Why Everyone Should Be Talking About the Shoulder

If you are a physio or occupational therapist working with an individual who is utilising a manual or power wheelchair, you should have a better understanding of the shoulder than a sports physio. Yes, that’s right you read that sentence correctly. Our client needs us to better understand the shoulder than a sports physio. 

Whether you are the end-user, therapist, family, dealer/supplier everyone should be thinking about the client’s shoulders. The statistics are staggering. We know that shoulder pain and dysfunction is a problem for all of us in this world, but this becomes even more significant to consider and address if the end-user relies on their upper extremities for mobility. The percentage of shoulder pain in individuals that utilise a manual wheelchair for their mobility ranges from 32% to 78% (1).

It’s not just individuals who propel a manual wheelchair that we should be talking about! Even an individual utilising a power wheelchair? Yes! This is because although we like to blame propulsion for all the shoulder pain, this is just one piece. We also have to think about transfers, overhead reaching, loading/unloading a chair into the car, activities of daily living… just to name a few. This is part of the problem, but there is a whole other side to this story that we need to consider.

What if the individual already has shoulder pain, limited range of motion, decreased strength, or muscles around the shoulder are not fully innervated? How often as a therapist do you assess your client’s shoulder? Are you assessing for pain? Do you quickly run a gross range of motion assessment and then dive further if you see any limitations? Have you at a minimum grossly tested shoulder strength?

Yes, understanding how the equipment will affect shoulder health is crucial and this is something that I talk about extensively if you have been in one of my courses. But what about how the shoulder at its current state of health and future health will impact the client in the equipment we are selecting? We cannot determine the most appropriate equipment for a client without understanding their shoulder health and we CANNOT assess the shoulder if we do not ask questions and get hands-on.

This is why we need to know as much or more than the sports physio. We are assessing a shoulder to perform at a high level with activities that the shoulder was not designed for. Now some of our clients may have a fully intact, strong shoulder with no reports of pain similar to an athlete or they may even be an athlete themselves. But many of our clients will have already existing shoulder impairments and pain. It is our job not only to understand what we need to complete in an assessment to determine their equipment selection such as their environment and goals, but we also need to be able to assess and understand a complex shoulder joint and how this will impact our decision.

It is a big responsibility, but also one that can really show our level of education, assessment and critical thinking skills.

So, where do we learn this information? We learned a foundation in our university, but we cannot stop there. We have to continue to further understand the shoulder and how the individual activities of each client affect their shoulders. I would suggest an orthopaedic course on the shoulder. Yes, I know. This may seem like a strange suggestion, but we and the orthopaedic-based therapists have a common goal! You could even try to see if you can attend a course that is not in our specific field of study – an occupational therapy course for a physio and vice versa. Some courses allow OTs, physios, chiropractors, etc… these can be great courses to learn not only from the instructor, but also from each other.

Finally – your Clinical Educators! We are happy to help you further your knowledge and can help you to work on integrating the shoulder with the wheelchair and client to achieve the optimal outcome. Join our free webinar on the shoulder on March 24th at 12pm AEDT. If you haven’t registered yet, click this link to register for our webinar and begin your further education of the shoulder.

Finally, remember the why. We are asking our clients’ shoulders to work hard, and we need to make sure they are able to handle the demands that we are placing on them. This might include considering a power assist add-on to a manual wheelchair, a power wheelchair with ActiveHeight and ActiveReach, or creating a home exercise program to name a few. The statistics are too high. We need to help to decrease this percentage of individuals experiencing shoulder pain and the only way to do this is through education of ourselves and our clients in order to complete a proper assessment and equipment recommendation.

Written by: Rachel Fabiniak, PT, DPT Clinical Education Specialist