Wheelchair Racing: Different Strokes for Different Folks

Reviewed by Gary D. Vogin, MD

May 8, 2001 -- Wheelchair racing is growing in popularity worldwide as such elite athletes as American Jean Driscoll, Australian Louise Sauvage, and Dutchman Ernst Van Dyke put global faces on the sport.

The increase in popularity is one of the reasons that John W. Chow, PhD, and his former colleagues at the University of Illinois, Urbana-Champaign, set out to determine whether a newly developed propulsion technique has advantages over the conventional method. Their findings are published in a recent issue of Medicine & Science in Sports & Exercise.

With the conventional technique -- also known as the thumb technique -- racers' hands, which are protected by tape, are fully flexed in a tight fist with the thumb in a slightly extended "hitchhiker's" position. The forearm is bent forward and the shoulder is internally rotated. The first contact with the wheel or pushrim involves the first joint and knuckle of the thumb. Then the forearm is bent backward and the back of the index and middle fingers (between the middle joint and knuckle) begin to make contact with the side of the wheel. Racers often flick their wrist at the bottom of the stroke.

Research has shown that racers using this technique frequently develop injuries to their shoulder, elbow, wrist, and upper extremities, says Chow, associate professor and director of the biomechanics laboratory at the University of Florida in Gainesville. Tennis elbow symptoms are especially common.

Enter the para-backhanded technique (PBT), developed by former wheelchair athlete-turned-coach Marty I. Morse, MS, the University of Illinois' men's and women's wheelchair track and field/road-racing coach.

With the new technique, racers who wear specially designed gloves place their thumb against the index finger of a closed fist. Their hand makes initial contact with the wheel, using the back of the index and middle fingers between the first and second joints rather than the thumb.

After the initial contact, the hand rises along the side of the wheel and the contact point is switched to the base of the thumb, the index, middle, and ring finger cuticles.

Unlike the conventional technique, there is limited bending of the forearm and shoulder rotation, which may potentially stave off injuries by decreasing stress in these areas.

Morse found that when racers used the new technique along with a preracing conditioning program, the number of injuries they sustained were reduced drastically.

"The main difference is the point of contact with the wheel," Chow tells WebMD.

"It's not that hard to learn," Chow says. "The problem is whenever you learn a new technique you sacrifice your performance at the very beginning."

"PBT may be more suitable for endurance athletes who use less power in their pushing strokes," Chow says. "That's our recommendation, [but] we didn't have enough data to address whether PBT is better in terms of minimizing injuries."

The two techniques are suitable for different types of athletes, often depending on their physical characteristics, he says. To arrive at their findings, Chow and colleagues compared eight elite athletes who used the CVT stroke with seven who used the PBT.

That's not to say that racers have readily adapted to the new technique, which requires a closed hand.

"A lot of people can't push that way so they turn back to the conventional technique," says Morse.

The PBT stroke is hard to pick up, he says. "It can take anywhere from two days to six years to get right."

What does a wheelchair racer need to get started?

"You need a feel for making contact with the hand ring of the wheel, a comfortable pair of gloves, and to be comfortable in the chair itself," says Morse.

Training can be intense, he says. "If you are getting ready for a marathon, you have to do 120 to 200-plus miles a week," Morse says.

In wheelchair racing, "the Boston Marathon is the biggest race. Once you have won it, it's just an incredible rite of passage," Morse says, likening it to what Daytona is for NASCAR drivers.

Morse trained eight-time Boston Marathon winner Jean Driscoll, who has used both methods in her career.

"I used the thumb technique from 1987 through November 1991, and then in December of 1991, I started to experiment with the PBT," she tells WebMD. "It took me about two weeks going nine miles an hour to figure it out, but once I picked it up, I broke the world record by six minutes."

"I was going fast with the thumb technique, but when I switched to PBT, I went even faster," she says. Her record still stands at 1:34:22.

Driscoll retired from racing on Nov. 30, 2000, and is now speaking and writing. Her book, Determined to Win, hit bookstores everywhere in September.

One of the best ways for wheelchair racers to stave off injury is through conditioning, Driscoll tells WebMD.

"Be consistent in your training. Take care of rotator cuff muscles and strengthen your back muscles -- not just chest muscles," she says. "Many people don't realize how much back strength is required in wheelchair racing."

The U.S. Department of Veterans Affairs and Paralyzed Veterans of America are hosting the 21st annual National Veteran's Wheelchair games from July 1-5 in New York.

One of the scheduled participants, Gregory Morris, now 53, has been participating in the Games for 21 years. He participates in a slew of events from bowling to track races.

In his earlier years of racing, he used the CVT technique, but now he competes in a motorized chair.

While this method did not affect his shoulders or arms, he has seen it occur in other athletes.

"Those things do occur over the years, even if you are not an athlete, your arms weren't made to push a wheelchair," he tells WebMD.

Morris is planning to retire after this year's games. "I am ending my career in New York, my hometown, " he says. "I have had a blast all of the way. It's one hell of an experience being involved in wheelchair sports going around the country and meeting the people I have met."

When asked what advice he has to give wheelchair athletes who are about to begin their career, Morris says: "Try to get in the best shape possible by lifting weights, eating a proper diet, and getting the proper amount of rest. And I'd tell them to be committed to putting their best effort forth."

The No. 1 ingredient to a successful career, he says, is attitude. "If you don't go into it with the attitude that you are going to do your best, you may as well be a Sunday athlete," he says.