Transtibial amputee and U.S. Army Ranger, Sgt. 1st Class Joseph Kapacziewski deployed to Afghanistan four times after his amputation in 2005. Warrant officer Jonathan Holsey, also a transtibial amputee, runs two to three miles a day with his prosthetic leg to stay fit for his position in the Third Military Police Group. Thanks to advances in surgery and prosthetics, military amputees can achieve incredible functional gains. While a great deal of your recovery requires individualized training with physical and occupational therapists, there are some exercises you can do on your own to aid your recovery.
Short-Term Goals
In the first two to four weeks after your trans-tibial -- or below-the-knee -- amputation, "the goals are to promote healing, preserve knee-joint mobility and desensitize the limb," says Dennis Lesch, physical therapist and faculty member at Bellarmine University. Appropriate strengthening, stretching, and desensitization exercises play an important role in achieving these goals. Consult with your physician for specific instructions, as too much exercise or performing the wrong exercise can actually delay healing.
Strengthen the Affected Limb
Effective use of a lower-limb prosthesis requires significant strength in the quadriceps, hamstrings, hips and gluteal muscles. To address this, perform one set of 10 to 15 repetitions of the following exercises: isotonic quadriceps extensions; straight-leg raises, short-arc quadriceps extensions; supine hip adductions; long-arc quadriceps extensions; and hip-abduction in side lying. As your strength improves, increase the number of sets performed up to a maximum of three and increase the intensity by adding weights when possible.
Maximizing Flexibility
Loss of flexibility and range of motion -- or ROM -- of the knees and hips has a huge impact on the way your prosthesis fits and how well you can use it. Daily stretching aids you in achieving the knee and hip ROM needed to maximize your function. To begin, perform one to two repetitions of each of the following: stretches; seated hip adductions; side-lying hip abductions; the hurdlers stretch; and prone-hip flexion. Hold each stretch for 15 to 30 seconds, and as you improve, add additional exercises.
Desensitizing Your Limb
The Amputee Coalition of America reports that regularly massaging, tapping and performing desensitization exercises on your residual limb increases your tolerance to touch and pressure while decreasing phantom-pain sensations. Using a gentle kneading motion, massage the limb three to four times a day for five minutes. Be extremely careful around the sutures. Tap your residual limb three to four times a day for one to two minutes. Using your fingertips, gently tap around and -- if allowed -- on the suture line. Practice the following desensitization exercises two times a day for two to three minutes. In the beginning gently rub a cotton ball over the limb in a circular motion. As tolerated, you can progress to using rougher materials like a paper towel or bath towel.
Continued Recovery
Exercise plays a huge role in the recovery from a transtibial amputation. In addition, as rehabilitation techniques and prostheses development improve, there are fewer and fewer limitations to your function. For example, David Van Sleet, organizer of the Wounded Warrior softball team, put it this way: "I really think we are going to show the country that these guys got injured, had a limb amputated, were rehabilitated, and can now do a remarkable, skilled, physical activity."
References
- "Army Times"; Amputee NCO Honored for Selfless Service; Michelle Tan; June 2001
- U.S. Army; Army Amputee Runs on Inspiration; Alexandra Hemmerly-Brown; June 2011
- Dennis Lesch, physical therapist; Bellarmine University; Louisville, Kentucky
- "Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles"; John W. Michael, editor; March 2002
- Amputee Coalition of America: Wound and Skin Care
- "Sports Illustrated"; Courage on the Diamond: The Wounded Warrior Softball Team; Holly Krivokapich
