Wheelchair and Dry needling

Working in a rehabilitation Centre , I realized that I can’t treat a neurologic patient (i.e. spinal cord injury), without mastering my knowledge in orthopedics injuries and treatments.
As a result of repetitive loading from wheelchair propulsion and other daily living activities, including transferring and weight relief, manual wheelchairs put a lot of stress on upper limbs, particularly the shoulders.
These activities are often painful due to the limited muscle mass and low stability of the shoulder girdle.
There are several pathologies that are associated with shoulder pain, including shoulder/ subacromial impingement syndrome, rotator cuff tears, tendinopathies, bursitis, joint oedema, and glenohumeral instability.
Such pathologies can adversely affect the independence and quality of life of wheelchair users, as they may prevent them from being physically active.
71% of manual wheelchair users have experienced shoulder pain at some point in their lives.
It depends on the length of time that the wheelchair is used but also depends on the wheelchair user’s age.
I wasn’t surprised to find out that there were only a few studies that investigated shoulder pain in wheelchair users. In fact, in 2020, Mason et al wrote a scoping review about Managing shoulder pain in manual wheelchair users and revealed that only 21 studies have investigated it.
As physiotherapists we encounter a lot of patients who complain of nocturnal pain in the anteromedial shoulder aspect, shoulder stiffness, pain radiating to the elbow and lateral arm, and decreased shoulder movement beyond 60 degrees.
What is the best evidence-based way to treat the wheelchairs users?
I believe that Spinal cord injury patients who complain of shoulder pain should be treated as any other shoulder, keeping in mind that we need to add treatments that could help reduce the daily stress of using a wheelchair and of course to change the treatments’ goal according to their functional needs.
In 2022, Blanco-Díaz et al published an overview of the effectiveness of dry needling for the treatment of subacromial syndrome.
In this review a multimodal treatment plan was outlined, including stretching, manual therapy, mobilization techniques, application of cold packs, home exercises, ischemic compression of MTP in the shoulder muscles, ergonomic recommendations, and dry needling.
It has been demonstrated that combining dry needling with conventional physiotherapy leads to the best results in treating sub acromial impingement -related pain and disability.
Furthermore, dry needling together with conventional physiotherapy achieves the best results in treating pain-related shoulder injuries, as it also produces more stable, longer-lasting results than using these techniques separately.
Finally, I believe an Exercise-based intervention plan combined with dry needling of the rotator cuff muscles will be beneficial.