Safe and Effective Shoulder Exercise Training in Manual Wheelchair Users With SCI

The investigators hypothesis is that the biomechanically based exercise program will
demonstrate greater muscle activation of targeted muscles, and reduced compression risk to
the rotator cuff tendons.

Inclusion Criteria:

1. Persons with paraplegia at least 1 year post SCI. Prior to this time patients are
still adjusting to independent function with manual wheelchairs as their primary means
of mobility. This criteria ensures the subjects have had sufficient exposure to the
functional demands associated with their condition.

2. Age 21 to 60 years old; below age 21, particularly in males, the humeral growth plate
may not have fully closed. Including subjects above this age ensures skeletal
maturity. After age 60, even in able-bodied individuals, substantial degenerative
changes can begin to occur in the shoulder joint.

3. Use of a manual wheelchair as the primary means of mobility (> 50% time). This is the
population with most risk of development of shoulder pain and associated secondary
complications.

4. A history of unilateral or bilateral shoulder pain that interferes with at least one
functional task. Symptoms localized to the proximal anterior, lateral, or posterior
glenohumeral (shoulder joint) region are required. Rotator cuff tendinopathy and
"impingement" syndromes involve localized pain in this region. More diffuse symptoms
are consistent with combined shoulder/neck syndromes or radiating pain from cervical
spine pathology.

Exclusion Criteria:

1. Inability to provide informed consent.

2. Reproduction of shoulder pain, pain radiating down the upper extremity, numbness or
tingling in the upper extremity, or other upper extremity symptoms during a cervical
screening examination or thoracic outlet testing. This result would be indicative of
primary cervical or thoracic outlet pathology.

3. Shoulder pain of traumatic origin. Cumulative trauma disorders are of primary interest
and most amenable to the proposed exercise interventions.

4. History of shoulder surgery or dislocation.

5. Recent history of fracture (within 1 year), hospitalization (within the past month),
or cortisone injection to the shoulder (within 4 months). These conditions may
interfere with safe or effective completion of the exercise intervention.

6. A diagnosis or imaging findings of rheumatoid arthritis, end stage osteoarthritis,
full thickness rotator cuff tear, adhesive capsulitis, or complex regional pain
syndrome. These subjects may have joint disease progression that is severe, or not
appropriately treated with a stretching and strengthening intervention.

7. Diagnosed major depression, alcohol or substance abuse, or other serious medical
conditions. These conditions may prevent subjects from regularly completing the
exercise intervention

All criteria apply to both groups excepting manual wheelchair use and SCI criteria not
applicable to the able bodied subject group.