Archive for August, 2015

When friends and strangers in the internet ask for fitness advice, the first thing that comes to mind is “Do no harm.”. To be effective, advice given should be understood by the recipient and used as intended by the “online coach”. Bear in mind that online advice can not take the place of actual supervised training. It is a very good supplement to actual training provided that the “trainee” understands what she or he is doing and knows how to relay useful information to the online coach so as to receive appropriate feedback. The danger in giving advice online is that it may be misunderstood. If this happens, it would not produce the intended results in the expected time and eventually the trainee will lose interest. Or worst, it may cause injuries or trigger a heart attack waiting to coaching

To make the most out of online “consultation” whether free or paid, do the following first:

  1. Level expectations

– Specify what is it that you seek for and ask the online coach if he/she can help you online. Expectations should be leveled and the coach will advise you on what is needed to be done first. You should provide honest information as to what you are willing to do outside your comfort zone. With this information, the coach will also know if you are really committed.

– A written “Training Program” will not magically transform your body nor improve your health. The magic starts with you doing what you need to do for yourself.

  1. Clarify your training goal

– Sometimes the terms you used may have different meaning to your “online coach”. The word “strength” means the amount of maximum force generated by muscular effort. A lot of people think strong means big bulging muscles. This creates situation wherein the training program is not designed for the goal and this is caused by a simple misuse of a word. Spending time clarifying training goals saves a lot of training hours by having a focused training program. Make sure that both you and the coach use simple words which mean the same thing to both of you.

–  Is it something that you need or something you want? You may want to have 6 pack abdominal muscles but the coach may be suggesting something that needs to be addressed first before what you want may be realized.

3.  Do not compare yourself to others

– In the poem Desiderata, there is a line that says “do not compare yourselves with others, as always there will be greater and lesser persons than yourself”. The best person to compare yourself to is to yourself. Were you a better person than last week? Are you stronger now than last month? 

  1. Research first

– I decided to write blogs because I get emails asking for free fitness and rehab advice. I used to answer the questions individually like a usual correspondence that goes back and forth. But a lot of those who ask for free online advice do not seem to value the time and effort used to answer their questions- they do not reply to questions about them related to the advice they seek.

– I realized that a lot of questions are quite general and coach “Google” is always ready to answer. Waiting for the feedback of strangers who ask for free advice can also be frustrating since I devote time and effort to share what I know but then sometimes I get no feedback about the outcome. I then realized that people are lazy and they just don’t do their part and if I oblige, I am just encouraging bad despicable attitude. So before asking for free online advice, it would be best to do some research first and apply what is learned, then if there is still a particular question, that is the time to ask for that specific question to the person who has the qualifications and experience to answer your query.  Some would charge for giving advice since it takes a lot of money to acquire the knowledge and experience needed to answer those questions.

  1. Write down your goal or question and read it. If you are able to write down your goal or question, it is clearer.
  1. Realize that you are ultimately responsible for your health and safety even if you asked for advice.

-Physical activities have their inherent risks and these are minimized with supervision and guidance. So practice a lot of caution when you train alone. Make sure you understand whatever advice you asked for and ask for options if there are.

So to my friends who I have not seen for years and who asked for a “Training Program”, you probably were disappointed when I did not send you one. The truth is, I value your health and I understand that even apparently healthy individuals suddenly collapse while doing a new physical activity. It would be irresponsible to just dish out a training regimen when I do not know what you are capable or incapable of now. It would be better to “teach you how to fish” rather than just giving you a “fish” which you do not know how to cook. This is a free piece of advice. And the best things in life are free. Use it to Train Better, Live Better!

This is the second part of the preparation for Standing Balance and tolerance for amputees. (Click here for the initial preparation.) Strength here is not about how heavy the individual can lift yet. It is focused on the strength needed to enable him or her to support herself/ himself in standing and eventually to ambulate with walking aids and/or prosthesis depending on the case. The ultimate goal is to enhance the quality of life. The initial steps are developing the required physical and mental strength to enable yourself to live your life to the fullest despite some setbacks.

New goals: Be stronger

As we accept our condition, we can move on with what we can do. There are many things which are out of our control and we should not waste our energy in trying to change those. We should focus on things that we can control. We can control our behavior and reaction, and we should. After initially preparing our torso, shoulders, elbows, and wrists, it is time to move further by improving their strength. For some, it may be an entirely new experience to train to be physically stronger. Take it as an exciting adventure with its ups and downs. What is important is to keep a positive outlook. Your goal may be to be able to move and walk with as little help as possible. Think about this when you are tired and tell yourself you are getting better.

It is not easy because you are not yet used to it. But your mind and body will be stronger as you persist and soon positive changes happen. It may be gradual but they happen. Here are some guidelines:

      1. To be able to develop upper body strength needed for bed mobility, transfers, and to support oneself on walker.

  • Sufficient arm strength is needed to safely transfer from the bed to the wheelchair or walkers or crutches. The arms will eventually bear the rest of the body weight with the aid of walkers or crutches. Using the wheelchair also requires arm strength. Using walkers and crutches require skill and strength. It takes time to develop strength so it is best to train for arm strength even before practicing using walkers or crutches. If you have sufficient strength, learning how to shift weight on the walker or crutches will be a lot easier. Improved strength also allows you to maintain or recover balance. It will be hard at first but it will become easier as the weeks pass by provided that you do them regularly- every other day to daily. Remember, do these exercise for yourself. If you really want to be able to move around, put in a lot of effort and the effort is very well worth it!

