Constraints influencing sports wheelchair propulsion performance and injury risk

Abstract

The Paralympic Games are the pinnacle of sport for many athletes with a disability. A potential issue for many wheelchair athletes is how to train hard to maximise performance while also reducing the risk of injuries, particularly to the shoulder due to the accumulation of stress placed on this joint during activities of daily living, training and competition. The overall purpose of this narrative review was to use the constraints-led approach of dynamical systems theory to examine how various constraints acting upon the wheelchair-user interface may alter hand rim wheelchair performance during sporting activities, and to a lesser extent, their injury risk. As we found no studies involving Paralympic athletes that have directly utilised the dynamical systems approach to interpret their data, we have used this approach to select some potential constraints and discussed how they may alter wheelchair performance and/or injury risk. Organism constraints examined included player classifications, wheelchair setup, training and intrinsic injury risk factors. Task constraints examined the influence of velocity and types of locomotion (court sports vs racing) in wheelchair propulsion, while environmental constraints focused on forces that tend to oppose motion such as friction and surface inclination. Finally, the ecological validity of the research studies assessing wheelchair propulsion was critiqued prior to recommendations for practice and future research being given.

Using a Robust Design Approach to Optimize Chair Set-up in Wheelchair Sport

“…This requires individual assessments of wheelchair set-up, as set-up parameters have varying effects on players despite similar classification scores. Seat height, for example, can be lowered to provide greater access to the pushrim and wheel, increasing time for force application [9]. However, lowering the seat height potentially limits ball handling capabilities which is clearly undesirable in court sports.…”

Injury Prevention of Elite Wheelchair Racing Athletes Using Simulation Approaches

“…Kinematic stroke patterns have been associated with injury risk, such as those with greater range of motion during the propulsion phases [1], when hands are in contact with the push rim, and when the peak reaction forces and moments occur [4]. Additionally, overuse has commonly been reported to increase injury risk [3], along with low movement variability [1].…”

“…The high incidence of injury can be attributed to the nature of the shoulder girdle being ill-equipped for the kinematic requirements of wheelchair propulsion. For example, the shoulder girdle, which is responsible for the majority of kinetic requirements of wheelchair propulsion, is structured to maximise freedom of movement [1]. However, in order to obtain maximum speed, athletes must apply large forces over short durations to achieve a high net impulse.…”

“…Upper limb injuries are common amongst wheelchair athletes, particularly in the shoulder [1]. Research has identified that wheelchair racing, and road racing are amongst the greatest risk for sustaining a soft tissue injury [2].…”

“…Additionally, overuse has commonly been reported to increase injury risk [3], along with low movement variability [1].…”