A–C: Valid targets for (a) foil, (b) epee, and (c) sabre . Permission for use granted by IWAS (©IWAS)
Holding the Weapon
The hand cannot leave the weapon handle or slip along the handle during an offensive action . If a special device or attachment is on the handle, or there is a special shape to the handle, the upper surface of the thumb must be in the same plane as the grove in the blade (at foil or at epee) and perpendicular to the plane of flexibility at the blade of sabre . The weapon must be used with one hand only, and the fencer cannot change hands until the end of a bout, unless the referee gives special permission, for example, due to injury . Fencers with loss of grip or poor strength in weapon hand may bind the weapon to their hand with the approval of two IWF classifiers .
On Guard: Beginning, Stopping, and Restarting a Bout
Competitors are always put on guard in the upright position (sitting upright in the center of the width of their chairs) . The referee will order “On Guard!” and then asks “Are you ready?”. Without any objections, the command “Play!” is given. A bout stops on the word “Halt!”. This may occur if one of the competitors is disarmed and loses balance or if the fixation of a wheelchair or ground cable to the epee aprons is unfastened .
Lifting from the Chair and Balance
A fencer’s foot cannot leave the wheelchair footrest or use the floor to gain advantage during play . A fencer cannot leave the wheelchair seat except one buttock off the seat is allowed . If a fencer loses balance or becomes unfastened in the chair, “Halt!” is called. Importantly, a hit scored before balance is lost is valid .
Stoppage: Wheelchair Damage and Injuries
If wheelchair damage occurs, the referee allows a maximum of 10 min to fix the chair. If the fencer cannot continue to fight, the referee will determine if the fencer should retire (in individual event) or be replaced (in team event) .
If a disability-related event occurs (such as a muscle spasm), the referee may allow time for recovery (without time restrictions) but also must be sure athletes are not taking unfair advantage of this . If an injury occurs during a bout and is properly assessed by an IWF delegate or physician, the referee can allow a 10 min break for evaluation . After evaluation and treatment of that injury only, the doctor will determine if the athlete should continue . That fencer should not have another break during that day, unless another and different injury occurs . If the fencer cannot finish a bout due to injury, they can still participate in other bouts that day, but only if given permission by the physician .
Field of Play
The field of play on which all wheelchair fencing competitions occur is called a piste. It is an even surface with a fencing frame on it for the fixation of the two wheelchairs to the piste. The frame must be arranged in a way to enable fencers to fence with their preferred fencing arm  (Picture 17.2). There is also a ratchet strap that secures the front of the chair so it will not tip . The distance between the fencers on the piste is determined prior to the start of the match using each player’s arm length with weapon in hand . In the case of fencers with unequal arm length, the fencer with the shorter arm may chose a distance that lies in between his and his opponent’s distance. Fencers with restricted arm movements (within Category C) will determine the measure by reaching a point 10 cm beyond the inner forearm for foil or 10 cm inside the outer edge of the elbow for sabre and epee .
The wheelchair back and seating can be rigid or flexible . The wheelchair can be a maximum of 53 cm from the floor to the seat rail, and it cannot exceed 3 cm from the fencer’s hip when they are in the center of the wheelchair. The back of the wheelchair must be a minimum height of 15 cm from the seat of the wheelchair or the cushion when the fencer is sitting on it. It must be 90° to the horizontal. If the fencer requires the need for a different material or different angle for the back of the wheelchair, it must be pre-approved . A side-guard cannot be used on the fencing arm side of the wheelchair. The side-guard on the non-fencing arm must meet a minimum height from the seat of the chair and minimum length from the back of the chair, available for review from the materials handbook . If a cushion is used, it cannot be rigid or wedge shaped and must have an even thickness . Camber may be added to the wheels to facilitate turning; however, the wheels must fit within the fencing frames . Fencers can elect to use a grab handle for the unarmed hand . Belts can be used to fasten the legs or unarmed hand, as long as it is not elastic and does not cover the valid target . For athletes with deficiency of a lower limb, the prosthetic legs must be removed for competitions .
