Hamstring Length and Wheelchair Positioning
by Theresa Hobson, PT
Tight hamstrings are a common culprit in sabotaging wheelchair positioning for the elderly.
In a perfect world, a person could sit in a chair with knees flexed at 90◦ and their pelvis in a neutral or anterior tilt, assisting with upright trunk posture. However, in our world of long term care, many of our patients sit with their knees in extension, feet anterior to the body, which automatically moves them into a posterior pelvic tilt. This tilt leads to precarious sacral sitting, dangerous sliding, and possible skin breakdown.
When positioning a frail elder in a wheelchair it is very important to have hamstring length evaluated, primarily because it is a two joint muscle. It is also important to note that the role of wheelchair positioning management is to accommodate tight hamstrings, not to lengthen them.
A resident’s hamstring length should be assessed as it relates to the position of the pelvis while sitting so that you can determine proper foot support. Most elderly have tight hamstrings and therefore sacral sit due to posterior pelvic tilt. Use of elevating leg rests or leg rests that are too long can further increase posterior tilt and tendency to sacral slide.
A solution for residents with tight hamstrings may be as simple as changing to standard swingaway footrests that are adjusted to the correct length. This will often increase knee flexion, help maintain hip flexion, assist the pelvis to neutral, and increase safety and stability.
References
J.,D. “Real Solutions.” Wheelchairnet.org. 18 Jul. 2009.
http://www.wheelchairnet,org/WCN_ProdServ/Docs/TeamRehab/
RR_95/9505art1.PDF
Portoghese, Caroline. “Seated Impact.” Rehabpub.com. Jun. 2005.
18 Jul. 2009. http://www.rehabpub.com/features/62005/5.asp
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