01 Dec How to keep moving after lower-limb amputation
More than 8,000 lower-limb amputations are performed each year in Australia. Men are more than twice as likely to undergo a lower-limb amputation compared to women, more than half will be over 60 years old, and half of these will also have type 2 diabetes.
The most common causes for lower-limb amputation include:
- type 2 diabetes
- vascular disease
- birth defects
Some individuals will also undergo amputation following multiple failed surgeries, in the hope of greater functional outcomes.
Depending on the circumstances, an amputation may be performed above-the-knee (transfemoral), below-the-knee (transtibial), partial foot (excluding toes), or at the toes.
THE BENEFITS OF EXERCISE
Regular exercise has a multitude of powerful health benefits for the general population, and these same principles and physiological benefits apply in the exact same way following an amputation.
One of the primary complaints following a lower-limb amputation is reduced balance, as well as inactivity and difficulty completing everyday tasks. Further, these individuals also tend to experience significant losses in lower limb strength, bilaterally.
However, individualised exercise treatment can help an individual with an amputation in the following ways:
- improved muscular strength
- improved walking performance
- greater quality of life
- reduced use of pain medications
- reduced pain severity
- reduced impact of an amputation on daily life
THINGS TO BE AWARE OF
Many individuals with a lower limb amputation have difficulty engaging in daily and social activities, due to a commonly-shared fear of falling. Following an amputation there are many physical challenges, as well as increased stress. These commonly include musculoskeletal pain, avoidance of physical activity and lower back pain (occurring in over half of single-limb amputees).
For those with a single-limb amputation, individuals often experience movement asymmetry, increased wear and tear on joints, leg length differences, muscle loss and strength loss. Together, this increases the strain on the body to complete everyday activities. Further to this, limb and muscle loss changes movement strategies, reduces movement efficiency and increases the demand on remaining muscles to carry out movements.
The higher the level of amputation, the harder the body has to work to move safely and effectively.
Individuals with amputation experience several key changes to movement including:
- greater work by the hips, e.g., twisting, shifting and hiking the hips
- increased work by the calf muscles on the remaining limb
- greater side-bending and extending through the lower back
- reduced knee range of motion on the side of the amputation
- differences in leg length i.e., remaining limb vs. prosthetic leg
- differences in lower limb weight i.e., remaining limb vs. prosthetic leg
TYPES OF EXERCISE RECOMMENDED
The long-term goal for individuals following amputation is to optimise physical function and independence with daily living activities, e.g., stair climbing, walking and prolonged standing.
The basic principles of exercise recommendations for individuals with an amputation are the same for those of the general population, and aim to improve function and reduce chronic disease:
- Aerobic exercise: 30-60 minutes of moderate intensity exercise 5 days per week, or 20-60 minutes of vigorous intensity exercise 3 days per week.
- Strength exercise: 2-3 days per week.
- Neuromotor training: This is also known as functional training and is recommended 2-3 days per week. This includes balance, agility, coordination and body awareness training. This area of training is the most important component for an individual with an amputation.
Individuals with an amputation show the same ability to improve their overall fitness compared to the general population. Research has shown that for amputees, with the goal to return to running, regular and individualised exercise treatment improves hip strength and movement quality enough to allow safe running. However, more importantly, without ongoing training of these skills, these individuals show a loss of skill and commonly return to being prosthetic walkers only.
SPEAK TO THE EXERCISE PROFESSIONALS
Every individual with an amputation is different which means your exercise regimen should take that into account! If you are looking to rehabilitate after surgery, are only just returning to exercise, or need help with specific issues, an Accredited Exercise Physiologist will be your best source for information, guidance, and support to develop an exercise program that is safe, effective and enjoyable.
Click here to find an Accredited Exercise Physiologist near you.
Expert contributor: Jessica Bitzios (nee. Coy) , Accredited Exercise Physiologist at Combined Wellness Solutions