The impact of seating and positioning on the development of repetitive strain injuries of the upper extremity in wheelchair athletes

The population of people who use wheelchairs has been increasing due to technological advances. With this increase, there has also been an increase in participation in wheelchair sports. The incidence of upper extremity injury in wheelchair users has been reported to be between 31 and 73% [2,13,23,26,29]. Wheelchair athletes may be at an increased risk for upper extremity injury due to increased upper extremity use with sport. The purpose of this paper is to ascertain whether proper seating and positioning have an impact on the prevention of repetitive strain injuries (RSI) of the soft tissues, including peripheral nerve entrapments and muscle injury, of the upper extremity in wheelchair athletes. A review of current research on wheelchair propulsion and RSI revealed several hazards for wheelchair athletes to develop RSI's. These include duration of impairment, muscle imbalance, awkward positioning, inadequate rest breaks, repetition of muscle use in daily activities and in sport participation, the degree of force needed for propulsion, and fatigue. Current research does not provide conclusive information on optimal seating. Suggestions of preventative measures are given including suggestions with regard to positioning in the wheelchair.