A Scoping Review on Shoulder Injuries of Wheelchair Tennis Players: Potential Risk-Factors and Musculoskeletal Adaptations

Exploring the biomechanical link between wheelchair propulsion, shoulder injury and shoulder pain: A scoping review

A high prevalence of shoulder pain and injuries exists in manual wheelchair users (MWUs). Wheelchair propulsion is believed to be related to shoulder pain and injuries, but the exact cause-effect relation remains unclear. The research questions of this narrative review were: 1) What are the differences in propulsion biomechanics for MWUs with different levels of shoulder pain and injuries? 2) How much proof is there for a cause-effect relationship between wheelchair propulsion and the development of shoulder pain and injuries in MWUs? A systematic literature search identified 18 articles matching the selection criteria. MWUs with shoulder pain or injury exhibited different propulsion patterns than those without. A long push angle, low stroke frequency, low peak forces and sufficient variability possibly relate to lower levels of shoulder pain and injuries. However, it is not yet clear whether this propulsion technique decreases the risk of developing shoulder pain and injuries, or if it serves as a protective mechanism of MWUs who have already developed pain and injuries. More longitudinal studies, including real-life biomechanical measurements, with a focus on within-subject changes are needed to better understand the bidirectional and time-varying biomechanical relationship between shoulder pain and injuries and wheelchair propulsion.

Kinematic and muscle co-activation patterns in the dominant arm across forehand stroke phases in wheelchair tennis

Objective

This study investigated upper limb kinematics and muscle co-activation in wheelchair tennis players during the forehand stroke. By analyzing linear and angular kinematic variables alongside muscle co-activation patterns, the study aimed to provide insights into the biomechanical mechanisms supporting forehand stroke performance.

Method

Fifteen professional male wheelchair tennis players (height: 163.9 ± 2.05 cm; mass: 64.1 ± 3.07 kg; age: 32.2 ± 7.97 years) participated in this study. Electromyographic data from six muscles around the dominant arm joints were recorded using the Myon system. Four fixed GoPro Hero 8 cameras (120 Hz) captured 3D video, and kinematic analyses were performed using the APAS system. The forehand stroke was analyzed across three phases: (1) backswing, (2) forwardswing, and (3) follow-through.

Results

The results showed significant phase-specific changes in muscle co-activation for the shoulder (p < 0.001), elbow (p < 0.005), and wrist (p < 0.01). Muscle co-activation was highest during the backswing phase, decreased during the forwardswing, and increased again during the follow-through phase. This pattern reflects the need for joint stability and control, particularly when changing stroke direction and slowing the arm after impact.

Conclusion

These findings provide novel insights into the kinematic and neuromuscular mechanisms underlying the forehand stroke in wheelchair tennis. The data provide hypotheses about potential training and rehabilitation strategies that should be tested by prospective studies. The results also highlight the unique demands of wheelchair tennis, contributing to inclusive, evidence-based approaches to enhancing performance and safety in disability sports.

Eight-week exercise intervention improves shoulder pain and body posture of wheelchair athletes with spinal cord injury

BACKGROUND

Wheelchair athletes, as a group of elite athletes who participate in high-level sports activities, are constantly exposed to musculoskeletal injuries and disorders due to their frequent use of wheelchairs and overworked upper limbs. In this study, we investigated the effect of elastic band exercises on the extent of athletes' forward head angle, kyphosis, rounded shoulder, and pain scores.

METHODS

Twenty-six male and female wheelchair athletes with spinal cord injuries (age: 27.11±6.67), active in table tennis, basketball and pétanque, were selected and randomly divided into either a control or training group. The Wheelchair User's Shoulder Pain Index (WUSPI) questionnaire was used to investigate the level of shoulder pain. A sagittal view photogrammetry method was used to measure the forward head angle and round shoulder angle, and a flexible ruler was used to measure the thoracic kyphosis angle. For our statistical analysis, a covariance test (ANCOVA) and independent and dependent T tests were used.

