm means a loss of independence during recovery. If your shoulder damage is bad enough, surgery can be worth it, but it’s a decision that shouldn’t be taken lightly. One piece of promising news: Some wheelchair users with blown-out shoulders are having success with a newer surgery option called reverse total shoulder arthoplasty, also known as total reverse shoulder replacement. Carol Spiker, 76, a T7-8 para, had RTSA last year and you can read about how she coped with the recovery from this major surgery.
If you’ve had shoulder issues or treatments that aren’t reflected here, please let us know so we can incorporate your experiences into future articles |
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| The Health & Wellness newsletter is written by Seth McBride. A C7 quad since 2000, McBride is drawing on two and a half decades of personal experience, seven years of disability reporting experience, and a deep archive of New Mobility content to translate complex health and wellness topics into a monthly narrative newsletter with something for everyone. Whether you like the format and want to let us know, see something we missed or want to suggest a topic for us to cover in the future, please reach out or respond to this email. |
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