Jump to content

An Overview of Neck Pain in Wheelchair Users

Original Editor - Mark Sia as part of the Nottingham University Spinal Rehabilitation Project
Top Contributors - Mark Sia, Lucinda hampton and Kim Jackson

Introduction

Prevalence of spinal pain among wheelchair users is high and is associated with a lower quality of life.[1] Mechanical neck pain in wheelchair users usually occurs as a result of poor posture and may be of mechanical or myofascial origin.[2]

Epidemiology

Epidemiolgy is hard to be exact with as usage varies from daily use to competitive use. There are also those who are ambulatory wheelchair users - users who can at times mobilise without the need for a chair but use a chair for more effective, appropriate or pain-free ways of getting around. Prevalence of Neck Pain in Wheelchair Users

  1. The pooled prevalence was 30% (95% CI 14–54%) in a 2021 study.[1]
  2. A qualitative study interviewed 64 electric powered wheelchair users about their experiences of pain since becoming a wheelchair users: 86% of participants experienced pain related to sitting in past or present wheelchairs: 59% felt their pain was influenced by their wheelchair : 17% reported experiencing severe pain[3] 
  3. A cross-sectional cohort study to evaluate neck pain of wheelchair users found: 66% (n=45) reported neck/upper back pain at any time since they started using a wheelchair[4]
  4. A cross-sectional study conducted at 4 major Spanish hospitals offering education and training related to using a wheelchair permanently, either due to spinal cord injury or other reasons found: 56% = prevalence of neck pain.[5]

Aetiology and Risk Factors

Potential causes of neck pain in wheelchair users include:

  1. Wheelchair Egonomics: Wheelchair ergonomics relates to a wide variety of issues that ultimately may impact on the positioning of patients in a wheelchair. This may include seat heights, widths and depths, thoracic supports, lumbar supports, cervical supports, arm supports, cushions, angle of footrests or any other adaptations that may influence positioning and subsequently the neck posture and position in patients. Examples include: lower seat height may cause greater cervical extension which is associated with repetitive overuse type injuries to the C-spine in wheelchair users[6]; a neurodegenerative condition may cause a impaired sitting balance due to a loss of muscle strength, endurance and co-ordination. Consequently the person may require a variety of wheelchair supports in order to keep them in a comfortable position.
  2. Different terrains: examples include- Uneven surfaces increase the physical demands on those self-propelling; the vibrations and 'jolting' that occurs with going over uneven surfaces; going up kerbs; bumpy pavements[3]. The idea that challenging terrains may be problematic for wheelchair users is supported by NICE Guidance [7]on the issue that suggests 'Local councils should improve the quality of footpaths so more people can be active'.
  3. Age - an increased age is associated with increased prevalence of neck pain in this population
  4. Duration of being a wheelchair user - the longer the patient has been a wheelchair user the more likely they are to develop neck pain
  5. Potential impact of underlying medical conditions eg Osteoarthritis, trauma (i.e. RTA that led to spinal cord damage).
  6. Decreased Activity Levels - the majority of wheelchair users do not meet physical activity recommendations and is associated with secondary medical complications
  7. Decreased societal engagement - impact on psychological health and well-being and association in the pain perspective. Those with a decreased quality of life have an increased risk of developing neck pain in wheelchair users
  8. Living alone - the increased dependency as a result of living alone and having to be functional completely independent increases the physical demands on the individual thus increasing the risk of developing pain.

[8][9][10][11]

Outcome Measures

Include:

Management

Management of mechanical neck pain in the general population overlaps with the management for this specific population. Overall management can be divided into four main areas:

  1. Medications
  2. Education is a vital role in the management of patients with neck pain[13] and should involve reinforcing positive messages about remaining active, providing information about the injury and recovery, addressing negative beliefs and ideas and potentially discussing pain education [14]. Further information around the issue of education for general neck pain can be found here. Evidence Based Interventions for Neck Pain
  3. Exercise: Individualised approach will be required and includes: Focusing specifically on wheelchair users, work on sitting balance and trunk strength and endurance.; Generic neck strengthening, endurance and flexibility exercises will be beneficial; There is research into more general activities such as Tai Chi and Pilates group sessions for wheelchair users that shows beneficial results in terms of function and pain but also in improving quality of life, an important consideration in this population.
  4. Exercise Examples Specific To Wheelchair users'
  5. Balance and Functional Seated Exercise
  6. Group General Activity: eg Pilates, working on core stability and endurance exercises to improve sitting balance.; Tai Chi, can improve sitting balance helping wheelchair users to maintain a posture that is comfortable to them. Furthermore, tai chi can improve quality of life for wheelchair users and provides a holistic approach to care[15]
  7. Manual Therapy: Current evidence shows that manual therapy presents its value for the short-term management of mechanical neck pain only. Long-term manual therapy management does not have strong evidence-based effectiveness. Future research is likely to have a significant impact on the effectiveness of these treatments.  