RESULTS

After eight weeks of training, there was a significant decrease in the angle of the forward head tilt, kyphosis, round shoulder, and pain questionnaire scores in the training group (P<0.05).

CONCLUSIONS

Changes in the forward head angle, rounded shoulder and kyphosis angle, and pain scores show the desirable effect of resistance training with an elastic band. Therefore, this exercise program is recommended for wheelchair athletes with spinal cord injuries.

Overhead and Wheelchair Sport-Related Injuries in Para Athletes: Interplay Between Disability and Sport-Specific Factors

ABSTRACT

With the increasing opportunities for people with disabilities to engage in competitive Para sports, it becomes imperative to understand the injury consequences that may impact both sports participation and daily life activities. This narrative review aims to examine the intrinsic and extrinsic risk factors inherent in overhead and wheelchair summer Para sports, while also exploring prospective avenues for implementing prevention strategies. By understanding the injury epidemiology in this cohort of Para athletes, this review aims to explore the intricate interplay between the athletes' underlying disability with sport-specific factors, such as how wheelchair use might amplify injury susceptibility. Specifically, we highlight the impact of impairment, daily activity, and workload or discipline-induced overuse on injury occurrence, as well as how surveillance methods can be tailored to this population. In this regard, we propose practical injury surveillance methods that encompass a sensitive injury definition, severity assessment, incidence rate calculation, and the recording of adaptive equipment (e.g., type of wheelchair) and workload monitoring. It is worth noting that studies of prospective injury surveillance systems coupled with workload monitoring within a dedicated Para sport web-based platform are scarce. To establish a comprehensive understanding of Para athlete health, the monitoring framework should incorporate regular athlete follow-ups and facilitate knowledge transfer.

Changes in Electromyographic Activity of the Dominant Arm Muscles during Forehand Stroke Phases in Wheelchair Tennis

The aim of this study was to determine the muscle activations of the dominant arm during the forehand stroke of wheelchair tennis. Five players participated in the present study (age: 32.6 ± 9.9 years; body mass: 63.8 ± 3.12 kg; height: 164.4 ± 1.7 cm). The electrical muscle activity of six dominant arm muscles was recorded using an sEMG system. A significant effect of the muscle's activity was observed, and it was shown that the muscle activation was significantly higher in the execution phase compared to the preparation phase in the anterior deltoid and biceps brachii (34.98 ± 10.23% and 29.13 ± 8.27%, p < 0.001); the posterior deltoid, triceps brachii, flexor carpi radialis, and extensor carpi radialis were higher in the follow-through phase than in the execution phase (16.43 ± 11.72%, 16.96 ± 12.19%, 36.23 ± 21.47% and 19.13 ± 12.55%, p < 0.01). In conclusion, it was determined that the muscle activations of the dominant arm muscles demonstrate variances throughout the phases of the forehand stroke. Furthermore, the application of electromyographic analysis to the primary arm muscles has been beneficial in understanding the muscular activity of the shoulder, elbow, and wrist throughout the various phases of the forehand stroke in wheelchair tennis.

A newly developed hand rim for wheelchair tennis improves propulsion technique and efficiency in able-bodied novices

A new wheelchair tennis hand rim was developed, having a larger contact area and higher friction. How does this new hand rim compare to a regular hand rim regarding submaximal propulsion with a tennis racket during practice in novices? Twenty-four able-bodied novices (12 Regular Rim, 12 New Rim) completed a one-day experiment: pre-test, three practice-sessions and a post-test of 3 × 4 min each on a wheelchair ergometer (1.11 m/s, 7W). The New Rim group compared to the Regular Rim group, had a lower negative work per cycle (-0.83J vs. -2.06J, p = 0.01) at the post-test. There was a significantly larger increase in mechanical efficiency between the pre- and post-test in the New Rim group (2.3-3.4% vs. 2.1-2.5%, p = 0.02) compared to the Regular Rim group. The new rim led to a more ergonomic propulsion technique, with a reduction in negative power and higher mechanical efficiency between the pre- and post-test at submaximal propulsion.