Your activity level may go down for reasons out of your control like seasonal weather changes, illness, or mandated stay-at-home restrictions. Prolonged inactivity can alter the fit of your prosthesis, which can limit mobility until you have had it refit. An at-home exercise routine can help maintain your strength, the fit of your prosthesis, and overall independence.
Get Strong by Focusing on the Glutes
“It’s all about the butt, ” said Cosi Belloso, a physical therapist who specializes in working with amputees. She frequently uses this no-nonsense phrase on Cosi Talks, her live Facebook broadcast for amputees and clinicians. Whether it’s a relatively new amputee or someone who has used a prosthesis for years, the glutes are often weak and underutilized even though they provide much of the body’s power and stability.
While you work the glutes, the hamstrings, quadriceps, IT band, inner thigh, and lower back are often activated, too. So if you’re looking to maintain the fit of your prosthesis from home, working the glutes with the following three exercises can also touch on other important lower body muscles.
Every amputation and residual is different, so there are suggested modifications with each exercise. There are also tips on how to put a routine together to accommodate your fitness level.
Before you begin, keep in mind that a prosthesis puts extra pressure on the skin and contributes to added heat and perspiration inside the liner or sock. You’ll need to take extra care of your skin to maintain its integrity. Daily use of a gentle cleanser and skin moisturizers prevent bacterial or fungal infections and keep the skin supple. You can also use a liquid-to-powder product to create a protective barrier that reduces and prevents chafing.
Bridge Exercise (Hip Thrust)
- Lie on your back with arms at your sides and palms against the floor.
- Place the feet under the knees, hip-width apart.
- Tighten the abs and glutes as you press your heels into the floor, raising the hips until you create a straight line from the knees to the shoulders.
- Hold this position until the glutes start to feel tired then release.
Pay attention to muscle balance as you bridge. Your amputation side glute should bear as much weight as the non-amputation side.
Modifications: Add some cardio into the mix by doing bridge exercises in quick succession, but make sure to use good form. Another option — as you raise into the bridge, straighten one leg, holding the bridge with a single stabilizing leg. You can hold at the bridge’s peak or do quick reps for a cardio boost.
- Stand with your back against the wall, feet hip-width apart.
- Slowly lower yourself down, keeping your back against the wall until you reach a sitting position.
- Hold until the glutes and quads feel tired, then slide up and release.
Modifications: You don’t need to go into a full squat to reap the benefits of this classic move. Start by supporting yourself with sturdy furniture on either side and only go down as far as you can safely and comfortably hold the squat.
For an extra challenge, skip the wall altogether, and opt for a single-leg squat. Be sure to keep your back straight as you lower and hold until the muscles begin to feel tired.
Clamshell (Side-Lying Abduction)
- Lie on your side, resting your head on the floor-side arm or supporting it with the elbow and cradling the head in the hand.
- With knees together, bend them to about a 45-degree angle, but keep the heels in line with the spine.
- Keep the heels together as you flex the glutes and raise the top knee toward the ceiling.
- Lower the knee and repeat.
Your prosthetic will add quite a bit of resistance until you get used to this exercise.
Modification: Lie on your side with both legs straight. Tighten the glutes and lift the top leg, keeping the glutes and foot flexed with the knee facing forward.
Put Together Your Routine
Now that you’ve got some exercise ideas, it’s time to put together a quick at-home routine. Belloso helped out here, explaining that, “in order for the muscles to be strengthened, you have to apply the Overload Principle.” In order for a muscle to get stronger, it must perform a higher workload than it’s used to doing. In other words, you have to challenge the muscle.
When a muscle does a challenging strength exercise, it actually creates tiny micro-tears in the muscle fibers. At that point, you start to feel muscle fatigue or a slight burn in the muscle. These little tears heal once you’re at rest, and the muscle fibers heal stronger. The key is what Belloso calls the "Goldilocks Method" — not too much, not too little. Too much force on the muscle can lead to injury. Too little and you’re in the same place you started.
Everyone is at a different fitness level and has unique strengths and weaknesses surrounding their amputation. Belloso warns against a “cookie-cutter approach” to reps and sets, instead suggesting, “...doing the exercise [repetitions] until you fatigue then do more sets at that repetition.”
For example, begin by doing ten repetitions. If the muscle starts to feel tired at rep nine or ten, stay at ten repetitions for three sets. If the muscles feel tired at rep six or seven, do three sets of seven reps. If the muscles are fatigued after two sets, stop after two sets.
For bridges and squats, you can also try holding them for a specific time. At first, you may only be able to hold the position for five to ten seconds. Try to add a second or two every day, slowly working up to one minute. You can add time, repetitions, sets, or resistance (hand weights or resistance bands) as you get stronger.