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Wheelchair Users (Staying Healthy & Preventing Problems)

Using a wheelchair every day brings predictable health risks: pressure injuries, sore shoulders and wrists, falls during transfers, bladder and bowel problems, blood clots and low mood. Most can be prevented or caught early with daily habits, a good seating evaluation and the right equipment. Know the emergency signs first.

Call 911 for these signs.

  • Autonomic dysreflexia (spinal cord injury at or above the T6 level, mid-chest): a pounding headache with sudden high blood pressure, sweating or flushing above the injury, goose bumps, a stuffy nose, blurred vision or a slow pulse. It can lead to stroke, organ damage, seizures and death. Sit upright, loosen anything tight, check the bladder (a kinked catheter or full bladder), the bowel and the skin, and check blood pressure about every five minutes. Call 911 if you cannot find and fix the cause (MSKTC).
  • A possible clot in the lung: trouble breathing, chest pain that is worse with a deep breath, fainting, or a fast or irregular heartbeat, especially with a swollen, painful leg. The CDC says to seek medical help immediately (CDC).
  • Thoughts of suicide: call or text 988, or call 911 if you are in immediate danger (MSKTC).

Get urgent medical care, the same day, for:

Who this guide is for

People use wheelchairs for many reasons: spinal cord injury, cerebral palsy, spina bifida, multiple sclerosis, stroke, amputation, arthritis, or the changes of aging. MedlinePlus notes that assistive devices, including wheelchairs, can be used for a short time or for life (MedlinePlus). This guide is for manual and power wheelchair users and the people who help them. Much of the best research and the clearest self-care advice comes from spinal cord injury (SCI) programs, so many of our sources speak to SCI. Where advice depends on lost feeling or on the level of injury, we say so; ask your own care team how it applies to you.

It complements our guides on Spinal Cord Injury, Bed Sores, Shoulder, Cerebral Palsy and Spina Bifida. Our Paraplegia and Spastic Quadriplegia guides are planned.

The big picture

A wheelchair gives freedom, but sitting for long hours, pushing or transferring with the arms and having less feeling or movement below the waist create a set of risks that are mostly preventable. The most important daily habits are:

  • Shift your weight every 15 to 30 minutes and check your skin at least twice a day (MSKTC).
  • Protect your arms: long, smooth pushing strokes, level transfers and the lightest well-fitted chair you can get (PVA guideline).
  • Get a seating evaluation at least every two years, or sooner if your health or skin changes (MSKTC).
  • Stay active. Any activity is better than none (CDC).
  • Know your emergencies and keep a plan, a blood pressure monitor if you are at risk of autonomic dysreflexia, and your care team’s numbers handy.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A rehabilitation physician (physiatrist), physical and occupational therapists, a wheelchair seating clinic with a qualified supplier, nurses or wound-care specialists, and urology or bowel care when needed. Medicare Part B covers medically necessary wheelchairs and scooters, outpatient physical therapy and occupational therapy: after the deductible you pay 20% of the Medicare-approved amount if the supplier accepts assignment. Other costs: being researched. The team can prescribe and fit the chair, teach pressure reliefs, transfers and propulsion, and treat complications early. Most problems are far easier to treat when caught early.
Chiropractic Spinal and joint adjustment and soft-tissue work, mostly for back, neck and shoulder aches. About $55 to $100 for a self-pay follow-up and $90 to $200 for a first visit, per The Pricer. Medicare covers only spinal adjustments for a subluxation. We found little research on chiropractic care for wheelchair users. Bones can be thin and skin numb, so MBHA suggests clearance from your rehabilitation doctor first.
Acupuncture Fine needles, tried for shoulder and nerve pain in wheelchair users with spinal cord injury. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain. Two small trials in manual wheelchair users with shoulder pain saw pain fall, but a sham-controlled trial found no significant difference from sham needling.
Herbal medicine No herb or supplement has been shown to prevent pressure injuries, protect the shoulders or treat spasticity. Cost estimate being researched. Cranberry products showed little or no benefit against urinary infections in adults who cannot fully empty the bladder. Check every product with your pharmacist.
Massage therapy Gentle therapeutic massage for tight shoulder, neck and back muscles. One national chain: about $125 to $160 for a 60-minute massage for non-members, and about $70 to $90 a month for members, per The Pricer. Listed as an option for musculoskeletal pain after SCI. Needs a light touch and a therapist who knows about numb skin and clot risk.
MBHA Wellness Coach Daily habits: reminders for weight shifts and skin checks, exercise, fluids and nutrition, mood and peer support, and an emergency plan. Cost estimate being researched. Supports — never replaces — your care team. The research on teaching prevention is encouraging but uncertain, so routines are worth tailoring to you.

