Injuries in wheelchair athletes
Ever wondered what it takes to be an athlete, well nothing compared to what disabled athletes put their bodies through. This article by Chris Mallac Looks at injuries of wheelchair athletes. Enjoy:
The Para-Olympics are finally underway for 2012. The wheelchair events to look out for in the coming 11 days are T34 100m on the opening Friday, wheelchair basketball on the 1st Monday, the T54 1500m on Tuesday, Wednesday starts the ‘Murderball’ day known as wheelchair Rugby and wheelchair tennis on the Friday.
All of these sports have the obvious physical requirement of propelling a wheelchair whilst using the arms. So the obvious question that can be asked from a sports injury perspective is; what are the common injuries suffered by wheelchair athletes?
The obvious visual effect of high level elite wheelchair sports participation is the incredible upper body strength that wheelchair athletes possess. When your arms are all you have to propel that wheelchair as fast as possible, then you would expect that not only will the upper limbs be well developed, but that they are potentially going to be overused leading to injuries.
The most common injuries sustained by wheelchair athletes are soft tissue and nerve injuries in the upper extremity. These injuries include abrasions of the skin (due to falls and direct contact), sprains (ligaments of the shoulder and elbow), strains (upper extremity muscles), and contusions (from direct contact). All of the upper limb joints are susceptible including the shoulder, rotator cuff, arm, elbow, forearm, and wrist.
Muscular imbalances are a common cause of injuries in wheelchair athletes. Burnham et al (1993) found that shoulder muscle imbalance, with weakness of the humeral head depressors (shoulder rotators and adductors), is a possible cause of rotator cuff impingement syndrome in wheelchair athletes. They found that rotator cuff impingement is the most disabling injury experienced commonly by wheelchair athletes. The humeral head depressors are comprised of the infraspinatus, subscapularis, teres minor and the long head of the biceps.
What causes the shoulder muscle imbalances are postural stress, repetitive movement, repetitive microtrauma, lack of core stability, and altered neuromuscular efficiency. This can lead to the weakening of the humeral head depressors. The humeral head depressors reduce the impingement risk by depressing the humeral head as the arm is elevated. The action of the big powerful deltoid muscle is to lift the humerus but in doing so it also elevates the humeral head into the acromian. This may then ‘squash’ the supraspinatus tendon, or the subacromial bursa or the bicep tendon. Strengthening the humeral head depressors would aid in the prevention and rehabilitation of rotator cuff impingement syndrome in wheelchair athletes.
Biomechanics can play a role in the cause of injuries in wheelchair athletes. Elbow and wrist injuries are predictable in wheelchair athletes based on the biomechanics of the sport. The throwing motion, wheelchair racing, racquet sports, and field events can repetitively stress the hand, wrist, and elbow. This type of repetitive stress can lead to overuse injuries such as muscle-tendon imbalances, strains, and abrasions. Correction of these muscle-tendon imbalances is accomplished by maintaining strength and flexibility of the shoulder, triceps, forearms flexors and extensors.
Elite wheelchair athletes will generally have well designed and efficient machines to get them around the track or court. However, the cost of these can be cost prohibitive for some. The design of the wheelchair can also impact the wheelchair athlete’s injury profile. Higher quality competitive wheelchairs that are light and have frictionless moveable components improve the mechanical efficiency of participants. Using a better designed wheelchair can help reduce the risks of injuries. It would be the same analogy as a Tour de France cyclists using a cheap bike picked up in a second hand store. It would create an injury due to the extra muscle effort required to move it.
1. Burnham RS, May L, Nelson E, Steadward R, Reid DC: Shoulder pain in wheelchair athletes: the role of muscle imbalance. American Jour