Professional Wheelchair Athlete

By: Yvette van Niekerk (2025/2026 Fellow,

Level 4 international wheelchair rugby classifier)

As hand therapists, we already know how challenging upper-limb rehabilitation can be. Add a professional athlete who is also a wheelchair user into the mix, and the complexity increases significantly.

Unlike many able-bodied athletes, wheelchair athletes cannot simply “rest” an injured upper limb. Their arms and hands are not only essential for sport performance, but also for mobility, transfers, work, and independence in everyday life. Even when injured, daily upper-limb loading continues.^1,2

Professional wheelchair athletes also rarely have the opportunity to be full-time paid athletes. Financial pressures, contracts, competitive seasons, team expectations, and performance goals often push them toward an accelerated return to sport. This creates a difficult balance for both the wheelchair athlete and the treating therapist.^1,3

In a 2020 blog post, hand therapist Mo Herman wrote:¹

“For elite and professional athletes, a single day away from training or competing can negatively impact goal achievement, financial status, and future athletic seasons.”

Although this statement applies broadly to athletes, the impact is often amplified in wheelchair users because upper-limb injuries directly affect both sport participation and independence.

The Challenge for the Treating Therapist

Even with advanced training, it can be difficult to fully respect tissue-healing timelines when managing elite athletes. Wheelchair athletes often place unavoidable loads on healing structures during everyday activities, long before they are ready for sport-specific demands.²

The therapist’s role therefore becomes one of balancing:^1,2

                  • anatomical healing,

                  • sport-specific neuromuscular retraining,

                  • performance demands,

                  • and preservation of long-term upper-limb function.

Treatment goals should safely accelerate return to play while protecting the athlete’s future independence and quality of life. 

What Does the Research Say About Surgery and Return to Play?

Surgical management in athletes should ideally support accelerated rehabilitation and early sport integration when appropriate. Advances in surgical techniques have improved return-to-play timelines in several upper-limb injuries commonly seen in athletes.³

Examples include:²

                  • intramedullary screw fixation for metacarpal fractures,

                  • suture-tape augmentation for thumb ulnar collateral ligament (UCL) repairs,

                  • and individualized fixation strategies for scaphoid fractures.

Return-to-Play Considerations:

Metacarpal fractures (fixation):²

For skilled position athletes involved in contact sports, return to play generally requires:

                  • full range of motion,

                  • no extensor lag,

                  • and normalized grip strength.

Athletes may return in a protective thermoplastic orthosis at approximately 4–6 weeks, or unprotected at 6–8 weeks, depending on healing progression and radiographic findings.

For nonskilled position athletes in contact sport, the athlete may return to sport in a protective club cast after initial postoperative wound check.

Thumb UCL repair:²

Athletes are commonly immobilized in a thumb spica for four weeks, followed by a hand-based orthosis with gradual range-of-motion exercises for another four weeks.

For skilled position athletes unprotected return to sport is typically considered once motion and grip strength normalize, usually around two months postoperatively.

For nonskilled position athletes permitted to practice and play wearing this thumb spica if sport allows.

Scaphoid fractures treated with ORIF:²

For skilled position athletes’ range-of-motion and grip-strengthening exercises are often initiated around three weeks postoperatively using a removable thumb spica orthosis. CT-confirmed healing, typically at 2–3 months, is generally required before unprotected return to contact sport.

For nonskilled position athletes may return to contact sport in a cast after initial postoperative wound check.

Most literature on return-to-play timelines focuses on able-bodied athletes rather than wheelchair users. In my opinion, rehabilitation timelines for “skilled position athletes” are often more appropriate for wheelchair athletes due to the constant upper limb demands associated with mobility and daily living.

So, What Approach Should Hand Therapists Use?

Mo Herman emphasizes the importance of a multifactorial approach. Athletes tend to respond best to rehabilitation programs that are:¹

                  • goal-driven,

                  • sport-minded,

                  • competitive,

                  • and purposeful.

For wheelchair athletes, therapists should also understand²

                  • the specific wheelchair sport,

                  • the athlete’s role or classification within the team,

                  • the equipment demands,

                  • and the physical requirements of competition.

Building relationships with coaches, strength and conditioning staff, and medical teams can significantly improve clinical decision-making. Understanding the importance of upcoming tournaments or qualification events may also help therapists balance risk and progression more effectively.

The Psychological Component Matters^2,3

Wheelchair athletes often push themselves too hard, too quickly. The fear of losing performance, team selection, sponsorships, or independence can drive premature return to play and increase reinjury risk.

Psychological readiness is therefore just as important as physical recovery.

For many wheelchair athletes, reinjury does not only threaten sporting participation — it may also affect their ability to propel a wheelchair independently, transfer safely, or perform daily activities without pain.

Practical Strategies for Rehabilitation according to Mo Herman:¹

Several practical strategies suggested by Herman can be applied immediately in clinical practice:

1. Incorporate competitive games into treatment sessions to target upper extremity

range of motion.

2. Use graded sport simulation to address neuromuscular retraining goals.

3. Introduce sport-specific equipment early to identify compensatory movement

patterns.

4. Utilize custom orthoses to support accelerated but protected sport integration.

5. Use balls of different sizes and weights to challenge dexterity, coordination, and

strength.

6. Include mentally challenging activities during late-stage rehabilitation to improve

confidence.

 7. Create leaderboards or performance challenges to maintain engagement and

competitiveness.

Looking Beyond the Injury²

When treating wheelchair athletes, therapists must assess more than the injured structure alone.

Important considerations include:

                  • Wheelchair setup and cushion positioning: Poor setup may increase compensatory

upper-limb loading.

                  • Gripping aids and racing gloves: Taping, padding, or custom splinting may help

distribute pressure more effectively during propulsion.

                  • Transfer techniques: Proper transfers should minimize excessive wrist extension and

ulnar deviation to protect healing tissues.

Injury Prevention Remains Essential

One of the most valuable roles hand therapists play in elite sport is injury prevention.¹

Hand therapists are uniquely trained to assist with:

                  • improving grip strength and endurance,

                  • enhancing coordination and reaction time,

                  • optimizing biomechanics,

                  • implementing individualized strengthening programs,

                  • providing taping or bracing support,

                  • and educating athletes on recovery, rest, and load management.

Key Clinical Insight

For wheelchair athletes, upper-limb rehabilitation is never only about returning to sport. It is equally about protecting long-term independence, mobility, and quality of life. Successful rehabilitation programs must therefore balance performance goals with sustainable upper-limb function.

Conclusion

Regardless of age, level of competition, or type of sport, wheelchair athletes want to return to play as quickly and safely as possible — without sacrificing function in everyday life.

The athletes we treat benefit most from rehabilitation programs that are purposeful, sport-specific, competitive, and goal-driven. As therapists, we must understand not only the injury itself, but also the unique demands wheelchair athletes place on their upper limbs every single day.

References

1. Mo Herman (2020, Feb 12). 7 Innovative Hand Rehabilitation Strategies for Athletes. Medbridge.https://share.google/jwZufdnZIzR9C0BD0

2.     Sean Fyfe (2026, June). 8 key principles for rehab with para-athletes. Sport Injury Bulletin. Source: Sports Injury Bulletin https://share.google/X9yABSH65gpKS9pcc.

3.    David Matthew Noble, MD, Angelo Rashard Dacus, MD, Abhinav Bobby Chhabra, MD. Advances in the treatment of hand and wrist injuries in the elite athlete. Journal of Hand Surgery, Vol 49, Aug 2024.