How to Prevent Back Pain When Propelling a Manual Wheelchair

  1. Choose the right manual wheelchair with appropriate adjustments. We recommend selecting a wheelchair with adjustable rear wheel axles. Generally speaking, the position of a rear-wheel axle should be adjustable back, forth, up, and down. 
  2. Know how to operate a manual wheelchair correctly. 

Why are self-propel wheelchair users more likely to get back pain?

People who have used manual wheelchairs long term are no stranger to experiencing pain in the form of a Repetitive Strain Injury (RSI), with 59% of users obtaining this secondary injury. 49 – 73% of self-propelled wheelchair users have Carpal Tunnel Syndrome, and 30 – 50% of wheelchair users with paralyzed lower limbs have shoulder pain. Users with low-level spinal cord injuries are more susceptible to these secondary injuries as they spend most of their time in a wheelchair. An active self-propelled wheelchair user can do as much as 3,000 wheel pushes a day! The Repetitive Strain Injuries that can be sustained from this repetitive motion not only reduce daily life function and quality of life but also dramatically increases the demand for care. 

How to adjust the manual wheelchair wheels to avoid back pain?

Adjusting the position of the wheelchair axle affects not only the stability and agility of the wheelchair but also the effectiveness of the user’s self propel. An excellent manual wheelchair propel should be as long as possible, and the frequency should be as low as possible. By reducing the repetition of pushes, the user minimizes the chance of experiencing back pain.


1. Optimize the horizontal position of the rear wheel axle

These images demonstrate what happens to the wheel propel, depending on the horizontal placement of the rear wheel axle, which can be adjusted forward, and backward. 

For users who have just started using a manual wheelchair or are in recovery, we recommend that the rear wheel position be positioned further back. However, for users who are familiar with using a wheelchair, the more unstable rear axle position makes lifting the front wheels easier to move over obstacles.

2. Improve the vertical position of the rear wheel axle

Another point to consider when adjusting the position of the rear wheel axle is the access the user has to the hand rims, which depends on the vertical placement of the rear wheel axle. The axel can be adjusted up, and down. 

 If the user is going to propel themselves, then they need to be able to reach the hand rims comfortably. If the seat is positioned too high, they won’t be able to reach their full propel potential. If the wheelchair seat is positioned too low, the user risks injuring their shoulders to try and reach the hand rims. Therefore, finding the ideal seat height for a manual wheelchair can be the key to increase propelling efficiency. 


Not every wheelchair can be adjusted. You might need to find the best adjustable manual wheelchair first. With the correct rear wheel axle position and proper propelling methods after training, the best wheel propelling can be achieved, and the probability of Repetitive Strain Injuries reduced.

If you are a dealer or distributor, then you can access videos on the Karma Academy to find out how to adjust Karma manual wheelchairs in more detail. If you are interested in becoming a dealer or distributor, you can contact our sales team: [email protected]

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