R. SHOULDER PAIN*

R. THE SHOULDER INJURY ISSUE*2023 update

My advice: 

I recommend that you ignore any health professionals that tell to do, or not do, anything on the basis of shoulder pain. Shoulder pain was not an issue for me in over 30 years as a quad. I cannot see how an issue that does not emerge inside 30 years should have any effect on your day to day decision making.

Specifically, it is ridiculous for a C6 to be advised to make decisions that reduce independence and overall health and fitness on the basis of an issue that may or may not ever emerge. Such advice is telling C6s to endure 30 years of greatly reduced quality of life, and greatly reduced opportunities, in order to avoid some pain that may not arise.

My experience

I became a C6 in 1986. In over 30 years I had shoulder pain twice. On both occasions it was very painful and persistent. However, on both occasions it was a rotator cuff injury which was effectively treated over 3-4 weeks by some specific exercises prescribed by a physio. That was nearly 10 years ago.

Subsequently I avoided a recurrence of the injury by better wheelchair maintenance and by doing the exercises every now and then when I remember. The wheelchair maintenance required in my case was to not push around for weeks and weeks with tyres that are both a bit flat and quite bald of tread.

The connection between my rotator cuff injury and my tyres was that it altered the angle at which I was sitting, and pushing, to a more reclined position. This meant I had to rotate my shoulders inwards more when pushing. Doing that for many weeks seems to be enough to cause the rotator cuff shoulder injury if I am not doing the exercises.

The exercises are various arm movements designed to rotate the shoulders back rather than forwards. They are prescribed by physios to strengthen the muscles that pull the shoulders backwards. My understanding is that they are not specific to quads. They are the same exercises prescribed for able-bodied people with rotator cuff injuries.

In 2014

More recently, close to turning 50, I think I am getting some pain but not to a major level. However, I am also getting older and there are now many more options for wheelchairs out there that just manual v power. Given my age, I will be getting a power assist device to put on my manual chair to help with pushing when necessary. Its an easy and timely solution and it means I still don’t have to give up the independence and good health I have had.

In 2023

Since 2015, my shoulder pain has got progressively worse. However, it does seem to be worse when I have particularly low blood pressure, which is quite common but separate issue. See the separate page on that issue which describes my experience.

It was very good that I did get the power assist device back around 2018. I had a lot of issues with that device for a few years, see the separate page on that issue which describes my experience. In the last 12 months there have been some improvements in the hardware associated with the device, and it is now, mostly, working really well. I use it all the time now largely because of shoulder pain. If I tried to push any lengthy distance on the flat or uphill, it would be really difficult due to the shoulder pain. Given that I am now 58, my experience since 2014 hasn’t changed my opinion from that time, expressed above or my advice expressed below.

In fact, I would say the recent proliferation of power assist devices, only reinforces my point. It means that young quads should push as much as possible when they are young and capable of it, in order to stay fit and healthy and independent. Later, if shoulder pain becomes an issue, then there are many different power assist devices available and no doubt there will be more and better ones in the future. For example the Klaxon Twist is due to come out in May 2023 and looks like a big improvement on existing devices. So there really is no need for a long-term shoulder pain to stop anybody using a manual chair at a younger age, prior to pain becoming an issue. 

Conclusion

My understanding is that some C6s these days are not given the choice to be independent, they are simply told to use an electric chair rather than a manual chair, or not to transfer, or to learn the unnecessarily difficult legs down transfer technique. The rationale for this advice is apparently to avoid pain that may occur decades later.

Such advice is taking away choice from C6s. It is health professionals making a choice on behalf of C6s. It is health professionals forming the opinion that avoiding the possibility of a decade or two of pain at the end of life is worth giving up three or four decades of independence in the middle of life. Removing the ability of patients to choose independence and opportunity in this way is immoral. It is also contrary to evidence based medicine given that it is opinion in the absence of any evidence.

Here’s what the experts say 

CLICK HERE for a pdf all about preventing shoulder pain. I think most of it is nonsense except the exercises they recommend. It includes the rotator cuff exercises I mentioned above which are definitely useful. It also includes more general strength and conditioning ones which are probably sensible.

Rule number 26 – Don’t let anyone make you give up independence, health, fitness and opportunity for fear of future pain that may never occur.