# Quantifying Sex-Specific Musculoskeletal Adaptations to Wheelchair Use in Childhood and Adolescence

> **NIH NIH R03** · UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN · 2024 · $151,891

## Abstract

Project Summary
Up to 70% of manual wheelchair users experience shoulder pain, and as many as 90% develop pathologies like
rotator cuff tendinopathies and glenohumeral instability. This can have profound negative effects on quality of
life through reduced participation in everyday activities and can increase the lifetime risk of secondary medical
conditions like cardiovascular disease through reductions in physical activity. Yet, clinical guidelines for the
preservation of upper limb function in manual wheelchair users are only applicable to users with adult-onset
disabilities, and do not account for sex. As a result of this gap in knowledge, pain begins in adolescence and
increases significantly during the transition to adulthood in users with pediatric-onset disabilities. In addition, the
increase in pain during this period is far greater for females than males, even when accounting for years of
wheelchair use. Our central hypothesis is that this sex-related divergence in pain is precipitated by sex-specific
musculoskeletal adaptions to wheelchair use in childhood and adolescence. During this period of life, females
experience far lower upper extremity muscle and bone growth velocities and a shorter window in which to adapt
to wheelchair use. Moreover, musculoskeletal adaptations are driven by the mechanical demands one
experiences. We have evidence that wheelchair use is far more demanding of upper extremity musculature for
females than males, even when accounting for individual size. We will test our central hypothesis by establishing
the relationships between sex-specific adaptations to (Aim 1) glenohumeral muscle morphology, (Aim 2) scapula
shape, and (Aim 3) scapular kinematics and pain, while accounting for years of wheelchair use and arm
dominance. Our approach will leverage bilateral magnetic resonance imaging to determine the influence of sex
and wheelchair use in childhood and adolescence on the balance of glenohumeral musculature and the shape
of the glenoid and acromion, advanced biomechanical modeling to determine adaptations to scapular kinematics
at rest and during humerothoracic elevation and wheelchair propulsion, and patient-reported outcomes to
quantify shoulder pain and pain interference. We expect to reveal sex-specific musculoskeletal adaptations to
wheelchair use in childhood and adolescence associated with pain that can be immediately addressed with
established rehabilitation paradigms including strengthening exercise and motor training. Moreover, the results
of the proposed research will provide foundational knowledge for the development of sex-specific wheelchair
use guidelines for pain prevention. Finally, we expect to uncover potential mechanisms underlying the
development of glenohumeral instability and rotator cuff pathologies. By determining the etiology of shoulder
pain with consideration for sex, we hope to increase equity in the prevention and rehabilitation of secondary
musculoskeletal conditions associated wi...

## Key facts

- **NIH application ID:** 10816783
- **Project number:** 1R03HD114181-01
- **Recipient organization:** UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
- **Principal Investigator:** Joshua Leonardis
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $151,891
- **Award type:** 1
- **Project period:** 2024-08-01 → 2025-08-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10816783

## Citation

> US National Institutes of Health, RePORTER application 10816783, Quantifying Sex-Specific Musculoskeletal Adaptations to Wheelchair Use in Childhood and Adolescence (1R03HD114181-01). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10816783. Licensed CC0.

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