W heelchairs provide mobility for millions of people with physical impairments. However, prolonged manual wheelchair use can lead to pain and repetitive strain injury (RSI) of the upper extremities. The number of manual wheelchair users experiencing pain tends to increase with the time spent using a wheelchair. Although manual wheelchairs have improved tremendously over the past 15 years, many people continue to develop arm pain and injury due to cumulative trauma. What causes this problem may not be the wheelchair. RSI may be caused by transfers or other activities of daily living. Yet, most clinicians and researchers agree that the wheelchair itself contributes substantially to the development of RSI. We present an overview of the current perspective on repetitive strain injury among manual wheelchair users.