Recall that there are three weapon categories: foil, sabre, and epee. The foil is a thrusting weapon and is a maximum weight of 500 g . Epee is also a thrusting weapon, like the foil, but heavier (maximum weight 770 g) . Sabre utilizes a light cutting and thrusting weapon and the maximum weight of the sabre is 500 g . For specific information on weapons, gloves, masks, bodywire, and jackets, reference the IWF Rules for Competition, Material Rules .
Classification Process for Wheelchair Fencing
Athletes that participate in wheelchair fencing must have lower limb impairments. Commonly athletes have spinal cord injuries, cerebral palsy, or limb deficiency (congenital or amputations). Athletes must undergo a series of functional and technical tests (Fig. 17.1, Picture 17.3) in order to be placed into one of five sports classes that is further subdivided into three categories (A, B, and C) Fig. 17.2 . There is also “Bench Testing” available for fencers with spinal disabilities, fencers with spasticity, athetosis and dystonia, and orthopedic injuries that may result in lack of range of motion .
There are no definitive studies on the specific biomechanics of wheelchair fencers in the offensive and defensive positions compared to able-bodied fencers. Studies in able-bodied fencers typically focus on the lunge and lower body mechanics with regard to performance, which would not apply to the wheelchair fencers . Wheelchair fencers rely strictly on their upper body and trunk for competitions. One could speculate that the repetitive asymmetrical activity of wheelchair fencers could lead to upper body functional asymmetry, similar to that seen in able-bodied fencers . Between this asymmetry and poor trunk control (lack of the kinetic chain), the upper extremity shoulder girdle and scapular muscles may be prone to overuse injuries . This may be a contributing factor to why wheelchair fencers have frequent injuries to their upper limbs .
Common Injuries and Injury Prevention
Common Wheelchair Athlete Injuries
Common wheelchair athlete injuries are summarized in Fig. 17.3 and expanded on in this section. For review of studies looking at injuries specific to wheelchair fencers, see section “Wheelchair Fencing Injuries” in this chapter.
Common wheelchair sport injuries (For references, please refer to text)
Upper Limb Injuries
In general for wheelchair sports, upper limb injuries are most commonly reported. A 1991 study reported injuries commonly occurred in the hand (20%), followed then by the shoulder (15.5%), fingers (11.1%), and arm (10%) . Another study, looking at only wheelchair athletes in track and field, wheelchair basketball, quad rugby, fencing, table tennis, tennis, and volleyball, similarly demonstrated soft tissues injuries commonly occurring in the shoulder (18%), followed by the arm (12%) and the wrist (12%) . The general consensus within the adaptive sport literature is that injuries most commonly involve the shoulder, ranging between 15  and 72% with the highest incidence in female wheelchair basketball players [8–10]. In those with arm injuries, the most likely diagnosis was muscle strains (52%), tendinopathy (30%), bursitis (15.6%), and contusions [6, 7]. Interestingly, a 2012 Summer Paralympic study, which included all adaptive athletes (wheelchair and non-wheelchair users), determined that irrespective of impairment type, the upper limb accounted for 50.2% of all injuries, with shoulder being most common (17.7%), followed by the wrist/hand (11.4%) and elbow (8.8%) [11, 12].
In wheelchair athletes, it appears chronic injuries (35–60%) may be more likely than acute, but this could be sport and study specific depending on the definition of acute versus chronic and methods to collect data [13–15]. Upper limb nerve entrapments are also common, specifically median mononeuropathy (50%) at the wrist and ulnar neuropathy (25%) at the wrist .
While the shoulder may be the most common site of reported pain in wheelchair athletes, the actual site of pathology in one study was determined to be the cervical and thoracic spine (59 and 8%, respectively), suggesting common referral of pain to the shoulder . This stresses the importance of a thorough physical examination.
Soft Tissue Injuries
Soft tissue injuries are often reported to include sprains, strains, and tendinopathies of the shoulder, elbow, arm, and hand, as well as blisters (74%) abrasions (68%), lacerations (12%), and decubitus ulcers (8.9%) . Another study reported blisters and skin lacerations accounting for up to 35% of reported injuries . Recall that the likely mechanism of blisters, abrasions, and lacerations (when there is not a collision involved) is contact of the hand or wrist with the chair rim. Since these may require minimum medical care, they may even be under reported .