5 Common Wheelchair Mistakes That Cause Pain (And How to Fix Them)

Getting your first wheelchair is often a trial by fire. You are frequently handed a piece of complex equipment with little more than a "good luck" from the hospital discharge team. It is overwhelming, and frankly, it is physically exhausting.

But here is the reality: most of the fatigue, shoulder pain, and discomfort new users experience isn't inevitable. It is usually the result of poor setup or technique.

In this guide, we will break down the five most common technical and postural mistakes wheelchair users make. By correcting these, you can protect your shoulders, save your energy, and prevent long-term injury.

2. Ignoring Tyre Pressure

If you use a manual wheelchair with pneumatic (air-filled) tyres, this is critical. Pushing a chair with soft tyres is like trying to ride a bicycle through sand. It dramatically increases the rolling resistance, which forces your shoulders to work twice as hard for half the distance.

The Strategy:

• The Thumb Test: Press your thumb firmly into the tyre. If you can depress it more than a few millimetres, it needs air.

• Weekly Ritual: Check your pressure once a week. Keep a small pump in your bag. Hard tyres roll faster and pivot easier.

3. Improper Footplate Height

Your footplates are not just a place to rest your feet; they determine your weight distribution.

The Mistake: If the footplates are too low, your thighs press hard against the front edge of the seat, cutting off circulation and potentially causing nerve damage. If they are too high, your knees rise above your hips. This forces all your weight onto your "sit bones" (ischial tuberosities), massively increasing the risk of pressure sores.

The Fix: Your thighs should be parallel to the ground, with weight distributed evenly across the full length of the thigh. You should be able to slide a flat hand under your thigh near the front edge of the seat with only slight resistance.

4. Incorrect Centre of Gravity

This is a slightly more advanced technical point, but it is vital for active users. The centre of gravity is determined by the position of the rear axle relative to your body.

• The Safe (but Sluggish) Zone: If the rear wheels are too far back, the chair is very stable (it won't tip over), but it becomes incredibly heavy to push and difficult to turn (do a wheelie).

• The Sweet Spot: Moving the axle forward places the wheel more directly under your centre of mass. This makes the chair feel lighter and easier to manoeuvre.

Warning: Moving the axle forward makes the chair "tippy." Always use anti-tip bars when adjusting your centre of gravity until you are confident in your balance skills.

5. Ignoring Skin Integrity

This is a YMYL (Your Money or Your Life) topic. Pressure ulcers (bedsores) are not just an annoyance; they are a serious medical emergency that can lead to hospitalisation.

The Mistake: Believing that a standard foam cushion is "good enough" for all-day use, or forgetting to perform pressure relief (shifting your weight) regularly.

The Protocol:

• The Equipment: Ensure you are using a pressure-relieving cushion suited to your risk level (e.g., air cell, gel, or high-density foam).

• The Action: Every 20 to 30 minutes, you must shift your weight. Lean forward, lean to the side, or push up (if you have the arm strength) to let the blood return to the skin on your buttocks.

Summary Checklist: Your Daily 30-Second Audit

To ensure you are riding safely, perform this quick "How-To" audit before you leave the house:

• [ ] Tyres: Are they hard?

• [ ] Brakes: Do they lock firmly without slipping?

• [ ] Cushion: Is it positioned correctly (velcro aligned)?

• [ ] Posture: Is your pelvis touching the backrest?