Editor’s Note: Our friends at The Mobility Project – an initiative created by Mobility Management magazine – are sharing a series of articles with Wheel:Life to help empower our community of wheelchair users, assistive technology users and their families! We’ll be posting the article highlights with a link to the full story below. 

pushrimHow many strokes does it take to propel a manual wheelchair each day? The short answer is a lot.

Diane Ulmer, OTR/L, manager of the Spinal Cord Injury Program at Madonna Rehabilitation Center in Lincoln, Neb., says the number is between 2,000 and 3,000 strokes. Unfortunately, that amount of repetitive activity can put a person at greater risk for developing a repetitive use injury such as tendonitis, carpal tunnel syndrome or impingement.

Who’s at Risk?
If you think about the stress being put on your upper extremities each day, you might wonder how you’ve managed to come this far without an injury.

“They not only have repetitive motions to the hand and shoulder during wheelchair propulsion but also to complete transfers, loading/unloading a wheelchair and the other activities of daily living,” Ulmer says. “The general population is at high risk due to excessive computer usage, repetitive industry work and other vocational activities that put them at risk. Individuals with SCI have these same risks associated with their work tasks in addition to the risk from the wheelchair propulsion and transfers in their daily routine.”

In fact, spinal cord injury (SCI) puts you at a greater risk because your arms are functioning in a much different manner.


“You have fewer muscles to choose from, which means oftentimes the amount of repetition for the muscles that you have active is much higher than normal. For example, for somebody that has a spinal cord injury at their waist level or even at the chest level, they’re using their arms in place of what they used to use their legs for,” says Kristin Kaupang, PT, NCS, ATP, a physical therapy clinical specialist at Harborview Medical Center, which is part of Northwest Regional Spinal Cord Injury System, in Seattle, Wash. “So there’s a lot more strain, a lot more stress on joints that are not meant to be stressed upon in that manner.”

See a doctor if your shoulders or arms are causing you pain.
See a doctor if your shoulders or arms are causing you pain.

The most common repetitive use injuries occur at the wrist and shoulder. The wrist injury is commonly carpal tunnel syndrome that results in numbness or tingling, Kaupang explains. At the shoulder, the injury is typically impingement or tightening around the shoulder capsule.

And as Ulmer mentioned, it’s not only wheelchair use that’s to blame for these injuries.

“If you’re using different muscles to dress yourself or to transfer or to be able to bathe yourself, those muscles are also being used in an alternative fashion than they were used prior to an injury,” Kaupang says.

Read the full story here for a list of preventative tips to protect your shoulders from the stress of pushing your chair.

About the Mobility Project
The Mobility Project (TMP) strives to help empower the community of wheelchair users, assistive technology users and their families by promoting dialogue and sharing ideas that can advance their many abilities and opportunities. TMP works to provide practical, timely information on assistive technology, accessibility, health-related resources, clinical conditions, advocacy and other topics of interest to this community and culture — while serving and appreciating people of all age groups and levels of ability. Learn more at

About Mobility Management
Mobility Management is the only industry publication written especially for mobility and rehab suppliers and clinicians. Mobility dealers/providers  and rehab professionals turn to Mobility Management every month for real-world solutions regarding new Medicare/Medicaid policies, client assessment, product innovations, pending legislation, auto and home accessibility and end-user views. Learn more at:

More Clinical Resources: Free Nurse CEUs


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That’s why we’ve partnered with to offer a series of FREE continuing education courses for clinicians. LoveYourNurse courses are fully accredited, and easy to follow online.  All you have to do is create an account and then login to access the course library! You can take tests at your convenience after you review the course material online.

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