Wheelchair Seating Positioning Tips

The pelvis is the key to maintain correct posture as it dictates the position of the head, trunk and extremities for users in wheelchairs.

Good posture is characterised by:

  • Straight position of head
  • Physiological curvatures of sagittal plane and straight spine in coronal plane
  • Well-formed chest
  • Shoulders slightly backward in relation to pelvis
  • Symmetrical alignment of pelvis

Modifications to posture and position are best done in small incremental changes as these allow the user to physiologically adapt to them and for the assessor to manage the progress sufficiently.


Lightning Mobility
Clinical Issue Common suggestions for intervention Product Choice
Posterior Pelvic Tilt
  • Decrease thigh to calf angle

  • Drop front of cushion down/build up at rear for sloping seat surface

  • Provide more posterior pelvic support through backrest

  • Create biangular shaping in backrest to accommodate asymmetries

  • Check depth of cushion – may be too deep

Spex Cushion

Spex Backrest

Anterior pelvic tilt/Lordosis
  • Neutral alignment of the pelvis

  • Encourage more weight bearing on ischial tuberosities

  • Position hip belt over ASIS

  • Create a rearward sloping seat and carefully set up the back angle to reduce the tendency to lumbar Lordosis

  • Provide contouring in the backrest to support the users back

  • Using an adapted tray to form an anterior support for the trunk is often very effective and functional for the user

Spex Cushion

Spex Backrest

Tight hamstrings
  • Drop front of cushion down/build up at rear for sloping seat surface

  • Open seat to back angle

  • Decrease thigh to calf angle with footplate position

Spex Cushion
Limited hip flexion (one side or both)
  • Accommodate fixed limitation in hip flexion by wedging cushion sloping to the front
Spex Cushion
Sliding forward on seat
  • Provide increased pre-ischial shelf build-up

  • Stabilize pelvis using appropriately angled pelvic belt

Spex Cushion
Extensor Thrust
  • Increase hip and knee flexion
Spex Cushion
Leg length discrepancy
  • Leg discrepancy cut-out in cushion
Customised Spex Cushion
Pelvic rotation
  • Create build-up in pre-ischial support under affected pelvis
  • Contour the back surface to support pelvis if fixed
  • Maximise use of hip belt to control forward side
  • Check dimensions of chair and components. A chair that is too wide, for example, can facilitate pelvic rotation
  • Contoured cushions with good leg troughs
  • Appropriate lower back support is preferable to a canvas back which may mould to the rotated pelvis

Spex Cushion

Spex Backrest

  • Hip and thigh lateral supports
  • Provide more adductor/abductor support on the cushion with higher contouring/deeper leg troughs

Customised Spex Cushion

Spex thigh supports