Upper Limb Joint Health in Wheelchair Exercisers 

Overview:

When using a wheelchair the shoulders work hard so the person can move around and perform various tasks specific to wheelchair use. These tasks often require the person to take their body weight through the arms, when transferring between chairs for example, something which the shoulder was not designed to do. Playing sport places further demands on the shoulder as this often involves having to move more quickly than usual as well as performing the sporting tasks. Wheelchair tennis is one such sport that requires the athlete to move quickly around the court, change direction sharply, and perform the tennis strokes.

Wheelchair users often have pain in their shoulders. The pain could be caused by the shoulder joint, especially the shoulder blade, not moving in the correct way. What is unknown is whether playing a wheelchair sport has any effect on the way the shoulder moves. Certain forms of exercise will help to protect the shoulder because the shoulder muscles will be trained to work in the correct way. However, some exercises can place abnormal forces onto the shoulder causing the muscles to work differently and change the way the shoulder blade moves. 

This study is investigating how the shoulder joint functions in a group of wheelchair tennis players compared to wheelchair users who do not take part in sports. Shoulder function will be measured using some physiotherapy tests and assessments, as well as self-reported questionnaires.  The movements of the shoulder, specifically the shoulder blade, and arm will be measured using specialist cameras that track their movements in 3D. This will enable accurate measurement of how the shoulder moves and functions. The results of the study will form the basis for further research to develop ways of protecting the shoulders to enable wheelchair users to take part in sporting activities without causing shoulder problems.

Aims and Objectives:

• The aim of the study is to investigate the shoulder function in wheelchair tennis players compared to non-athletic wheelchair users in terms of: 
• Amount of self-reported shoulder pain and quality of life in relation to the amount of physical activity they perform;
• Physiotherapy assessment of their shoulder function and pain; 
• Movement of their shoulder joints, in particular the shoulder blade, during arm movements; and
• Measurement of how the muscles control these movements of the shoulder.

Outputs:

• Mason, B, Warner, M., Briley, S., Goosey-Tolfrey, V., & Vegter, R. Managing shoulder pain in manual wheelchair users: a scoping review of conservative treatment interventions (2020). Clinical Rehabilitation. DOI: 10.1177/0269215520917437 
• Warner, MB, Wilson, D, Heller, MO, Wood D, Worlsey, P, Mottram, S, Webborn, N, Veeger, DJ and Batt, M.  Scapular Kinematics in Professional Wheelchair Tennis Players. Clinical Biomechanics Vol 53, March 2018, pages 7-13.  DOI: 10.1016/j.clinbiomech.2018.01.022 

Work Package	Stratified Care and Personalised Medicine: Care
Objective	1.2i
Lead	Dr Martin Warner
Investigators	Dr Peter Worsley; University of Southampton, Dr Maggie Donovan-Hall; University of Southampton, Dr Barry Mason; Loughborough University.
Institution	University of Southampton