An accessible route can still wreck a shoulder

Gradient and surface decide how much force a manual wheelchair user pushes through one joint on the way to a seat.

Compliance says the ramp is fine. The shoulder disagrees.

A manual wheelchair user pushing on level smooth ground puts a modest, repeatable load through the shoulder each stroke, and the joint tolerates that reasonably well because it is built for a lot of low-force cycling. Tilt the ground and the arithmetic changes fast. On a gradient, part of each push is spent fighting gravity rather than moving forward, so peak force per stroke rises, the number of strokes rises too because each one covers less ground, and the arm spends more of its cycle in the ranges where the rotator cuff tendons sit closest to bone.

That combination, higher force plus more repetitions plus a compromised position, is the standard recipe for tendon overload in any sport. It is exactly what a coach would be criticised for programming. Venues program it by accident, in concrete, and then leave it in place for forty years.

Surface matters as much as slope, and it gets less attention. Rolling resistance on a paved apron with wide joints, or on the loose bonded gravel that architects like around new grounds, can be several times what it is on smooth concrete. Every joint the small front casters drop into is a jolt the arms absorb. The route looks compliant on a plan. Under a wheel it is a series of impacts.

Then there is the transfer at the end, which is the highest single load of the day. Lifting the whole body weight through both arms into a seat, then out again, is a maximal effort on a joint that is not a weight bearing joint by design. Do that twice per fixture, twenty fixtures a season, after a push up a long ramp that already fatigued the same muscles, and the fatigue order is the problem. Tired stabilisers let the head of the humerus drift, and the tendon takes the contact it would otherwise avoid.

My view is that accessibility standards are written in the language of gradient limits and door widths because those are inspectable, while cumulative joint load is not. It is the wrong unit. The honest measure is how much total work a route demands and in what order, because a shoulder that has already done the ramp is not the same shoulder that arrived at the gate.

Shorten the push. Smooth the surface. Put the lift before the climb, never after.