What is the Most Comfortable Manual Wheelchair?

Scott Grant ATP

There are many important factors that can make a wheelchair comfortable or miserable. As a matter of fact, usually the problem isn’t the wheelchair itself. Accessories like cushions and padded backs can make a big difference. Here is how you can make your current chair more comfortable.

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The pursuit of comfort in a wheelchair is often challenging. It can be difficult to enjoy sitting in a steel and vinyl chair that is made for the masses. There are many important factors that can make a wheelchair comfortable or miserable. The problem is most people aren’t aware of their options. But, don’t worry! I am going to sort out for you what is the most comfortable manual wheelchair!

Disclaimer: the recommendations below are for comfort only not for clinical pressure relief. If you have a history of pressure ulcers, skin problems, or are at risk for them, please consult your healthcare professional and a RESNA-certified Assistive Technology Professional in your area. Also, the recommendations are for the general population and may not apply to people with severe deformities or progressive neurological disorders.

Why are Wheelchairs So Uncomfortable in the First Place?

Look closely at the construction of a wheelchair. It is essentially a metal frame with a metal cross brace under the seat. Stretched tightly across this frame is a piece of vinyl or nylon upholstery. That same upholstery is also strung across the back posts. There are two metal arms with hard rubber pads that are never in the right spot. And those 2 back canes are always rubbing the shoulders. No fun!

Wheelchair Upholstery Problems

lady sleeping in a comfortable wheelchair

Then that upholstery is bolted to a frame. In effect, the wheelchair rider is sitting in a sling. Remember in grade school when you would swing on the swing set and your butt would go numb? Or just hurt from the squeezing motion of the seat as you settled in it?  You get the same effect sitting in a wheelchair.

As the upholstery on a manual wheelchair stretches and settles with time, it sags in the middle. That’s what wheelchair nerds like me call the “hammock effect.” Eventually, the rider sits lower and lower in a hole until it is just like being in a grade school swing.

Manual Wheelchairs Often Don’t Encourage Good Posture

Because of the way standard manual wheelchairs are made, there is not a lot of support for an elderly person’s posture.

  • The arms are too low causing the person to hunch forward to make contact with them.
  • The legs don’t always elevate causing leg swelling, leg pain, and even lower back pain.
  • As the upholstery stretches on the back of the wheelchairs, the shoulders and back round out leading to back pain.
  • The same stretching on the wheelchair seat cushion leads to a leaning posture too.

Insurance Companies Don’t Pay for Comfort!

For an insurance company to pay for a wheelchair, it has to be proven to them that it is “medically necessary.” It must be needed for the person to care for themselves and to provide mobility when they can’t move on their own. Providing the most comfortable wheelchairs is not part of their equation.

There is one small exception to this policy that even some durable medical equipment companies do not know about. Insurance companies including Medicare and Medicaid will pay for “general use” cushion and back cushions. General use cushions are simple foam type cushions that can make sitting in a wheelchair more comfortable. Insurance guidelines are way beyond the scope of this article, but it can be done. Ask your DME provider.

The Wheelchair is not Sized Properly

I’ll try not to get on my soapbox here. But, it’s hard. Fitting people properly for wheelchairs is what I do for a living. These are general comments too – I have taken hours long classes about this.

I often see people that are placed into wheelchairs that just plain don’t fit. Usually, the chairs are too wide and too short. For proper wheelchair use and positioning, the wheelchair seating area should be NO MORE than 1″ to 2″ wider than the hip measurement. The seat depth (from the wheelchair back to the front of the seat) should be NO LESS than 1″ less than the seat depth of the user (back of the butt to the inside of the knee).

If a wheelchair is too wide, the user may lean and not be able to reach the wheels properly which causes pain. If the seat depth is too short, the legs will often spread which causes pain too.

The footrest length is very important too! The top of the legs (femur) should be parallel to the floor when the footrests are at the right length, generally. There are exceptions based on individual patient needs.

