Biomechanics of Adaptive Rowing in Active and Inactive Manual Wheelchair Users

This research is being performed to characterize the rowing stroke in active and inactive individuals who use a manual wheelchair. The investigators will be looking at muscle activity of four shoulder muscles (upper trapezius, lower trapezius, serratus anterior, and posterior deltoid) and motion of the arms, shoulder blade, and trunk during rowing. This will be done for three rowing conditions (1: adapted rowing ergometer, 2: rowing ergometer from a chair, 3: standard seated row exercise using an elastic band \[TheraBand\]). The investigators are also looking at shoulder strength, range of motion, quality of life, and community participation.

Individuals who use a manual wheelchair (MWC) are at a high risk of developing long-term shoulder pain and impairment caused by increased demand and load on the shoulder during normal daily activities. Two main contributors to shoulder pain are overuse and shoulder muscle imbalance. Rehabilitation programs targeting shoulder pain suggest stretching anterior shoulder muscles and strengthening posterior shoulder muscles to promote balance and stability across the shoulder. Rowing-type exercises have been shown to be beneficial in accomplishing this. In addition to reducing shoulder pain, it is crucial to identify methods and modes of exercise which are more widely accessible. Participation in physical activity provides physical, psychological, and social benefits. However, several barriers to physical activity have been reported in this population. Less than half of individuals with physical disabilities meet the American College of Sports Medicine's physical activity guidelines.

The primary aim of this study is to determine the biomechanics of the rowing stroke in active and inactive individuals who use a MWC for mobility. Muscle activity (electromyography) of four shoulder muscles (upper trapezius, lower trapezius, serratus anterior, and posterior deltoid) and 3D motion analysis of the arms, shoulder blade, and trunk will be analyzed across three rowing conditions (adapted rowing ergometer, rowing ergometer from chair, standard row exercise). The investigators hypothesize rowing on the adapted rowing ergometer will lead to greater muscle activity than the standard rowing exercise and there will be no difference in arm, shoulder blade, and trunk movement between rowing conditions. The secondary aim of this study is to assess shoulder range of motion, pectoralis minor muscle extensibility, quality of life, and community participation. The investigators hypothesize active individuals will have a greater range of motion and pectoralis minor muscle extensibility and report lower quality of life and community participation than inactive individuals. This study seeks to lay the groundwork of evidence to suggest participation in rowing as a viable option to reduce the frequency and intensity of shoulder pain and provide a more accessible form of physical activity. Additionally, the investigators hope to contribute further insight into clinical measures (shoulder strength, range of motion, pectoralis minor muscle extensibility), subjective quality of life, and community participation in this population.

Eligibility Criteria:
Inclusion Criteria:

* between 18 and 70 years of age
* use a manual wheelchair for at least 50% of community mobility
* able to transfer independently (with or without the use of adaptive equipment)
* able to achieve humeral elevation of greater than or equal to 90 degrees (bilaterally)
* cleared for exercise participation as indicated by the ACSM Preparticipation Health Screening (Riebe et al., 2015)
* able to read and understand English

Exclusion Criteria:

* have an active pressure sore or skin breakdown
* have a presence of shoulder pain as indicated by a score of greater than 12 on the Wheelchair Users Shoulder Pain Index (Mulroy et al., 2015)
* have impaired upper extremity function as indicated by a score of greater than 40 on the QuickDASH (Angst et al., 2011; Kennedy et al., 2011)