Although my shoulders are achy and damaged, they still have full range of motion and function. Considering my 39 years of travel, sports and adventure, they’ve stayed healthy a lot longer than in many of my peers’ cases. I owe a lot of this resilience to day-to-day tips I’ve picked up from clinicians and peers. If I’d learned some of these tips earlier, and if certain assistive devices had been available, my shoulders might be 100% healthy. Here’s what I’ve learned that has helped, and what I wish I’d known or had on hand earlier.

To make shoulders last for the long run, physiotherapist and certified athletic trainer Erica Platil says it is important to do daily exercises that keep the shoulder muscles in balance. Wheelchair pushing builds substantial muscle up front, which over time can pull the shoulders forward, so it’s important to build up muscles in the back and between the shoulder blades to keep the head of the shoulder centered in the shoulder socket.

I learned this early on from a peer who would wheel backward up ramps and long inclines. I adopted this habit and could feel the burn in my upper back and the backs of my shoulders, and I’m confident this helped keep my shoulders balanced and healthy. Another way I found to work the back muscles is, when operating a handcycle or arm ergometer, to exert on the back part of the “peddle stroke” — pulling back — and to relax my arms on the forward-push part of the stroke. These days my damaged shoulders feel considerably better after going for gentle 30-minute handcycle rides using this technique. A lot of shoulder-balance exercises can be done at home with inexpensive Therabands (see “Preservation of Upper Limb Function: What You Should Know”).

“Listen to your body,” says Platil. If your shoulders are sore, rest them! This is much easier these days with lightweight power-assist units like the SmartDrive and SMOOV. For me, the SmartDrive has been a lifesaver and is something I’ve used more and more since I first tried one in 2013. Without it my shoulders would have failed long ago. I wish the SmartDrive were around decades earlier to let me rest my shoulders at the first sign of aggravation. If your shoulder is aggravated, perhaps use a sliding board and shower bench for a while so you can fully rest your shoulders until inflamed tendons settle down — more advice I wish I’d heard long ago.

“Resting is also important, even if the soreness is just muscle soreness,” she says. “If you had a hard workout and are sore, using assistive devices to rest your shoulders enables the muscle microtears from the workout to heal, which in the long run will build up more muscle and should make a stronger shoulder.”

Evidence shows that a combination of the following can help with shoulders and overall health:

• Get enough sleep: Your body heals when you are sleeping.
• Mind your diet: Avoiding sugar and simple carbs that turn to sugar helps reduce inflammation, because sugars feed inflammation.
• Listen to your body: Don’t do things that hurt your shoulders.
• Adjust your sleep position: Not lying on a sore shoulder benefits the shoulders and overall health.
  

Anecdotally, I find that keeping my weight down has helped my shoulders. Even when they were pain-free and strong, I found transfers to be much easier when I was leaner. As I age, keeping off weight is more challenging but also very important.

Pay attention to basic biomechanics. Avoid lifting with outstretched arms since it puts a tremendous strain on shoulders — something I didn’t pay much attention to until I learned about a famous wheelchair racer who tore his rotator cuff simply hefting a garbage bag with an outstretched arm. Since then, I focus on keeping my upper arms close to my sides when lifting, so that I’m using my biceps and not my shoulders.

Other shoulder preservation ideas fit the category of “pushing smarter, not harder,” like making sure wheels are in proper alignment and, since it requires more effort to propel your chair when tires are low, keeping them at the maximum pressure listed on the sides of the tires. For this I keep a tire gauge and portable electric high-pressure pump handy — available online for $40-$80 — and check tire pressure once a week. I also keep an eye on rear-wheel alignment to be sure they are not toed-in or toed-out. If you seem to be wearing tires out a lot quicker than normal, or if brand new tires squeak loudly when rolling in a straight line, it’s likely your wheels are out of alignment.

Finally, though it may seem cool to drive a big 4×4 or higher-than-normal vehicle, the extra strain on shoulders adds up over time. My shoulders prefer a car where the chair-to-car-seat transfer is about the same height. And since pulling puts less strain on shoulders than pushing, I grab the overhead handle inside the door to pull myself up and into the seat rather than push up off the wheelchair. When you pull your chair into the car, it is easier to lean the seat back, rest your shoulder against the inside of the car frame and lift the chair with a bicep curl rather than with your whole arm.