Addressing Shoulder Pain in Wheelchair Users following SCI

For individuals with spinal cord injuries (SCI), maintaining mobility and independence often relies heavily on wheelchair use. However, the repetitive demands of propulsion and transfers can lead to significant shoulder pain—a common yet complex challenge in SCI rehabilitation.(1) Shoulder discomfort not only impacts physical well-being but can also hinder daily function and quality of life.

mTrigger surface electromyography (sEMG) biofeedback is a powerful tool that can help clinicians optimize rehabilitation strategies. By providing real-time insights into muscle activation patterns, mTrigger biofeedback enables targeted interventions to strengthen key muscles, improve biomechanics, and reduce strain on the shoulders.

In this blog, we’ll explore how sEMG biofeedback can be integrated into treatment plans to alleviate shoulder pain in wheelchair users with SCI. Discover practical techniques, the science behind this innovative approach, and how it empowers patients to achieve lasting relief and improved mobility.

Following a spinal cord injury (SCI), undergoing physical therapy for musculoskeletal pain shoulder pain is common amongst wheelchair users.(1) Fatigue and muscle imbalances are often the culprit of this nagging musculoskeletal pain.(1) For example, when the upper trap is overused for wheelchair pushing, without sufficient rest between pushing cycles, shoulder pain can result.(1) Studies have shown that using sEMG biofeedback while wheelchair training can help users focus on decreasing upper trap activation, increase activation of additional muscle groups, and improve the rest/recovery between each pushing cycle.(1)

General shoulder rehabilitation after SCI often focuses on the upper traps, lower traps, anterior deltoid, and infraspinatus with exercises such as shrugging/relaxing, shoulder abduction, and shoulder flexion where the patient is instructed on form and technique. In a study by Middaugh/Thomas et al. two exercise intervention groups where compared, one with just exercise, and one with exercise + biofeedback.(1) To no surprise, there was a huge benefit to adding sEMG biofeedback to exercise interventions for shoulder pain in wheelchair users.(1) In fact, exercise and biofeedback were twice as effective at reducing shoulder pain compared to exercise alone!(1)

Patients using biofeedback learned how to decrease upper trap activation and increase lower trap activation first through simple shoulder motions such as flexion, abduction, and shrugging/depressing.(1)After they were able to see their muscles doing this effectively and feel the correct motion, they worked on wheelchair pushing with biofeedback in the same manner – to decrease upper trap activation and relax quickly between each pushing cycle.(1) A similar pattern using the anterior deltoid and infraspinatus can be used to encourage a more balanced scapular pushing approach.(1)

In this exercise example, the patient is working on decreasing upper trap activation (Channel 1) and increasing lower trap activation (Channel 2) while performing a shoulder flexion exercise. This is a difficult task regardless of SCI or not!

In addition, mTrigger biofeedback can be used during different common shoulder exercises that are beneficial for improving muscle efficacy, form, and decreasing shoulder pain such as rows, scapular depression, and pushing motions.(2)

Here are a few video demonstrations.

Rowing

High Row with External Rotation

Shoulder External Rotation

Summary
Incorporating mTrigger biofeedback into the rehabilitation program of wheelchair users after a spinal cord injury can be an effective way to help improve shoulder pain. By teaching proper muscle activation techniques and movement patterns, you can help provide independence, longevity, and an improved quality of life for your patients.

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