Our bodies have ways of adapting to situations to ensure we meet our short term goals. While the path of least resistance may seem like a sure direction at the start, it can often impede us from achieving our long term goals. This can be seen with prosthetic gait deviations.

New unilateral prosthetic users often stand with their unaffected leg close to midline/under their body to increase sense of security and balance. While this may seem to create stability, it promotes poor posturing of the pelvis.1 The muscles become accustomed to this position and do not activate to provide stabilization and leveling of the pelvis and hip girdle.  This narrow base of support often continues even when the prosthesis is introduced leading to decreased weightbearing through the prosthesis. Without this downward force through the residual limb, osteopenia can occur (i.e., loss of calcium and bone mass; risk factor of osteoporosis).2

Over time, the sound leg will start to turn out, further accommodating to increase stability. This leads to rotational forces at the knee joint with walking. The repetitive torque applied to the knee can lead to osteoarthritis with associated swelling and pain2. Thankfully, most of this can be prevented.

Self-awareness leads to better understanding. Try looking in a long mirror when standing to see how you position your prosthesis. Perhaps, have someone film your gait so you may see how you walk. Without a doubt, learn to engage your hip abductor muscles with ambulation by trying the clamshell exercise.3 These muscles are often overlooked, but they are vital to stable, energy efficient gait.

Clamshell Exercise

This can be performed with your prosthesis on or off; the set-up just changes slightly. Lay on your sound side ensuring you are not tipped forward or backward (top hip should be pointing towards ceiling). Slightly bend your hips and knees (unlock prosthetic knee joint as applicable) and place your prosthetic foot on top of your unaffected foot.

Tighten your buttocks muscles and slowly raise your prosthesis towards the ceiling keeping feet in starting position. You will be opening your legs like a clam shell.  Perform 2-3 sets of 15-20 repetitions moving slowly and watching your form. Be sure to repeat exercise for both hips, go slowly, remember to breathe and watch your technique.

Wish to try without your prosthesis? Keep your top leg extended and lift straight up to the ceiling rather than opening like a clam. Too hard? Decrease the number of repetitions and increase the number of sets (e.g., 4 sets of 10 repetitions). Too easy? Wrap a looped exercise band around your thighs to add resistance as shown.

More to come on self-correcting compensatory gait deviations…

References

  1. Tojumi, Anis, et al. “Standng Posture and Balance Modalities in Unilateral Transfemoral and Transtibial Amputees.” Journal of Bodywork and Movement Therapties, vol. 27, 2021, pp. 634-639.
  2. Gailey, Robert, et al. “Review of Secondary Physical Conditions Associated with Lower-Limb Amputation and Long-Term Prosthesis Use.” Journal of Rehabilitation Research and Development, vol. 45, no. 1, 2008, pp. 15-30.
  3. Wilhoite, Sydni, , et al. “Rehabilitation, Guidelines, and Exercise Prescription for Lower Limb Amputees”. Strength and Conditioning Journal, vol. 42, no. 2, April 2020, pp. 95-102. doi: 10.1519/SSC.0000000000000523
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