Ok, sounds terrible, doesn’t it? Here is how to fix these problems.

holding hands in front of a wheelchair
Finding the Most Comfortable Wheelchair for the Elderly

Many of the problems listed above, can be dealt with during the wheelchair selection process. I know. I know. Most people don’t know a thing about wheelchairs until they need one. Often, at that point, they just take what they are offered. And what the insurance company provides for them.

But, you do have a choice. Most plans will allow you to upgrade and pay the difference. OR the insurance plan will buy the base wheelchair and you can pay for the added accessories. Check with your DME provider or insurance company first.

If you decide to purchase a manual wheelchair outside of insurance benefits, here are the same recommendations I make to the patients I serve as an Assistive Technology Professional.

  • Nylon upholstery – holds its shape longer than vinyl upholstery
  • Adjustable height arms – allows the arms to be raised or lowered based on the user’s needs
  • Adjustable angle back – allows the back to be set at a slight recline rather than a straight up and down 90 degrees.
  • Elevating leg rests – raise the legs to reduce pain and swelling
  • Seat Cushion – for soft cushioning of the seat
  • Cushion rigidizer – this is a plastic or wood insert that goes under the cushion to give it more support.
  • Back Cushion – for better back support but make sure it folds with the chair or removes easily
  • Lightweight – lightweight wheelchairs are easier and more comfortable to propel.

The items in this checklist are ideal to get the most comfort out of a wheelchair. These features need to be balanced with the patient’s needs, the insurance requirements if applicable or the financial ability of the elderly or their caregiver. For other wheelchair buying suggestions, check out my online wheelchair buying guide.

Drive Medical Cruiser X4 Lightweight Dual Axle Wheelchair with Adjustable Detachable Arms, Full Arms, Elevating Leg Rests, 18" Seat

This manual wheelchair has nearly all the adjustments and option I recommend to make a wheelchair comfortable for its users. Here is a rundown of all the adjustments that can be made with this wheelchair – straight out of the box!

  • Upholstery – durable and easy to clean nylon.
  • Arms – height adjustable by use of a simple lever. This makes adjustment easy to do on the fly. The arms also flip back out of the way for transfer,
  • Back – also height adjustable in a range of 16″ to 18″. Adjustment is made by removing a bolt on each back cane and putting it back in a different setting. It is NOT angle adjustable but it does have back canes with a bend in them that keeps the push handles out of the way.
  • Elevating leg rests – included and have a tool-less length adjustment. They also swing out of the way for transfers
  • Wheelchair height – adjustable by moving the wheels and casters to lower or raise the wheelchair.
  • Seat Depth – the chair is adjustable from 16″ to 18″ deep without additional parts.

These adjustments may seem intimidating but are not. Someone with basic mechanical skills and tools will be able to make these adjustments. Most do not require tools! The manufacturer has an adjustment guide to help.

This chair is also affordable at less than $200 for 16″ wide and 18″ wide and less than $250 for 20″ wide. To figure out which size width you need, measure the user’s hips while seated upright and add an inch or two.

Add on a Cushion…

Drive Medical Molded General Use 1 3/4" Wheelchair Seat Cushion, Black, 18" x 16" x 1. 75"

I recommend adding this cushion to the wheelchair for max comfort. This is a low-maintenance cushion that is easy to clean and has a slight contour shape to keep the legs in line.

Be sure to order the correct width to match your chair width! These also make great gifts for existing wheelchair users.

and a Back Cushion

DMI Relax-a-Bac - Best Selling Lumbar Back Support Cushion Pillow with Insert and Strap Recommended by Chiropractors to Properly Align the Spine and Ease Lower Back Pain, Black


I considered many wheelchairs for this guide but found this was the only wheelchair available online that met all my recommendations. I am continuing to research this topic because I would love to give you more than one product to consider!

Do you have any tips for making a wheelchair more comfortable? Have you used a wheelchair that you thought was comfortable? Help my readers out by leaving the details in the comments below!

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