Approach 1 of 6

Conventional medicine (AMA)

A wheelchair is prescribed medical equipment, and the best results come from a team. For seating that team usually includes you, your family or caregivers, a rehabilitation physician who writes the prescription, an occupational or physical therapist experienced in wheelchair evaluation, and a qualified wheelchair supplier (MSKTC). For long-term pain in the arms, the PVA guideline recommends an interdisciplinary approach to assessment and treatment (PVA guideline). The topics below each have their own section further down.

What it costs

Medicare Part B covers wheelchairs and scooters when they are medically necessary; after the Part B deductible you pay 20% of the Medicare-approved amount if your supplier accepts assignment (Medicare.gov). Outpatient physical therapy and occupational therapy that are medically necessary are covered the same way (Medicare.gov, Medicare.gov). Costs for private insurance, repairs and cushions: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractors treat back, neck and joint pain with adjustments and soft-tissue work. We found little research on chiropractic care specifically for wheelchair users, and none showing it prevents the problems in this guide.

Safety

NCCIH says spinal manipulation often causes mild side effects such as soreness, stiffness or headache. Serious problems are very rare but may be more likely in people with underlying health problems that raise the risk of injury, so patients should share their health conditions with the practitioner (NCCIH). For wheelchair users, two cautions stand out. After spinal cord injury bone loss occurs in almost everyone, and fractures can happen with little force (MSKTC). Numb skin also hides pain, a warning sign (MSKTC). The PVA guideline asks clinicians to find out what alternative treatments you use and to watch for harmful interactions (PVA guideline). MBHA suggests getting your rehabilitation doctor’s clearance before any forceful adjustment, and asking for gentle techniques.

What it costs

The Pricer lists about $55 to $100 for a self-pay follow-up and about $90 to $200 for a first visit (The Pricer). Medicare Part B covers only spinal adjustments by a chiropractor to correct a subluxation, not other services such as massage or acupuncture ordered by the chiropractor (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture uses fine needles at specific points. It is one of the few complementary approaches that has been tested in wheelchair users themselves.

What the research says

  • Shoulder pain, 2007: in a small double-blind trial of 17 manual wheelchair users with chronic shoulder pain after spinal cord injury, pain fell in both the acupuncture group (66%) and the sham-needling group (43%), with no significant difference between them. The authors saw a medium effect for acupuncture but said a larger trial was needed (Dyson-Hudson et al., 2007).
  • Shoulder pain, 2001: in 18 manual wheelchair users, shoulder pain scores dropped about 53% with either acupuncture or a hands-on method called Trager, and stayed down five weeks later. Results were compared with each person’s own five-week baseline, not a control group (Dyson-Hudson et al., 2001).
  • Spinal cord injury in general: a review of 16 trials found encouraging but limited evidence for recovery of function, bladder problems and pain, and asked for better sham-controlled trials (Heo et al., 2013).

Safety and cost

NCCIH reports relatively few complications, but nonsterile needles and improper technique have caused infections, punctured organs and injury to the nervous system; the FDA requires acupuncture needles to be sterile and single-use (NCCIH). Because any painful stimulus below the level of injury can trigger autonomic dysreflexia, even if you cannot feel it (MSKTC), MBHA suggests telling your acupuncturist your level of injury and having your blood pressure checked if you are at risk. The Pricer lists about $90 to $185 per follow-up visit and $125 to $230 for a first private visit; community clinics are about $50 to $90 (The Pricer). Medicare Part B covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been shown to prevent pressure injuries, protect overused shoulders or treat spasticity. A 2020 review of 26 trials of Chinese herbal medicine in spinal cord injury found improvements in some scores but rated the trials as mostly poor quality and called for larger, better studies (Zheng et al., 2020).

Cranberry and urinary infections

A 2023 Cochrane review of 50 studies found cranberry products reduced symptomatic urinary tract infections in some groups, but the evidence did not support their use in adults with nerve-related bladder dysfunction who empty the bladder incompletely; three studies of 464 people showed little or no difference (Williams et al., 2023). MSKTC likewise calls the research on cranberries mixed (MSKTC).

Cannabis and safety

MSKTC says studies so far have not shown cannabis products to be effective for pain after spinal cord injury, and that smoking cannabis is not recommended (MSKTC). NCCIH reminds us that supplements may interact with medicines or pose risks with certain medical problems, and that “natural” does not always mean safe (NCCIH). Many wheelchair users take several medicines, for example for spasticity or bladder control, so check every product with your pharmacist. Cost estimate being researched.

