Why the Right Wheelchair Fit is Critical for Your Health

For the hundreds of thousands of people in the UK who rely on a wheelchair, it's a gateway to independence, opening up the world of work, education, and social life. However, a wheelchair is far more than just a set of wheels. The right one can transform a life, but an ill-fitting one can cause significant harm.

In an episode of the 'Your Comfort Place' podcast, communications consultant Bernard Ginns spoke with Dr Patrick Wynn, a senior GP and hospital specialist, about the crucial, yet often overlooked, issue of wheelchair comfort and safety. Their conversation revealed that when it comes to mobility aids, a one-size-fits-all approach can be dangerous.

What Makes a Wheelchair 'Appropriate'?

The World Health Organisation (WHO) defines an appropriate wheelchair as one that "meets the user's needs and environmental conditions," provides "proper fit and postural support," and is both "safe and durable". This goes far beyond simple mobility. An appropriate wheelchair can help reduce major health problems, such as pressure sores, and prevent the progression of deformities. Additionally, it can improve fundamental bodily functions, including respiration and digestion.

The reality, however, is that not every user has a chair that meets these vital criteria. Dr Wynn notes that he often sees patients with issues that are a direct result of an inappropriate wheelchair.

"I will see, I guess, disproportionate numbers of people," Dr Wynn explains. "Someone will come in with a wheelchair and have musculoskeletal pain related to it. That could be neck, shoulder, back, or perish the thought pressure sores, which of course, are dreadful things".

The Hidden Dangers of a Poor Fit

An ill-fitting wheelchair doesn't just cause discomfort; it can lead to severe and long-lasting health complications.

Pressure Sores: A Preventable Danger

Pressure sores (also known as pressure ulcers) are a serious risk. They occur when skin is compressed for an extended period, cutting off the blood supply and causing the tissue to break down. For someone with limited mobility or sensation, this can happen without them even realising it.

"If you haven't got that sort of mobility or sensation," Dr Wynn warns, "you might remain sat on that hard seat until such a time as you'd actually killed off the skin".

Once a pressure sore develops, it can be incredibly difficult to treat. Dr Wynn stresses that they can become "a long-term problem" or, in some cases, "just never recover". This makes prevention absolutely paramount.

Postural and Internal Health

Beyond skin health, a poorly fitting chair can wreak havoc on the body's structure and internal systems. If a wheelchair doesn't provide adequate support for someone without core stability, perhaps due to a spinal injury or a condition like multiple sclerosis, it can lead to "postural problems, deformities and such because it doesn't fit them right". Similarly, being forced into a stooped or slumped position can compromise breathing and digestion.

Always Get an Assessment

So, how can these problems be avoided? Dr Wynn’s advice is clear and consistent: a proper wheelchair assessment is non-negotiable.

"My role generally with wheelchairs is to make a referral for a wheelchair assessment, and that's critical. It's an assessment. It's not just here's a wheelchair," he states.

With long waiting lists for NHS services being a reality in some areas, many people are tempted to buy a wheelchair privately. While this can be a solution, it comes with a strong caution from Dr Wynn. "My advice would be that if you were going to do that, make sure that it comes with a wheelchair assessment," he urges. "Just buying a chair and assuming it's a chair, it'll be fine… might be okay for some people most of the time, but if you've got a particular needs, the chair needs to address those needs".

The Power of the Cushion

A critical component of a safe wheelchair setup is the cushion. This isn't about decoration; it's a specialised piece of medical equipment designed to distribute pressure and protect the skin.

"We're not just talking about a cushion for your sofa," Dr Wynn clarifies. "This is something that is medically designed specifically to prevent pressure sores".

When choosing a pressure cushion, look for a product that is rated for medical use. A key indicator is a risk score. Professionals use a scientific scale to assess a person's risk of developing pressure sores (low, medium, or high), and the cushion they are given corresponds to that risk level.

As a "rule of thumb" for those buying privately, Dr Wynn suggests, "make sure it has a risk score or risk staged high, medium, low, because that means it's been through that level of assessment". A standard cushion from a homeware shop simply won't provide the necessary protection.

The Main Takeaway

A wheelchair is an essential tool that profoundly impacts a user's health and quality of life. Hand-me-downs or unassessed purchases might seem convenient, but they carry significant risks. As Dr Wynn concludes, "if somebody is going to spend any significant amount of time in a wheelchair, it needs to be done properly".

Getting a professional assessment isn't just a box-ticking exercise; it's the most important step in ensuring a wheelchair provides comfort, independence, and, most importantly, safety for years to come.

View episode 3, Your Comfort Place series, where Dr Patrick Wynn and Bernard Ginns discuss wheelchairs and more: