700 Children's Blog

Shoulder Pain and Injury in the Adaptive Athlete

Jul 11, 2018
image of wheelchair athlete on a track

As adaptive sports competition for individuals with physical disabilities grows on a local, statewide, national and international level to the Paralympic stage, so does the inevitable risk of injury. In fact, when comparing elite athletes at the Olympic and Paralympic Games of London and Rio, the overall injury rates are similar in both populations.

Injuries to Upper Extremities

Based on the mechanics of adaptive sports, there is a much higher risk of upper extremity and shoulder injury in athletes with physical disabilities. The best strategy for combating these injuries is appropriate injury prevention strategies and training.

Adaptive sports such as sled (or sledge) hockey, rowing, wheelchair track, rugby and basketball involve force and movement generated by the arms and shoulders. Adaptive sports such as seated shotput, fencing and bocce require a stable base and greater reliance on upper body and core strength and control for performance when compared to able bodied throwers, who use their hips and lower bodies to generate force and stability.

Just as able bodied runners are at risk of overuse injuries to the hips, knees and ankles, similar forces are transferred to the upper body in the athlete competing at the wheelchair level. Some of the most common upper extremity overuse injuries in this population are seen in the rotator cuff, biceps and tricep tendons. Some of the most common causes of these injuries are poor fit or position in the adaptive equipment (wheelchair, sled, oar), improper form and overtraining.

Choosing the Right Equipment

An elite runner must be fit for a proper running shoe and an athlete competing in a wheelchair needs the proper fit of a sports chair. Unlike wheelchairs for daily use, sport chairs are built to maximize function and performance rather than all day comfort. Sports chairs have a wider base of support due to the angle of the wheels, yet a narrower seat than an everyday chair.

The two most important features in fitting a sport chair is the width between the wheels and the forward/backward alignment of the wheels beneath the seat. Participating in a chair that is too wide or narrow or with the wheels too far forward or back forces an unnatural and awkward position of the shoulders, significantly increasing the risk of shoulder injury and over use.

Form and Technique

Another way to reduce the risk of injury is to insure proper form and technique when participating in adaptive sports. Even with the proper fit of the chair, reaching too far backward or altering a movement can also lead to overuse injuries. Specialized coaching, practice and repetition is important when learning a new sport to reduce injury risk but also maximize performance.

Muscular development and training also plays a key role. Most people, able-bodied or not, are at risk of tightness of the front of the shoulder and corresponding weakness of the upper back. This leads to a rounded posture which increases the risk of pain and injury to the shoulder. Often the first step in preventing or treating an overuse shoulder injury is strengthening of the muscles of the upper back that control shoulder position and function.

The Risk of Overtraining

Overtraining is often to blame for injuries in athletes of all levels and abilities, beginner to elite. It is extremely important for athletes of all physical abilities to condition their bodies into a new sport or season gradually.

Just as a marathon runner should not run 20 miles their first day of training, when preparing for a new sport or season adaptive athletes shouldn’t spend hours in their sports chairs either. A safe and simple program in runners is “The 10 percent rule,” where weekly training should not be increased greater than 10 percent of the previous week (i.e. a runner who ran a total of 10 miles last week should not run more than 11 miles the following week). Though not studied or proven in athletes who compete in wheelchairs, it is a good place to start, as we continue to study this population more closely.

The Importance of Nutrition

Another component of training and injury prevention is proper nutrition. The metabolism of many athletes with physical disabilities is very unique. When starting a new sport or increasing training volume it is important for athletes to balance energy (calorie) needs and make the appropriate adjustments to nutrition plans. Consultation with a sports dietitian can help athletes adjust to these changes and develop individualized plans.

A comprehensive approach is necessary in preventing and treating injuries in this specialized population. The Adaptive Sports Medicine Program at Nationwide Children's Hospital provides access to these resources in evaluation, rehabilitation, training and nutrition while working with community organizations to provide these athletes access to participation and coaching in various adaptive sports to meet their interests and maximize performance. 

Featured Expert

Nationwide Children's Hospital Medical Professional
Jonathan Napolitano, MD
Sports Medicine

Jonathan Napolitano, MD, brings diverse training and experience to our physician team with dual appointments in both Sports Medicine and Orthopedics. Board certified in Physical Medicine and Rehabilitation with subspecialty certification in Sports Medicine, Dr. Napolitano is uniquely prepared to care for athletes of all ages, experience levels, and physical abilities. He serves as a clinical assistant professor in the Department of Physical Medicine and Rehabilitation at The Ohio State University College of Medicine.

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