Approach 5 of 6

Massage therapy

MSKTC lists therapeutic massage as an option for musculoskeletal pain after spinal cord injury, the pain that comes from muscle tightness and imbalance (MSKTC). That is the realistic role for massage here: easing tight shoulders, neck and upper back, which work hard for wheelchair users. We found little research on massage in wheelchair users, and none showing it prevents skin or other problems.

Safety

NCCIH says the risk of harm from massage appears low, but rare serious problems such as a blood clot, nerve injury or fracture have been reported, some with vigorous deep-tissue work (NCCIH). With that in mind, MBHA suggests a light touch; no deep pressure over numb skin, red areas that do not fade, or open skin; no firm kneading of a swollen, warm calf; and a therapist who has been told about your bone, clot and skin risks. Skin that cannot feel pain can be injured without warning (MSKTC).

What it costs

At one national chain, franchise price lists show about $125 to $160 for a 60-minute massage for non-members and about $70 to $90 a month for members, plus tips (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Most wheelchair health problems are prevented by small things done every day. An MBHA Wellness Coach can help you build those habits, alongside — never instead of — your medical care.

  • Routines: phone reminders for weight shifts, a morning and bedtime skin check, an exercise schedule, and a calendar reminder for your two-yearly seating review (MSKTC).
  • Learning new skills: a 2019 review of 13 trials (581 people) found that structured wheelchair skills training raised skills scores, worked best for new users and reported no serious adverse events (Keeler et al., 2019).
  • Pacing activity and keeping up with strengthening so the arms stay strong (PVA guideline).
  • Mood and connection: joining a peer support group and building meaningful activities protect against depression (MSKTC).
  • Preparedness: an emergency kit and a plan that your neighbors know (MSKTC).

Honest caution: a Cochrane review of patient and carer education for pressure injury prevention found the evidence too weak, from 10 studies, to say whether education reduces new pressure injuries (O’Connor et al., 2021). A small randomized trial of a self-efficacy program in 47 people with SCI improved knowledge, confidence and self-care behavior (Kim & Cho, 2017). A coach works on habits, not on diagnosis or treatment.

Another approach

Pressure injuries: skin checks, weight shifts and cushions

A pressure injury (also called a pressure sore, pressure ulcer or bedsore) is damage to skin or deeper tissue from lost blood flow, usually over a bony area. After spinal cord injury, little or no feeling means no warning that you have sat too long (MSKTC). MSKTC reports that up to 80% of people with SCI will have a pressure sore in their lifetime, and that most are preventable (MSKTC). The NHS lists other risks: having had one before, being underweight, swollen, sweaty or broken skin, and poor circulation (NHS). Shearing from slouching or sliding during a transfer, wet skin, tight shoes and clothing seams all add to the risk (MSKTC). See also our Bed Sores guide.

Daily prevention

  • Pressure reliefs. MSKTC advises one every 15 to 30 minutes, for at least 30 to 90 seconds (MSKTC). Options include leaning side to side, leaning forward, or tilting a power chair; a tilt of 25 to 65 degrees has been shown to relieve pressure, but 15 degrees or less does not. Full push-ups may harm the rotator cuff, so use them only if you cannot do the others (MSKTC).
  • Skin checks at least morning and bedtime, by you or a caregiver, with a mirror. Look for redness or darkening, blisters, bruises, cracks, hardness, swelling or warmth, especially over bony areas such as the tailbone, seat bones and heels (MSKTC). On black or brown skin the patch may look purple or blue (NHS).
  • Sit upright, lift rather than slide during transfers, keep skin clean and dry, avoid powders, nothing in back pockets, and shoes one to two sizes longer and wider than before to allow for swelling (MSKTC).
  • Eat and drink well and do not smoke (MSKTC).

Cushions and seating

MSKTC advises a seating evaluation, including a pressure map, at least every two years (MSKTC). A 2024 systematic review concluded that air-cell cushions provided the best pressure relief and shear reduction, while small studies suggest off-loading cushions may do better still (Damiao & Gentry, 2024). The right one for you is a decision for your seating clinic. Check cushions and chairs daily for problems (MSKTC).

If you find a red patch

Get off it. A patch that does not fade within 30 minutes of pressure removal has begun to break down (stage 1). Keep it clean and dry, inspect it twice a day, and call your provider if it has not gone away in two to three days. If the skin is open, see your provider right away. Even a small sore deserves respect, because what shows on the surface is often the smallest part (MSKTC). PVA also publishes a clinical guideline on preventing and treating pressure ulcers in SCI (PVA guideline, 2001).

