There are several exercises which allow for greater ease of transfers and walking (pre-prosthesis fabrication) after a below the knee amputation. A patient should consult their physician to determine when exercise can be initiated after surgery. Listed and described below are 8 exercises which stretch and strengthen the legs. Under the order of a physician, a physical therapy evaluation can be helpful to determine the individual's problem areas so far as strength, range of motion and functional mobility (transfers, walking, stair climbing). Number of repetitions, frequency of exercise and resistance (i.e. ankle cuff weights) will vary pending the individual's current endurance and strength. Exercises should not be painful.
1) Long Arc Quad: In sitting (preferably in a chair with a back rest and arm rests for support and safety), patient slowly straightens the knee by tightening thigh muscle until knee is fully extended. After holding the end range position for a few seconds, the knee is bent and leg lowered in a controlled manner.
2) Straight Leg Raise: Lying on your back with the opposite leg bent. Patient slowly raises leg to the height of the uninvolved knee with the knee as straight as possible. After holding at the top for 2-3 seconds, leg is slowly lowered back to the bed, making sure the involved knee stays straight.
3) Hip Extension: Lying on your stomach. Leg is raised to slightly above the plane of your body with the knee straight. This exercise should not strain your back, if so, do not lift the leg as high.
4) Quad Set: Sitting or lying with the knee straight, tighten the thigh muscle until the knee is as straight as possible. Hold 5 seconds. Rest. Repeat.
5) Prone Hamstring curls: Lying on your stomach. Bend your knee with the muscles in the back of the thigh slowly. When straightening the knee and lowering leg back to the bed use a slow, controlled motion.
6) Pillow Squeezes: Can be done with knees bent or straight pending patient comfort. Place folded pillow between the knees. Using the inner thigh muscles to squeeze the pillow holding 5 seconds. Rest. Repeat.
7) Hip Abduction: Lying on your side, lift the top leg up and outward about 45 degrees from the other leg. You do not have to kick the leg out too high. Keep your hips and knees straight.
8) Bridge with Towel Roll: Lie on your back and place a large towel roll under the residual limb to support it. The opposite leg should be comfortably bent with foot flat on bed. Squeeze the hip muscles and lift hips up from the bed. Hold 5 seconds, then slowly lower to the bed.
Stump Wrapping: If the patient is a candidate for eventual prosthestic fitting and training, the physician may recommend ace wrapping the residual limb to shape it. Due to post-operative swelling, the residual limb becomes round and bulbous at the end. Patient and caregiver training in the inpatient setting regarding stump wrapping can be helpful to start cone shaping the residual limb. A patient should consult his/her Physician to determine if stump wrapping is appropriate.
All illustrations are from 1989 Therapy Skill Builders with permission to reproduce for instructional use. Next month's article will discuss prosthetics and training with walking after a below the knee amputation.
