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Thirteen subjects with a spinal cord injury (paraplegia) performed handcycling with different handbike setups at constant power output: four crank positions (two distances, two heights) and four backrest inclinations. The <jats:styled-content style=\"fixed-case\"><jats:roman>O<jats:sub>2<\/jats:sub><\/jats:roman><\/jats:styled-content>\u2010consumption, kinetics, and kinematics were measured to calculate mechanical efficiency and shoulder load (glenohumeral contact force, net shoulder moments, and rotator cuff force). The analysis showed that more upright backrest positions resulted in lower shoulder load compared with the most reclined position [glenohumeral contact force (260 vs 335\u2009<jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>), supraspinatus (14.4% vs 18.2%), and infraspinatus force (5.4% vs 9.8%)], while there was no difference in efficiency. Except for a reduction in subscapularis force at the distant position, no differences in shoulder load or efficiency were found between crank positions. Recreational handbike users, who want to improve their physical capacity in a shoulder\u2010friendly way, should set up their handbike with a more upright backrest position and a distant crank placement.<\/jats:p>","DOI":"10.1111\/j.1600-0838.2012.01524.x","type":"journal-article","created":{"date-parts":[[2012,9,19]],"date-time":"2012-09-19T10:01:13Z","timestamp":1348048873000},"page":"386-394","source":"Crossref","is-referenced-by-count":26,"title":["The effect of crank position and backrest inclination on shoulder load and mechanical efficiency during handcycling"],"prefix":"10.1111","volume":"24","author":[{"given":"U.","family":"Arnet","sequence":"first","affiliation":[{"name":"Swiss Paraplegic Research  Nottwil Switzerland"},{"name":"Research Institute MOVE Faculty of Human Movement Sciences VU University Amsterdam  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"van Drongelen","sequence":"additional","affiliation":[{"name":"Swiss Paraplegic Research  Nottwil Switzerland"},{"name":"Research Institute MOVE Faculty of Human Movement Sciences VU University Amsterdam  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Schl\u00fcssel","sequence":"additional","affiliation":[{"name":"Swiss Paraplegic Research  Nottwil Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V.","family":"Lay","sequence":"additional","affiliation":[{"name":"Swiss Paraplegic Research  Nottwil Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. 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