Another approach

Shoulders, wrists and how you push

Arms that push, lift and transfer for decades wear out. In studies of people with SCI, carpal tunnel syndrome was found in 40% to 66% and shoulder problems in 30% to 60%, with wide ranges from differing study methods (PVA guideline). A review of manual wheelchairs also reports a very high prevalence of shoulder and wrist pain (Flemmer & Flemmer, 2016). See our Shoulder and Carpal Tunnel guides.

What the clinical guideline recommends

The Paralyzed Veterans of America (PVA) guideline, reprinted in the Journal of Spinal Cord Medicine, asks people to “move smarter” rather than do less (PVA guideline):

  • Fewer and gentler repetitions: reduce how often and how hard you push, transfer and reach.
  • Use long, smooth strokes that limit impact on the pushrim, and let the hand drift down below the rim between strokes in a semicircular pattern.
  • Avoid extreme wrist positions and use a handgrip rather than a flat palm when transferring.
  • Choose the lightest, fully adjustable chair and set the rear axle as far forward as is safe, so that the elbow is bent 100 to 120 degrees with the hand at the top of the rim.
  • Keep flexibility and strength with stretching and resistance training that is individualized and progressive.
  • If pain becomes chronic, manual users should seriously consider a power chair, or combining a manual and a power chair.

Does teaching it help?

In a randomized trial of 37 new manual wheelchair users, strict training on the guideline led to a lower push frequency at discharge, but no significant differences in pain, set-up or participation yet (Rice et al., 2014). A review of six studies found that real-time visual feedback could lengthen the push arc and slow the push rate, though focusing on one variable may change others (Symonds et al., 2018). A review of seven studies found exercise programs, such as arm cycling, strengthening and stretching, were linked to less shoulder pain (Cratsenberg et al., 2015). In a trial of 100 manual users without shoulder pain, an exercise and technique program was followed by less new shoulder pain at 18 and 36 months than in a comparison group from an earlier study (Haubert et al., 2021). Ask a therapist to teach you.

The guideline also says that well-informed people are more likely to notice and act on early signs of injury, when treatment works best. MBHA suggests reporting new shoulder pain, numbness or tingling in the hand early (PVA guideline).

Another approach

Transfers, falls and fractures

The transfer between chair, bed, car and toilet loads the arms and is where many injuries happen. The PVA guideline suggests level transfers when possible (equal height or downhill), a handgrip instead of a flat hand, avoiding the position of arm turned in, forward and out to the side, and a transfer-assist device for anyone with arm pain or weakness (PVA guideline). A randomized trial of 70 people with new SCI found no overall difference in transfer quality from structured training, though quality was better for people who needed assisted or dependent transfers (Rice et al., 2013).

Falls and fractures

  • A review of 24 studies found that about 69% of wheelchair users with SCI fell at least once in a year; contributing factors included muscle weakness, inattentiveness and uneven surfaces, some of which can be changed. The authors noted a high risk of sampling bias (Khan et al., 2019).
  • Strong spasms can throw you out of the chair during transfers or over bumps (MSKTC).
  • Bone loss occurs in almost everyone with SCI. Most fractures happen during transfers, by twisting or catching a leg or foot, or in falls, and about half of people injured for 10 years or more will have one. Watch for a loud snap, redness, swelling or low-grade fever (MSKTC). For bone health without SCI, see Osteoporosis.

MSKTC advises a supplier or therapist home assessment (MSKTC). Skills training can also help (Keeler et al., 2019).

Another approach

Seating clinics, equipment and paying for it

“One size fits all” is long gone, says MSKTC. A good wheelchair clinic offers test drives, a home assessment, and training on the finished chair (MSKTC).

  • The process: history and exam by a physician and OT or PT, a test drive, a home assessment, a letter of medical necessity, then delivery, fitting and training. Many therapists and suppliers hold RESNA’s Assistive Technology Practitioner credential, and Medicare requires a supplier with at least one (MSKTC).
  • Plan for change: a first chair may be temporary, and new pain or skin trouble in a long-time user may mean the seating needs changes. Keep a spare or loaner plan for breakdowns (MSKTC).
  • Power or manual: power tilt and recline can give pressure relief if you cannot lean or lift (MSKTC), and the PVA guideline suggests discussing power for people at high risk of overuse injury (PVA guideline).
  • Medicare: Part B covers wheelchairs and scooters when medically necessary. A power chair requires a face-to-face exam and written prescription, some types need prior authorization that your supplier usually requests, and you pay 20% after the deductible if the supplier accepts assignment (Medicare.gov).
  • Veterans: enrolled veterans referred by a physical medicine and rehabilitation physician can receive mobility aids such as wheelchairs (VA). The VA also runs a Spinal Cord Injuries and Disorders System of Care (VA).

