Shortening of the muscles and ligaments in your hips and knee is a common complication of transtibial amputation. Prolonged sitting in a wheelchair results in flexed hip and knee contracture. Active participation in your rehabilitation is essential to maintaining flexibility and range of motion in your hips and involved knee. Your physician will recommend stretching and strengthening exercises that target your knee and hip joint, promoting range of motion and muscle strength. Speak with your physician before starting an exercise program.
Knee Extension Exercises
A common complication of transtibial amputation is flexed knee contracture. The muscles and ligaments surrounding the involved knee joint shorten, causing the knee to develop a flexed or bent contracture. This results in reduced flexibility and range of motion in the knee joint. A flexed knee contracture destabilizes the pelvis, making it difficult to walk in a prosthesis. To prevent flexed knee contracture, your physician will recommend a variety of knee extension exercises, such as a straight leg raise, inner range quadriceps, static quadriceps and an alternative hip flexor stretch. A simple knee extension exercise that you can begin with is to sit upright in your bed and push the knee of your involved leg into the bed, ensuring that the knee is flat or extended. Once your master this knee extension exercise, you can progress to other knee extension exercises.
Knee Flexion Exercises
In addition to knee extension exercises, your physician will also recommend knee flexion stretches. When combined with knee extension exercises, knee flexor exercises promote flexibility and range of motion in your knee joint. It strengthens the quadriceps and hamstring muscles, and promotes coordination and balance. Knee flexion exercises that your physician may recommend include knee flexion in prone position, knee bending, hamstring stretch and sitting knee flexion and extension. Perform this simple knee flexion exercise lying face down in your bed with both legs extended behind you. Bend the knee of your involved leg as far as possible and hold this knee flexion for five seconds. Follow your physician's instructions when performing knee flexion exercises.
Hip Flexion Exercises
Stretching the ligaments and tendons in your hip joint is essential for preventing flexed hip contracture. Flexed hip contacture is typically seen in patients who sit in a wheelchair for prolonged periods or have muscular imbalance in the lower extremity as a result of amputation. Your physician will recommend a variety of hip flexion exercises, including variations of hip extension exercises to stretch your hip flexor muscles. One way to perform a hip flexion exercise is to lie supine on a flat surface, bend both knees and bring both legs toward your chest. When your uninvolved knee is close to your chest, slowly lower your affected leg to the flat surface. This stretches your hip flexor muscles and promotes flexibility and independence.
Hip Abduction and Adduction Exercises
Strengthening your hips, torso and abdominal muscles is an essential part of the rehabilitation process. Your physician will recommend an array of hip abduction exercises to strengthen and stabilize the muscles in your involved knee and hips, and enable you to walk in a prosthetic leg. In addition to abduction exercise, your physician may also recommend a pelvic tilt, partial situp, bridging and static gluteal contractions to strengthen your abdominal and lower back muscles. Strengthening these muscles is essential for maintaining mobility and independence, and reducing your injury potential. Perform a side lying abduction exercise to target and strengthen the muscles in the side of your hips, and to help stabilize the pelvis. Lie sideways with your involved leg on the topside of your body. Lift your residual leg away from your uninvolved leg and toward the ceiling. Hold this position for five seconds and repeat 10 times.
References
- Orthotics and Prosthetics Information: A Manual for Below-Knee (Trans-Tibial) Amputees
- Disaboom; Rehabilitation; Paul H. Lento, M.D.
- Ohio State University Medical Center; Below Knee Amputee Exercise Program
- International Society for Prosthetics and Orthotics: PhysioTherapy Exercises Following Transtibial (Below Knee) Amputation
- Premier Prosthetic Center: Below-Knee Amputee Home Exercise Program
- East Kent Hospitals University NHS Foundation Trust; Exercises Following Transtibial (Below Knee) Amputation; August 2010
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