Fatigue in wheelchair users

Making some sense of a complex problem

Fatigue is extremely common. One in five visits to the GP feature fatigue (1). In its worst forms, fatigue can have a devastating impact on a person’s life, limiting work, day-to-day activities and enjoying time with friends and family.

Despite this, it can be hard to define exactly what “fatigue” is. It can be categorised in various ways, including splitting it into physical and mental fatigue(2). Physical fatigue can include feeling sleepy, lacking energy or experiencing muscle weakness, whilst mental fatigue can include feeling emotionally drained or having difficulty concentrating (3).

Fatigue is extremely complex, and can be caused or contributed to by a wide range of physical and mental health problems. Amongst wheelchair users, MS is perhaps the most common, well-recognised cause of fatigue. However, research also indicates an increased risk of fatigue in those with spinal cord injury (4), hypermobile Ehlers-Danlos syndrome (5) and cerebral palsy (6), amongst others.

Pain and fatigue are symptoms that frequently go hand in hand (7)(8). This is of particular relevance to wheelchair users where back pain and shoulder pain are common place (9)(10)(11).  (SEE OUR POST ON BACK PAIN HERE)

Vibration is another important consideration. Wheelchair users have been shown to be exposed to vibration levels that exceed the threshold at which it is damaging for health (10). So far, most research concerning vibration and fatigue has been done on workers. This research has showed that workers exposed to vibration are overall roughly twice as likely to experience work-related fatigue, with those exposed to higher levels of vibration at higher risk (12). In testing of hand grip strength, vibration has also been shown to induce muscle fatigue (13).

Loopwheels are wheelchair wheels with built-in shock absorption. They are designed to improve the overall suspension capabilities of a chair, reducing the user’s exposure to harmful vibration and jolting. On testing in line with ISO-2631 (the international standard for vibration testing), Loopwheels were shown to reduce harmful vibration by up to 70% (14). In our April 2022 Customer Survey, we asked users why they purchased Loopwheels and how they had benefited from them. Despite the complexity of fatigue, an impressive 42% of respondents who purchased Loopwheels to manage fatigue reported a noticeable improvement.

To find out more about Loopwheels products, see the Loopwheels range of 4 different wheelchair wheels here.


This post was researched and written by Harrison Smalley, a postgraduate[1] from the University of Nottingham as part of a work placement[2] at Loopwheels. It was funded by the University of Nottingham.


  1. Morelli V. Fatigue and Chronic Fatigue in the Elderly: Definitions, Diagnoses, and Treatments. Clin Geriatr Med [Internet]. 2011 Nov 1 [cited 2022 Jun 7];27(4):673–86. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0749069011000498
  2. Aaronson LS, Teel CS, Cassmeyer V, Neuberger GB, Pallikkathayil L, Pierce J, et al. Defining and Measuring Fatigue. J Nurs Scholarsh [Internet]. 1999 Mar 1 [cited 2022 Jun 7];31(1):45–50. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1547-5069.1999.tb00420.x
  3. Hardy SE, Studenski SA. Qualities of Fatigue and Associated Chronic Conditions Among Older Adults. J Pain Symptom Manage [Internet]. 2010 Jun [cited 2022 Jun 7];39(6):1033. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884149/
  4. Craig A, Tran Y, Wijesuriya N, Middleton J. Fatigue and tiredness in people with spinal cord injury. J Psychosom Res [Internet]. 2012 Sep [cited 2022 Jun 8];73(3):205–10. Available from: https://www.sciencedirect.com/science/article/pii/S0022399912001857
  5. Voermans NC, Knoop H. Both pain and fatigue are important possible determinants of disability in patients with the Ehlers-Danlos syndrome hypermobility type. https://doi.org/103109/096382882010531373 [Internet]. 2010 Nov [cited 2022 Jun 8];33(8):706–7. Available from: https://www.tandfonline.com/doi/full/10.3109/09638288.2010.531373
  6. Jahnsen R, Villien L, Stanghelle JK, Holm I. Fatigue in adults with cerebral palsy in Norway compared with the general population. Dev Med Child Neurol [Internet]. 2003;45(5):296–303. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-8749.2003.tb00399.x
  7. Eccles JA, Davies KA. The challenges of chronic pain and fatigue. Clin Med (Northfield Il) [Internet]. 2021 Jan 1 [cited 2022 Jun 8];21(1):19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850224/
  8. Creavin ST, Dunn KM, Mallen CD, Nijrolder I, van der Windt DAWM. Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults. Eur J Pain [Internet]. 2010 Mar 1 [cited 2022 Jun 8];14(3):327–34. Available from: https://onlinelibrary.wiley.com/doi/10.1016/j.ejpain.2009.05.010
  9. Kovacs FM, Seco J, Royuela A, Barriga A, Zamora J. Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study. Spinal Cord 2017 564 [Internet]. 2017 Dec 28 [cited 2022 May 10];56(4):392–405. Available from: https://www.nature.com/articles/s41393-017-0029-z
  10. Garcia-Mendez Y, Pearlman JL, Boninger ML, Cooper RA. Health risks of vibration exposure to wheelchair users in the community. J Spinal Cord Med [Internet]. 2013 Jul [cited 2022 May 10];36(4):375. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758533/
  11. Wessels KK, Brown JL, Ebersole KT, Sosnoff JJ. Sex, shoulder pain, and range of motion in manual wheelchair users. J Rehabil Res Dev [Internet]. 2013;50(3):351–6. Available from: https://www.rehab.research.va.gov/jour/2013/503/pdf/page351.pdf
  12. Ahn YD, Rhie J, Kim MG. The relevant factors of work-related fatigue for occupational vibration-exposed employees. Ann Occup Environ Med [Internet]. 2022 [cited 2022 Jun 8];34(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9005887/
  13. Adamo DE, Martin BJ, Johnson PW. Vibration-induced muscle fatigue, a possible contribution to musculoskeletal injury. Eur J Appl Physiol [Internet]. 2002 [cited 2022 Jun 8];88(1–2):134–40. Available from: https://pubmed.ncbi.nlm.nih.gov/12436281/
  14. Loopwheels. Vibration Reduction Assessment of Loopwheels [Internet]. 2017 [cited 2022 May 31]. Available from: https://loopwheels.com/2017/12/testing-vibration-reduction/



[1] Harrison completed an intercalated degree in Sport and Exercise Medicine at the University of Nottingham in 2021, as a year out from his medical degree at the University of Leicester.

[2] https://www.nottingham.ac.uk/workingwithbusiness/services/postgraduate-placements-nottingham.aspx