RehabMove 2018: PROPULSION BIOMECHANICS OF MANUAL WHEELCHAIR USERS WITH UPPER LIMB PAIN

Rotator cuff injuries, carpal tunnel syndrome and other overuse injuries in the upper limbs are very common in manual wheelchair users (MWUs). Because of the high dependence of MWUs on the upper limbs, these injuries can have significant disadvantages to their quality of life. Propulsion technique is a key component in causing overuse injuries and can therefore be important for preventing or reducing injuries. This review aims to bundle information about propulsion biomechanics in MWUs with upper limb pain or injuries and to distinguish a pattern of causality to help clinicians in the development of rehabilitation for these patients. A literature search using PubMed was conducted to find relevant literature. Articles were included for this review if they included a measure for pain or a grouping system based on the presence of pain. The reported pain needed to be in the area of the upper limbs, including the shoulder. Reviews and non-English articles were excluded from this study. A total of nine articles were included, seven of which studied shoulder injury and two examined wrist injury. Because intervention studies about this topic have not been conducted and are difficult to perform, a causal relationship cannot be established with certainty. However, theoretic explanation given in the articles was examined. Propulsion forces not contributing to forward movement were suggested to cause injuries. Contradictory results were reported for motor variability. However, increasing variability without overstraining other muscle groups is suggested to reduce upper limb pain, while minimizing risk for future injury. Further research should be conducted to develop alternative propulsion techniques or propulsion aides for MWUs with upper limb pain