Safe Pushing Techniques for Wheelchairs: A Guide to Manual Handling Mobility

One Alzheimers forum member described taking her mother Christmas shopping. Half an hour of pushing up and down steep slopes. Her arm was still in pain several weeks later. Shooting pains down her arm as she typed. She was not doing anything dramatically wrong. She was just pushing a heavy chair without any guidance on technique, on terrain that was genuinely hard work, for longer than her body could manage without consequence.

That story is not unusual. Pushing a wheelchair is physical work and it adds up. If you do it regularly without thinking about how you do it, your back, shoulders and wrists will eventually tell you about it.

How to stand and push

Feet shoulder width apart. Knees slightly bent. Back straight. Push from your legs, not your arms. Your leg muscles are much stronger than your arm muscles and using them properly takes the strain off your shoulders and lower back. Keep the chair close to your body rather than reaching forward to push it.

Do not grip the handles tightly. A firm but relaxed grip gives you control without creating tension in your forearms and wrists that builds up over a long outing.

Avoid twisting at the waist when you turn the chair. Pivot with your feet instead, pointing them in the direction you want to go and then turning the chair. Twisting under load is how back injuries happen.

Kerbs — the bit everyone gets wrong

Scope forum members are clear on this. Your wife will need to gently tilt the chair backwards even on dropped kerbs. You need to act as a spotter.

Going forward over a kerb or threshold without tilting the front wheels first is how the chair comes to a sudden stop and throws the user forward. The front casters catch the edge and the chair stops dead. To avoid this, use the tipping levers. These are the small horizontal pegs at the bottom rear of the chair frame. Step on them with your foot while gripping the push handles and the front of the chair lifts. Roll the front wheels over the kerb first, then lower them and push the rear wheels up.

One Scope forum member discovered that smaller casters made this worse. His new chair had smaller castors than the previous one and he was tipped out twice hitting potholes before he swapped them for larger ones and found it transformed the difference. If your chair is catching on every small crack and threshold, larger casters are worth looking at.

Going down a kerb, turn the chair around and go backwards. Rear wheels down first, then lower the front. Safer and more controlled than trying to go forward down a drop.

Slopes

Going uphill, lean into the push and drive from your legs. Short controlled pushes work better than trying to maintain continuous momentum. Take breaks if you need to. There is no shame in that.

Going downhill is where most people get caught out. Without attendant brakes on the push handles the only way to control a loaded chair going down a slope is to physically hold it back. One Alzheimers forum member described it as alarming, trying to hang on going downhill even gripping the brakes, because the brakes on the chair were parking brakes only, not speed control brakes.

If your chair does not have loop brakes on the push handles and you regularly navigate slopes, this is worth fixing. Loop brakes give you progressive speed control going downhill, like bicycle brakes. Without them, downhill becomes a physical struggle and eventually a safety issue.

Go backwards down steep slopes when you can. Much easier to control. The person in the chair will not love it, but it is safer and kinder to your back.

Uneven ground

One Scope forum member pointed out that uneven paving slabs are a particular problem. They are. The front casters catch on every raised edge and the chair jars to a stop. The technique is the same as for kerbs — keep the front wheels light, slightly tilted back, so they ride over small obstacles rather than catching on them. You do not need to lift the front high. Just take some weight off it.

Grass, gravel and rough paths take noticeably more effort. Short firm pushes rather than trying to maintain speed. If you do a lot of outdoor pushing over rough ground, pneumatic tyres on the rear wheels make a real difference compared to solid tyres.

Doorways

Approach square on. An angle almost always ends with a footrest catching the door frame. Slow down well before the doorway. Hold the door open with one hand, push through with the other. Or get a door wedge and carry it in the bag on the chair. Small thing. Saves a lot of fumbling.

Frequently asked questions

Why does my back hurt after pushing a wheelchair ? 

Usually posture, chair weight or terrain. Pushing with arms rather than legs, using a heavy chair, and navigating slopes without attendant brakes all contribute. Start with the lightest chair you can get.

How do you get a wheelchair over a kerb safely ? 

Use the tipping levers at the rear of the frame to lift the front wheels, roll them over the kerb first, then bring the rear wheels up. Go down kerbs backwards, rear wheels first.

What are attendant brakes and do I need them ? 

Loop style brakes on the push handles that give progressive speed control downhill, like bicycle brakes. If you push on any slopes at all, yes you need them.

How heavy a wheelchair can one person safely push ? 

That depends on the terrain and the carer. On flat smooth ground most people manage a heavier chair. On slopes and rough ground a lighter chair makes a very significant difference. If pushing is causing pain, the chair is too heavy for the situation.

Is pushing a wheelchair bad for your back long term ? 

It can be, particularly with poor technique, a heavy chair or difficult terrain. Good posture, using your legs, a lighter chair and attendant brakes on slopes all reduce the risk considerably. For musculoskeletal health guidance click here.