Conclusion

Overall, 'mechanical' type neck pain is very common in patients who have become wheelchair users. Whilst there is overlap with general mechanical neck pain there are some important key differences in its cases. Wheelchair ergonomics plays a large role in posture and positioning of patients in wheelchairs and therefore comprehensive assessments are required for appropriate wheelchair fittings. There is limited research into the management of neck pain in wheelchair users, however, it can be treated using a standard multi-factorial treatment plan incorporating education, exercise, medication and for short term benefits only, manual therapies. However, what has been apparent throughout the research and design process of this page is the need for far greater research into wheelchair users as a population in general.

References

  1. ↑ 1.0 1.1 Kovacs FM, Seco J, Royuela A, Barriga A, Zamora J. Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study. Spinal cord. 2018 Apr;56(4):392-405.Available: https://pubmed.ncbi.nlm.nih.gov/29284794/ (accessed 13.11.2024)
  2. ↑ Liampas A, Neophytou P, Sokratous M, Varrassi G, Ioannou C, Hadjigeorgiou GM, Zis P. Musculoskeletal pain due to wheelchair use: a systematic review and meta-analysis. Pain and therapy. 2021 Dec;10(2):973-84.Available:https://pubmed.ncbi.nlm.nih.gov/29284794/ (accessed 13.11.204)
  3. ↑ 3.0 3.1 Frank, A. De Souza, L. Frank, J. Neophytou, C. (2012). The pain experiences of powered wheelchair users. Disability and Rehabilitation . 34 (9), 770-778.​
  4. ↑ Boninger, M.L., Cooper, R.A., Fitzgerald, S.G., Lin, J., Cooper, R., Dicianno, B. and Liu, B., 2003. Investigating neck pain in wheelchair users. American journal of physical medicine & rehabilitation, 82(3), pp.197-202​
  5. ↑ Kovacs, F.M., Seco, J., Royuela, A., Barriga, A. and Zamora, J., 2018. Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study. Spinal cord, 56(4), p.392.
  6. ↑ Sabari, J. Shea, M. Chen, L. Laurenceau, A. Leung, E. (2016). Impact of wheelchair seat height on neck and shoulder range of motion during functional task performance. Assistive Technology. 20 (3), 183-189.​
  7. ↑ NICE. (2018). Local councils should improve the quality of footpaths so more people can be active. Available: https://www.nice.org.uk/news/article/local-councils-should-improve-the-quality-of-footpaths-so-more-people-can-be-active-says-nice. Last accessed 23rd May 2018.​
  8. ↑ Requejo PS, Furumaso J, Mulroy SJ, 2016, Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users, Geriatric Rehabilitation, 31, 26-41​
  9. ↑ Finley MA, Euiler E, 2019, Association of musculoskeletal pain, fear-avoidance factors, and quality of life in active manual wheelchair users with SCI: A pilot study, Journal of Spinal Cord Medicine, 42, 225-229
  10. ↑ Hastings, J., Robins, H., Griffiths, Y., & Hamilton, C. (2011). The differ- ences in self-esteem, function, and participation between adults with low cervical motor tetraplegia who use power or manual wheelchairs.Archives of Physical Medicine and Rehabilitation, 92(11), 1785–1788.
  11. ↑ Farley, R. Clark, J. Davidson, C. Evans, G. MacLennan, K. Michael, S. Morrow, M. Thorpe, S.. (2003). What is the evidence for the effectiveness of postural management?. International Journal of Therapeutics and Rehabilitation. 10 (10), 449-455.​
  12. ↑ Crane BA, Holm MB, Hobson D, Cooper RA, Reed MP, Stadelmier S, 2005, Test-Retest Reliability, Internal Item consistency, and concurrent validity of the wheelchair seating discomfort assessment tool, Journal of Assistive Technology, 17, 98-107​
  13. ↑ Bedell SE, Graboys TB, Bedell E, Lown B. Words that harm, words that heal. Arch Intern Med 2004; 164:1365–8
  14. ↑ Rebbeck T. The Role of Exercise and Patient Education in the Noninvasive Management of Whiplash: A Clinical Commentary. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jun 16(0):1-32
  15. ↑ Qi, Y. Zhang, X. Zhoa, Y. Xie, H. Shen, Y. Niu, W. Wang, Y. (2018). The effect of wheelchair Tai Chi on balance control and quality of life among survivors of spinal cord injuries: A randomized controlled trial. Complementary Therapies in Clinical Practice. 33 (1), 7-11.​
Retrieved from "https://www.physio-pedia.com/w/index.php?title=An_Overview_of_Neck_Pain_in_Wheelchair_Users&oldid=363028"