A spinal cord injured individual is forced to rely on their upper extremities for their weight bearing activities such as transfers, mobility needs and activities of daily living (ADLs) using limbs that were designed to place hands in space (Consortium for Spinal Cord Medicine 2005; Dalyan et al. 1999; Dyson-Hudson & Kirshblum 2004). Repeated use of the upper limb for weight bearing activities such as manual wheelchair propulsion, transfers, raised ischial pressure reliefs (weight shifts) and reaching from a seated position in the wheelchair in environments designed for nondisabled individuals places a great deal of stress on the bones, joints and soft tissues of the shoulder complex. This places the structures of the upper limb at significant risk for overuse and subsequent injury (Dyson-Hudson & Kirshblum 2004). Pain in the early post injury period is typically due to increased demands on anatomically weakened muscles or muscle weakness induced because of deconditioning.
Upper limb pain is known to interfere with a wide range of functional activities, transfers, ambulation, pressure relief and self-care (Curtis et al. 1995a, Dalyan et al. 1999); many individuals report alteration/cessation of activities critical to functional independence (Pentland & Twomey 1994; Sie et al. 1992). Shoulder pain may be functionally and economically equivalent to a higher level of lesion (Salisbury et al. 2003). Dalyan et al. (1999) reported that of individuals with upper limb pain, 26% needed additional help with functional activities and 28% reported limitations of independence. Subbarao et al. (1994) and Gerhart et al. (1993) reported that individuals with SCI reported that their dependence in personal care assistants fluctuated with upper limb pain and was a major reason for functional decline. The Consortium for Spinal Cord Medicine (2005) has written clinical practice guidelines “Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health Care Professionals,” as a way to address upper limb problems.