Care of your back, hip, knees and shoulders

When you are missing a limb, your problems can go far beyond the fact that you are missing an arm or a leg. If, for example, you have a pre-existing condition, such as decreased circulation in your extremities, or if you experience increased pressure on your residual limb because of a poorly fitting prosthetic socket, you may experience additional problems in that extremity. These potential problems include skin breakdown, infection, and even the need for another amputation higher up on that same limb. But your problems don’t necessarily even end on the residual limb. That missing limb can also lead to a wide variety of additional physical problems and impairments unless you take steps to prevent them. The absence of a limb, may, for example, impair mobility on the affected side, which can then lead to an overuse, compensation or repetitive movement injury in the remaining sound limb or in another part of the body. Areas that are commonly affected are the back, hip, knee and shoulder. And these injuries can really be a pain – both figuratively and literally.

Back Problems – Because the back is so willing to “help out” during daily activities, it is easily injured. The back (usually the lower back) tries to compensate for decreased or abnormal motion of the legs during walking, and this additional stress is sometimes more than the back can handle. If you use a prosthesis, it is, therefore, crucial that you learn to walk properly with it. By making sure that your prosthesis fits properly and participating in gait training with a physiotherapist, you can help ensure that you walk in a way that minimises any negative forces on your back. Though trunk stabilisation and strength are important for everyone, they are even more critical for someone with a lower extremity amputation. A back that is stable and strong is much less likely to be injured. Amputees who use wheelchairs can also develop back problems due to constant static positioning of the trunk, which can result in muscle tightness. Maintaining erect posture throughout the day, stretching your trunk muscles, learning to use your lower extremities whether they are sound or prosthetic, and focusing on exercises for the stomach and back will help you avoid these problems.

Hip and Knee Problems – It is also fairly common for those with a lower extremity amputation to have hip or knee pain in their residual or sound limb as a result of a poor walking pattern or constant positioning. Immediately after a limb amputation, the body quickly attempts to decrease its use of the residual limb because of pain or apprehension. Unfortunately, this attempt to protect the residual limb can be detrimental to the sound limb. When people who use a leg prosthesis swing their leg on their prosthetic side unnaturally to move their prosthetic leg forward, they can injure their hip. In addition, when they try to avoid putting weight on their residual limb to protect it when they walk, they often put increased weight on their sound limb. This additional weight can cause injury to their knee. Today, prosthetic limbs are made to be functional, not to be used as a crutch or an assistive device. Unfortunately, people who don’t know how to walk properly with their prosthesis sometimes use it more like a weight-bearing crutch. Walking with good, equal weight on both the sound and prosthetic leg will assist in decreasing hip and knee pain and perhaps decrease the chance of more debilitating injuries. Physiotherapy to work on gait training and improving muscle balance can help you achieve such a symmetric walking pattern. In addition to using your prosthesis properly, it is essential that you increase your stability and strength in both your residual and sound limb and establish good muscle control in both, regardless of the length of your residual limb. Amputees who use wheelchairs can also develop hip and knee problems due to constant static positioning of their trunk and lower extremities, which can result in muscle tightness. Hip and leg range-of-motion exercises for those who walk and those who use wheelchairs will help you decrease soreness and tightness in your joints.

Shoulder Problems – Overuse and repetitive motions generally cause most shoulder pain, and this pain can be initiated or exacerbated by an upper extremity amputation. Shoulder problems may occur as a result of increased use of the sound limb or constant motions of the residual limb due to prosthesis use. The discomfort or tightness commonly felt between the shoulder and neck in conjunction with shoulder pain can be very problematic. Overhead activities, whether performed daily or during the occasional “weekend painting project”, can increase shoulder pain, especially if the individual has neglected stretching, strengthening and stabilisation exercises of the shoulder muscles, primarily the rotator cuff. Stretching before and frequent breaks during upper body activities can assist in decreasing overall shoulder pain. In addition, a slow, progressive exercise programme that does not increase pain during the exercise, but which may result in a feeling of muscle fatigue for one to two days following it, should aid in decreasing overall pain. Amputees who use wheelchairs, especially manual wheelchairs, should focus on shoulder and arm strengthening exercises as directed by your healthcare provider to assist in reducing pain that may have been caused by propelling your wheelchair.

General Information – Ideally, extremities should be used equally to keep your joints free from pain. Proper muscle function will help strengthen your muscles, prevent injury, and alleviate joint stress. In addition, an active exercise programme will help prevent injury and allow good blood flow to maintain healthy joints. The key is to start slowly and work your way up to performing daily activities and exercises that help reduce the pain in the part of your body that is hurting. Though people with amputations have an increased chance of having joint pain in certain areas, it can be prevented or dealt with through commitment to an active exercise programme.

Tips to Help with Joint Pain

  • Stretch before any activity.
  • Establish a good exercise programme, especially one devoted to your problem areas. Enquire about aquatic exercises, which can be easier on the joints.
  • Be aware of your posture, whether you are at rest or active. Ask yourself questions like, “How’s my posture? Am I standing up straight, or am I slouching, putting extra stress on my back? Where is my weight in standing? Is it on both legs equally, or am I shifting my weight often enough to relieve stress on the joints?”
  • Get proper education and therapy in walking with prosthetic legs, using prosthetic arms, using a wheelchair, and/or increasing functional independence of your residual limbs.
  • Maintain a well-balanced diet, and enquire about a weight-reduction diet with a physician if you are overweight or obese. Obesity is a major cause of weight-bearing joint pain.
  • Understand that if certain exercises tend to increase pain while you are doing them or afterward, those exercises may be doing more harm than good. If you have this experience, notify your physiotherapist or doctor.
  • Consult a physician about pain-management options, especially if you are dealing with severe or chronic pain. Don’t just suffer in silence.

Today, people with amputations have a better quality of life and better physical abilities than they did in the past, regardless of whether they are elite athletes or older people with diabetes who use a wheelchair. Learning how to prevent or deal with back, hip, knee and shoulder pain is a crucial part of gaining as much independence as possible. Understanding that you can live without the constant fear of injury or constant joint or muscle pain is a good start. Doing something about it is the next step. You should contact your doctor or physiotherapist to help you establish the proper treatment plan for your specific concern.

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