Another approach

Bladder and bowel care

After spinal cord injury most people lose normal bladder and bowel control, so a plan from your doctor keeps the kidneys healthy and prevents accidents (MSKTC). Urinary tract infections are common because stool and catheters bring bacteria near the urethra and the bladder often cannot empty fully (MSKTC). MSKTC suggests emptying the bladder fully when needed, drinking enough water (urine golden yellow), and good hygiene; it does not usually recommend antibiotics to prevent infection (MSKTC). If you have signs of infection, give a sterile urine sample, not one from a leg or night bag (MSKTC).

A bowel program is a customized plan with timing, diet and fluids, medicines and techniques, aiming for regular, planned bowel movements; skipping it can lead to autonomic dysreflexia and spasticity (MSKTC). If your wheelchair use has other causes, see Bladder Problems and Bowel Problems.

Another approach

Spasticity

Spasticity, stiff or suddenly jerking muscles, affects about 65% to 93% of people with SCI. It is not always harmful and sometimes helps with standing or transferring, but it can cause pain, joint contractures, falls and skin rubbing (MSKTC). Triggers include a full bladder, urinary infection, constipation, a pressure injury, tight clothing and a fracture, so a change in spasticity can signal a hidden problem (MSKTC). Stretching at least twice a day, cycling and supported standing help. When they are not enough, doctors may use medicines, injections, or a pump that delivers medicine to the spinal canal, usually after other treatments fail (MSKTC). See also Cerebral Palsy and Multiple Sclerosis.

Another approach

Circulation and blood clots

Not moving slows blood flow in the legs and raises the chance of deep vein thrombosis (DVT) (NHLBI). The NHS lists pain and swelling, usually in one leg, with red, blue or darkened skin, and says to get urgent help and call emergency services if there is also shortness of breath or chest pain (NHS). The CDC says about half of people with DVT have no symptoms, and a lung clot can occur without leg symptoms (CDC). Staying active, drinking enough fluids, not smoking and moving around every hour or so help prevent clots (NHS). Swollen feet and legs also thin and injure skin (MSKTC). See Blood Clots and Circulation.

Another approach

Autonomic dysreflexia: preparing ahead

If your injury is at or above T6, ask your team for a blood pressure monitor and learn your usual numbers. MSKTC defines an episode as systolic pressure 20 to 40 points above your baseline from a trigger below the injury. The most common trigger is the bladder; others are the bowel, skin problems, a broken bone, and sexual activity or menstruation (MSKTC). Teach caregivers the steps in the box at the top of this page and carry the wallet card from your care team, which you can give to emergency staff (MSKTC).

Another approach

Exercise and heart health

MSKTC says most people with SCI can be active, and that a program should include aerobic exercise, strength, flexibility and functional training. About one in four people with SCI lack the fitness for basic daily activities. For adults with SCI, the minimum it cites is 20 minutes of moderate to vigorous aerobic exercise twice a week plus strength training twice a week, building toward 30 minutes three times (MSKTC). The CDC advises adults with disabilities who are able to aim for at least 150 minutes of moderate aerobic activity and two days of muscle strengthening, and says some activity is better than none (CDC). Examples include hand cycling, swimming, wheelchair basketball and brisk pushing (MSKTC). A 2025 trial of 49 manual users with paraplegia compared a whole-day activity approach with planned arm-crank exercise and found it comparable or better at raising activity (Martinez et al., 2025). Ask your doctor or therapist to tailor your plan (MSKTC).

Another approach

Mood, isolation and support

Depression is one of the most common problems after SCI: an estimated 12% to 40% in the first year, and 15% to 30% among those living in the community. It is treatable, and exercise and peer support help (MSKTC). The CDC notes that anyone with a disability can feel isolated or have low self-esteem (CDC). Tell your doctor if low mood lasts two weeks or more. In a crisis, call or text 988 (MSKTC). See Depression.

Another approach

Travel, access and your rights

  • The ADA: state and local governments and businesses must let people using manual or power wheelchairs into all areas open to the public (ADA.gov). They may not ask about the nature or extent of a disability. Complaints about businesses and state or local governments go to the U.S. Department of Justice (ADA.gov).
  • Airport security: tell the TSA officer you use a wheelchair; you can ask to be screened seated, and your cushions will be screened too (TSA). TSA Cares can help if you contact them at least 72 hours ahead; airport wheelchair service comes from your airline (TSA).
  • Driving: a certified driver rehabilitation specialist can assess you and recommend equipment (MSKTC).
  • Emergencies: keep a week of medicines and supplies, a lightweight backup chair, spare batteries for a power chair, chair details for responders, and a support network (MSKTC).

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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