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Back Pain with Lower Limb Loss1-5  

Back pain is the worldwide leading cause of disability and a common occurrence following lower limb loss. As high as 75% of individuals report low back pain (LBP) within 3-plus years following lower limb amputation. Various factors contribute to this secondary disability. Altered body biomechanics and unwanted forces are caused by asymmetries in gait & leg length plus decreased strength of spinal extensors leading to increased anterior tilt of the pelvis. Individuals report feeling “uneven posture” and fatigue with functional activities resulting in uneven movements and compensatory strategies.  Physical and mental status play a large role as well.

Exercise Reduces Low Back Pain5-9  

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Individuals with lower limb loss who regularly exercise report less back pain.  Those who complete resistance exercises have indicated as much as 60% less pain. Exercise promotes positive health outcomes, reduction of secondary disability and improved coping following limb loss. Resistance exercises, such as Pilates, have shown strong potential to help mitigate the altered mechanics with lower limb loss. Improved neuromuscular control, increased core strength and improved gait have been noted with the use of resistance exercises. Additionally, incorporation has shown lasting pain reduction with greater ability to complete activities of daily life compared to pain medications alone.

Resistance exercise includes a variety of methods targeted to strengthen key muscle groups particularly one’s core including the hip abductors. Weights can be used in the forms of machines, vests, free weights to simply one’s body weight. Resistance bands are another helpful and accessible tool. Exercise modifications can be made based on the level of amputation. Individuals with LBP following limb loss must be mindful to avoid exercises that cause the pain to spread to the arms and legs.

Unsure of which exercises to use? Contact your Physical Therapist. Unsure if your prosthesis can accommodate your level of exercise? Contact your Prosthetist.

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Self-acceptance and Emotional Well-Being10-14  

Quality of life is a vital component of healthy living. Unfortunately, lower limb loss associated LBP has been shown to decrease health related quality of life. Individuals may experience concomitant anxiety, depression, decreased sense of self and fear avoidance. Self-acceptance has been shown to be integral to one’s management and prevention of LBP, coping and mental well-being following limb loss. Finding the right support system can help one to identify positive approaches to well-being and avoid harmful maladaptive coping strategies. Thankfully, there is a bevy of reputable LLLD support connections. The Amputee Coalition Certified Peer Visitor Program is a well-known source where one can find one-on-one support, real-world experience and information about chapters in your area. Get connected today!

References:

  1. “Low back pain.” World Health Organization, https://www.who.int/news-room/fact-sheets/detail/low-back-pain
  2. Reichmann, James P. and Bartman, Kimberly R. “An Integrative Review of Peer Support for Patients Undergoing Major Limb Amputation.” Journal of Vascular Nursing, vol. 36, no. 1, 2018, pp. 34-39. https://doi.org/10.1016/j.jvn.2017.10.002 
  3. Sadowski, Piotr K., et al. “Low Back Pain in People with Lower Limb Amputation.” Spine, vol. 47, no. 22, Aug. 2022, pp. 1599-606. https://doi.org/10.1097/brs.0000000000004422 
  4. Wasser, Joseph G., et al. “Potential lower extremity amputation-induced mechanisms of chronic low back pain: role for focused resistance exercise.” Disability and Rehabilitation, vol. 4, no. 25, May 2019, pp. 3713-21. https://doi.org/10.1080/09638288.2019.1610507 
  5. Devan, Hemakumar, et al. “Perceptions of low back pain in people with lower limb amputation: A focus group study.” Disability and Rehabilitation, vol. 37, no. 10, Aug. 2014, pp. 873-83. https://doi.org/10.3109/09638288.2014.946158 
  6. Wnuk-Scardaccione, Agnieska, et al. “Exercise Therapy in Nonspecific Low Back Pain among Individuals with Lower-Limb Amputation: A Systematic Review.” Life, vol. 13, no. 3, Mar. 2023, p. 772. https://doi.org/10.3390/life13030772 
  7. “Discover Adaptive Pilates Exercises that Improve Flexibility and Mobility.” Adaptive Amputees, https://youtu.be/vmssHrv-2Hw?si=SNDon2QnNcR8ifxZ
  8. “Choose PT.” American Physical Therapy Association, https://www.choosept.com/find-a-pt?utm_source=ECHO&utm_medium=GDN&utm_campaign=find-a-pt&utm_content=DISPLAY&gad_source=1&gad_campaignid=22480667758&gbraid=0AAAAA-aH3eVXsoPxQvlx2vNo1hUFOMSmW&gclid=CjwKCAjw7rbEBhB5EiwA1V49nckat5Q_Xtw6bhOxw2gZl2D5khE5gDWmkYbY_pLtP4mHBBkeeZ1aYxoC7NUQAvD_BwE
  9. “Locating a Certified Prosthetist.” Amputee Coalition, https://amputee-coalition.org/resources/locating-a-certified-prosthetist/
  10. Serbic, Danijela, and Tamar Pincus. “The relationship between pain, disability, guilt and acceptance in low back pain: A Mediation Analysis.” Journal of Behavioral Medicine,  vol. 40, no. 4, Feb. 2017, pp. 651-58. https://doi.org/10.1007/s10865-017-9826-2 
  11. Withey, Alexandra, et al. “Exploring the associations between the biomechanical and psychological mechanistic pathways of lower back pain development amongst persons with lower-limb amputation: A study protocol.” Apr. 2024. https://doi.org/10.21203/rs.3.rs-4143760/v1 
  12. Amorelli, Catrinna, et al. “Amputees Unanimous: A 12-step program.” Prosthetics and Orthotics International, vol. 33, no. 3, pp. 293-300. https://doi.org/10.1177/0309364619836027
  13. “Strength in Numbers.” The O&P PT, https://oandp-pt.com/strength-in-numbers/
  14. “Certified Peer Visitor (CPV) Program.” Amputee Coalition, https://www.amputee-coalition.org/support-groups-peer-support/certified-peer-visitor-program/

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