Wheelchair>>Exercising From Your Wheelchair - 1/6/2007
Exercising From Your Wheelchair
Most techniques and exercise principles also apply to the wheelchair user; however, the wheelchair itself offers some unique challenges. Like people, wheelchairs come in many different dimensions and offer a variety of features. To allow for safety, you should be aware of the limits of your wheelchair. In particular, you should be aware of your wheelchair stability and center of gravity (COG) and its back height.
Wheelchair Stability and Center of Gravity
When exercising from the wheelchair, the first concern is that it is immobilized. It is not uncommon that wheelchair brakes do not hold, and many athletic wheelchairs do not even have brakes. If this is your case, you may not have any difficulty performing exercises down at your sides and close to your body, such as a biceps curl, but you may have some trouble with over-the-head exercises like the shoulder press.
A second concern that affects the stability of your wheelchair is its center of gravity. Some of the athletic wheelchairs move the center of gravity toward the front of the chair by simply moving the axle plate forward. This allows for faster turning and speed, but it also reduces the force needed to flip the chair backward. If your axle plate or COG is forward, you need to make sure your chair is adequately stabilized before performing over-the-head exercises.
You can immobilize your wheelchair in several ways:
- Weigh down the front end of your wheelchair with sand weights. You can also place sand weights behind the wheels to further prevent any forward or backward shifting or tipping.
- Position your wheelchair back against a wall. Be sure to place sand weights in front and behind the wheels in this technique as well.
- Hook the push handles over a high/low table if one is available. A high/low table will probably not be available in a community fitness setting, but most rehabilitation centers will have one.
- Have your workout partner stabilize your chair. This technique is probably the least desirable because it does now allow you total independence.
Back height should be determined by personal preference based on your level of injury, sensation, and balance. With spinal cord injuries, the general rule of thumb is that the higher the level of injury, the higher the backrest, because of the need for balance and stability.
You have some of the same options as you did for immobilizing your wheelchair. Try these suggestions:
- Back your wheelchair against a wall for support.
- Have your workout partner spot you for all over-the-head exercises.
- Perform unilateral over-the-head exercises and use the nonexercising arm for balance.
- Transfer into a chair with a higher back to perform your over-the-head exercises.
- Perform your over-the-head exercises with exercise machines rather than free weights. Without having to balance the weight, you may be able to safely and independently perform your exercise program.
Positioning and Strapping
An aligned, secure, and stabilized position is a necessity for you to perform exercises with your extremities. Your position or posture can also greatly influence your muscle tone and set off or prevent primitive reflexes if you have a head injury or cerebral palsy. Posture and trunk stability during exercise also affects your balance, no matter what your disability. General guidelines for positioning and strapping follow.
Head. To avoid the influences of primitive reflexes, your head and neck should be maintained in a neutral position during upper and lower extremity exercises. Refer to Table 5.3 on page 69.
Trunk. The trunk or body position should be erect, stabilized, and secure during upper and lower extremity exercises to avoid substitution of muscles. An elastic binder or belt can be wrapped around you and the wheelchair to stabilize the trunk and maintain balance. We recommend an elastic binder for anyone with mild to moderate balance deficits in the trunk. The elasticity of the binder allows some degree of control and enables the trunk musculature to contract for balance and stability during upper and lower extremity exercise. The more trunk control you possess, the looser the binder should be. People with moderate to severe trunk balance difficulty can use nonelastic belts or wraps. For example, if you do not have any trunk muscles (abdominal or back), you would benefit from a nonelastic strap that stabilizes your body against your chair while you exercise with your arms. If you have good trunk control, you may want to remove arm rests to allow more freedom of movement.
Upper Extremities. Some individuals with head injuries, stroke, or cerebral palsy may have one upper extremity that is more severely involved than the other. In many cases the more involved extremity can interfere while the opposite side is being exercised. Strapping your nonexercising extremity in a neutral position to the armrest of the wheelchair is often helpful. You could also secure the arm under your wheelchair seat belt.
Lower Extremities. People with conditions such as cerebral palsy, multiple sclerosis, head injuries, and spinal cord injuries often exhibit an extensor pattern or posture characterized by trunk, hip, and knee extension, hip adduction and internal rotation, and ankle plantarflexion (toes pointing down).
- If spasticity creates a positioning problem, your lower extremities should be positioned securely in full flexion when performing upper extremity exercise. The full flexion position can break up the lower extremity extension tone and securely position the buttocks and trunk to the back of the wheelchair seat and back. A strap or seat belt coming from underneath the wheelchair and crossing over t5he proximal (upper) hips can secure you in the wheelchair.
- The ideal 90/90-degree hip and knee angle may need to be modified by increasing the hip flexion if your hips continue to extend. Raising the footrests can also increase hip flexion. If footrests cannot be raised, use a strap above the footrests to allow more flexion at the hips and knees.
- Straps can also be applies around the front of the footrests to prevent knee extension and hip adduction with upper extremity exercise.
General Precautions With Strapping
When using straps, it is important to be aware of any areas of decreased sensation, typically seen with spinal cord injuries, strokes, head injuries, and multiple sclerosis. These areas of the body are prone to skin breakdowns. All areas that are strapped should be checked for redness. Straps should be at least 2 in. wide to increase the area of contact with the skin. Thinner straps may cause a tourniquet effect by applying too much pressure over one area. Be on the alert for skin color changes or swelling following strapping. If you feel some unusual sensations such as a "pins and needles" feeling, it is time to loosen and adjust your straps because the strap may have been placed over a major nerve or blood vessel. As a general rule, all straps should be loosened between sets.
- If your legs are strapped to a bench to perform exercise such as the bench press, stretch your legs before strapping to decrease the possibility of setting off spasms in your legs.
- Anyone with a history of hip pain, hip dislocations, and total hip replacements must be especially careful because strapping the lower extremities with the legs extended against spasticity can aggravate the hip condition.
- The lower extremities should be positioned with some degree of hip and knee flexion to allow for muscle slack and to avoid setting off a muscle spasm. Place rolled-up pillows, towels, or a bolster under the knees. If strapping is still needed for balance, place the straps above the hips to allow good stability on the bench without putting extra stress on the hips if spasms do occur.