The importance of proper seating in a wheelchair

For manual wheelchair users, the right seating and positioning aren’t just about comfort—they’re essential for health, mobility and independence. The right seat and back system, which includes both the cushion and the support behind your back, helps protect your skin and prevent serious medical issues such as painful pressure injuries (also known as pressure sores). These injuries occur when prolonged pressure damages the skin and underlying tissue, and they can lead to significant pain, infection and long-term complications. According to The Agency for Healthcare Research and Quality (AHRQ), pressure injuries cost the United States healthcare system nearly $10 billion annually, with treatment for a single injury ranging from $20,000 to more than  $150,000. [1]

A good cushion and backrest should keep you comfortable for prolonged periods, but more importantly, they need to support your posture. Knowing how to choose the right one is essential.

What to Consider When Selecting a Seat and Backrest

The best seating provides your back with strong support, functions well and feels comfortable throughout the day. Proper positioning helps reduce stress on your joints and muscles. Over time, poor alignment can make movement more difficult and affect your overall quality of life. With good posture, you can reach things more easily, push your chair with greater ease and participate more fully in daily life. A stable chair helps you feel secure and allows you to stay active.

Seat depth is a key factor and often overlooked.

• If the seat is too large, you may end up sitting in an improper position, which can lead to slouching or posture issues.
• If it is too short, it puts more pressure on a small area of the seat and can increase the risk of skin breakdown.

It is also important to consider energy use. A heavy or poorly fitted seat can cause you to expend more energy every day.

When selecting a seat, consider your lifestyle and preferences. Select a seat and backrest that will make your daily life more comfortable. Consider factors such as your living environment, the frequency of your travel and whether the chair is for daily use or temporary support.

Pressure Relief and the Variety of Cushion and Backrest Types

A good cushion’s main job is to relieve pressure and protect your skin. Cushions do this in different ways, depending on the amount of support you need and your risk of skin damage.

Common cushion types include:

• Foam cushions: Lightweight and low maintenance, but may compress over time.
• Gel or fluid cushions: Offer excellent pressure relief but require regular care.
• Air cushions: Highly adjustable and effective for pressure management, but may need frequent inflation checks.
• Hybrid cushions: Combine materials for balanced comfort, stability, and skin protection.

To learn more about these cushions, check out our latest article.

It is essential to conduct your own research and consult with a healthcare professional or seating specialist.  A good cushion distributes pressure evenly where it is highest. If these spots are ignored, they can lead to tissue damage.

Backrests also have their own benefits and drawbacks. Adjustable fabric backrests can be customized to fit you and are lightweight; however, they may not provide the best support or keep you comfortable.

The Significant Risks of an Incorrect Choice

Selecting the wrong seat can have serious consequences. The primary concern is the risk of pressure injuries, which are common among individuals who use wheelchairs. Poorly fitted seating can cause uneven weight distribution, friction, and moisture buildup-all factors that contribute to skin breakdown. These injuries can be painful, expensive to treat, and potentially life-threatening if infection occurs. Choosing the right seat is important to protect your long-term health.

Beyond health concerns, selecting the wrong equipment can lead to reduced independence and additional costs if you need to replace equipment that does not meet your needs.

Conclusion

Choosing the right wheelchair seat is about more than comfort – it is about your health, function, and safety. The right seat provides comfort, promotes better posture, and protects you from serious health issues, such as pressure injuries. To achieve the best results for your health and independence, explore your options, consult with other wheelchair users, and seek advice from a healthcare provider. By making an informed seating choice, you are investing not only in your comfort today but also in your overall health, independence, and quality of life for years to come.