In this month’s cover story, I write about the various ways that the health insurance wheelchair reimbursement system in the U.S. is broken.

And while you may benefit from an ultralightweight, high-spec wheelchair like a Panthera X, Apex Carbon or TiLite TR, getting an insurance company to pay for one of these can be a tall order. It’s undoubtedly worth the battle, but even if your insurance will only cover an aluminum-frame wheelchair, there are options and setup tweaks that can help you make the most of it.

The Forgotten Measurement

Center of gravity, the measurement of where your axle sits in relation to the rear-most part of your seat — typically your backrest bars — is often underappreciated in seating clinics. But if you’ve only ever sat in a wheelchair with conservative, therapist-approved CG, you’d be amazed at what a difference changing it can make with your push efficiency and ride quality. I can’t tell you how many inches of CG is optimal, as it varies for everyone. But for reference, my injury is at C7 complete, and I sit with my axle 3.5 inches forward of my backrest bars, which allows me to pop my front end off the ground by just leaning back.

On most wheelchairs, including ones with limited adjustability elsewhere, you can typically slide your axle position forward or backward by loosening a couple of hex bolts. Be careful to get the position exactly the same on each side, though, as clamping your camber tube even slightly off from perpendicular can pull your frame out of true.

The drawback of moving your axle forward is that it makes you chair easier to tip over backwards. The advantages, however, are enormous. For one, sitting farther behind your wheels gives you more wheel to push, increasing efficiency and allowing you to get from here to there with fewer repetitions. Second, you’ll have more of your weight on the big, rear wheels, rather than the small, front casters, which decreases rolling resistance. An aluminum frame chair with an optimized CG is easier than to push than a 5-pound carbon fiber frame with your weight over your front casters. Third, sitting with more weight on your rear wheels can reduce vibrations and improve your ride quality by letting your front casters float over cracks, bumps and rough ground. You might feel totally unstable when you first move your axle forward, but once your body recalibrates its balance points, there’s a good chance you’ll never want to go back.

The Tao of Adjustability

A few months ago, I wrote an article about adjusting your seating position, including front and rear seat height and backrest angle to maximize stability and increase push efficiency [“Dialing in Your Seating Position Without Changing Your Chair,” November 2020]. I used to think that highly-adjustable wheelchairs were only for newbies. It is true that adjustability has its drawbacks — adjustable components typically add weight, and over the years they’re prone to seize up, rendering them mostly useless. But my most recent wheelchair ordering experience has changed my tune a little. I had multiple chairs’ worth of experience when I ordered and the help of two extremely knowledgeable ATPs, but we still got two important measurements just slightly off. It was only because of a manufacturing error that I got a chance at a redo, and the fixes turned a good chair into a great one.

Fine tuning your seating position can make such a big difference in your chair’s performance, regardless of frame materials, that unless you know exactly what you want, it’s worth considering ordering a chair with high adjustability. Motion Composites makes an aluminum version of its Apex frame, which has fantastic adjustability — including a cool mechanism to bring your caster angle back to neutral after you’ve changed your front or rear seat height — but still manages to keep its weight in line with other manufacturers’ models.

The important point about adjustability, though, is that you have to use it. Give yourself time to get used to a seating position, but don’t be afraid to make small tweak after small tweak, even when you think you’ve got things right. You can always go back if you don’t like what you’ve tried, and you’ll never find your perfect position if you don’t go looking for it.

Taking Out the Rattle

How you sit in your chair can mitigate some of the drawbacks of aluminum, but there’s no getting around the fact that — in addition to their weight savings — titanium and carbon fiber are much better at dampening vibrations. In fact, chromoly steel does a fantastic job at shock absorption, but RGK, a British company, is about the only chair manufacturer I can find making chairs out of the stuff.

There are still some options for reducing the rattle of an aluminum-framed chair, though. Ki Mobility’s Ethos wheelchair is covered by most insurance companies and has a unique vibration dampening mechanism. The design separates the part of the wheelchair frame that touches the ground from the part that touches your body and connects them with polymer (fancy rubber) inserts, which stop some of the vibration transfer. The result is a smoother ride without the cost of advanced frame materials or the weight of beefier shock absorbers.

Otherwise, the old standby of Frog Legs front caster forks can take some of the bite out of rough roads. Likewise, wider, lower pressure tires can make for a smoother ride, but they come with their own drawbacks, like increased rolling resistance and a changed rear seat height.

There’s no setup that’s perfect for everyone, but with a willingness to play around, I hope you can find something that works well for you — even if your insurance doesn’t.