Your physician will work closely with you after lower leg amputation to restore strength to your lower limb muscles and hips and restore flexibility in your hips and knees. Flexed hip and knee contracture is a common complication of lower extremity amputation. Your physician will recommend strengthening, stretching and range of motion exercises to stretch and strengthen the ligaments, tendons and muscles in your hips and knees, as well as promote muscular tone and strength, balance, coordination and flexibility.
Stretching Exercises
A common complication in below and above the knee amputation is loss of range of motion in the hip and knee joint. It is common for the hip and knee to develop a flexed contacture as a result of prolonged sitting in a wheelchair. Prolonged sitting in a wheelchair encourages the development flexed hip contracture as well as muscular imbalance, and thus should be avoided. Your physician will recommend stretches that target the ligaments and muscles surrounding your knee and hip joint. To prevent flex knee contracture, your physician may recommend a straight-leg raise, static quadriceps, inner range quadriceps and hamstring stretches. These knee extension exercises should be mixed with knee flexion exercises such as knee bending to maintain flexibility and range of motion in your knees and prevent joint contracture. Your physician will also recommend exercises that stretch the hip flexor muscles. To maintain flexibility and range of motion, your physician will recommend a hip flexor and adductor stretch as part of your rehabilitation. You may need to place a rolled towel underneath the knee of your involved leg to properly perform these exercises.
Strengthening Exercises
Muscular imbalance in the lower limb can also result in knee and hip contracture. Strengthening the muscles in your hips and lower leg is essential in learning how to walk with a prosthesis. These muscles are vital to stabilizing the knee and pelvis, as well as providing power and force required to walk. Your physician will recommend knee and hip strengthening exercise to promote independence, mobility and to reduce your injury potential. Your physician may recommend variations of hip extension exercises, hip abduction exercises, a pelvic tilt and partial sit up to strengthen your torso, hips and abdominal muscles. Static quadriceps, inner and outer range quadriceps, as well as sitting flexion and extension strengthens the muscles and ligaments in your lower leg, and prevents joint contracture.
Balance Exercises
After a lower extremity amputation, your center of gravity is changed, and thus your balance will also be different. Your physician will recommend exercises that will train your body and brain to improve your balance. These balance exercises primarily revolve around daily activities. You will begin by practicing simple activities such as sitting and reaching for objects such as a cup. You will then progress to kneeling and standing on one leg. As you become comfortable with this, you will progress to standing and turning with side to side, with or without your prosthesis. If you are wearing a prosthesis, practice shifting your body weight onto your prosthetic leg and kicking a ball with your uninvolved leg. Your physician will also recommend other exercises to train the balance center in your brain.
Agility Exercises
In addition to balance exercises, your physician will recommend exercises to improve your agility. These exercises will increase your confidence and ability to move from place to place. Agility exercises that your physician may recommend include throwing or kicking a ball against a wall while sitting. Partner activities such as playing catch or dancing helps improve agility. These physician recommended exercises will be essential in the rehabilitation process and promoting balance and agility.
References
- Disaboom; Rehabilitation; Paul H. Lento, MD
- Orthotics and Prosthetics Information: A Manual for Below-Knee (Trans-Tibial) Amputees
- Orthotics and Prosthetics Information: A Manual for Above-Knee (Trans-Femoral) Amputees
- Ohio State University Medical Center; Below Knee Amputee Exercise Program
- International Society for Prosthetics and Orthotics: PhysioTherapy Exercises Following Transtibial (Below Knee) Amputation
- Senior Step: Keep Moving: Exercises for People with Lower-Extremity Amputations