What to do:

1.1. Dips. This is a very good exercise to develop specific strength and strength endurance of the arms needed in using the walker and crutches. Sit on a hard bench and have blocks of wood on your either side. Make sure that the blocks of wood will not slip off. Press down on the blocks of wood to lift your buttocks off the bench until your elbows are straight. Try to hold for 1-2 seconds before you gently lower yourself down. Pushing yourself up and lowering is one repetition.

sitting dips

1.2. Shoulder pressdowns. A bit similar to dips but this time the elbows will remain straight. The fulcrum of movement will be on both shoulders. Start the movement by having the elbows locked in a straight position. Press down on the blocks by moving the shoulders downward as if trying to keep them away from your ears. Press (or push) until your buttocks come off the bench. Hold for 1-2 seconds before lowering yourself on the bench. Wide muscles attaching your arm to your back will work hard as well as the muscles on the back of your arm.

sitting shoulder press up 

   2. To be able to develop standing balance and tolerance.

  • Depending on the severity of the condition, some individuals would even have a hard time sitting up without support. But our friend, who we dedicate this post to, is able to sit up for some time. When sitting, practice having an upright posture like the one you do when doing the breathing exercises (see photo in the previous post). The next stage would be to develop standing balance and tolerance even without the prosthesis. While waiting for the stump to fully heal, we might as well work on other areas which are equally important.
  • Once you are stronger, your confidence in using your arms to support yourself in sitting as well as in standing also improves. It is best to have a Physical Therapist or caregiver or somebody who is able to support you initially to be present when you first attempt to stand on your leg. The first attempt would be challenging. But think of your goal. Think of being able to move around with more freedom and you will find the strength to continue.

What to do:

2.1. Aided Standing Balance. This is best done with somebody who can immediately assist you just in case you lose balance. Position your wheelchair next to a sturdy post or a grab rail. From your wheelchair, push yourself up using your arms (like in dips). Then shift your weight to your standing leg. Let your leg bear your body weight while using one arm to grab the pole or grab rail. Pull yourself upright with your arms while at the same time push the ground with your leg so you can straighten your knee. Your body weight is now supported by your leg and your arms pulling on to the grab rail. Stand upright and look straight forward. You may be wobbly at first but that is why you have to train for this. Stand upright while supporting your balance with your arms. Do this for 30 seconds before sitting down. Rest for 1-2 minutes before standing up again. If 30 seconds seem easy, do 1 minute. If it is easy do 2 minutes. Progress as you can tolerate.

Amp aided squat

Aided standing balance

2.2. Standing Balance. If you are able to support yourself standing upright for 2 minutes while grabbing on to the pole or grab rail,  progress by letting go of one arm, then the other until all your weight is supported by your standing leg. Your caregiver may initially assist you by wrapping a thick belt around your waist. Practice standing upright while balancing yourself. Your progress is dictated by your determination as well as by listening carefully to what your body tells you. If you feel dizzy, rest long enough until you can stand up again.

standing balance

Standing Balance


   3. To develop leg strength.

  • After a few days practicing standing balance and tolerance, it is time to train your leg to be able to tolerate longer standing time and to be able to support your body weight.

What to do:

3.1 Supported squats. Just like when you are about to stand up, shift your body weight to your leg while your arms grab the supporting pole in front of you. Stand up straight but do not let go of your arms. Then lower yourself to a sitting position but the moment your thigh or buttucks touch the chair, stand up again. That is one repetition. Repeat as described in the chart.

This exercise makes your thighs strong enough to be able to support you as well as to enhance your balance. Along with the dips and shoulder pressdowns, it also prepares you to climb up and down the stairs.

Aided squats

Supported Squats

Follow the accompanying chart for the number of repetitions and sets per exercise. Rest for 1-4 minutes after every set and exercise or until your breathing has returned to normal. Breath every time you exert effort and do not hold your breath. The height of the wooden blocks are adjustable. As you get stronger, increase the height of the blocks. Usually, it takes 2 to 4 weeks to develop sufficient strength. If there is a caregiver or Physical Therapist who knows how to train you for the walker and crutches, your progress may be faster. But there are individuals who, by virtue of their will to break free from perceived limitations, are able to progress quite fast. But be wary also of overdoing things. The progression as shown in the charts, gives you a target as well as guideline on how to progress. Take also into consideration other factors so if you do not feel well for that day, you can lessen the sets or prolong the rest. But as you become stronger try to progress.

This table is for one week (week 1 of these exercises). Follow the next chart for the succeeding weeks.

Exercise Set Repetition (rep) Rest between sets (minutes)
Dips 3 10 2
Shoulder pressdowns 3 10 2
Supported Squats 3 6 2
Aided standing balance 3 1minute 2

Week 2 to 3:

Exercise Set Repetition (rep) Rest between sets (minutes)
Dips 3 to 4 15 2
Shoulder pressdowns 3 to 4 15 2
Supported Squats 3 to 4 10 2
Standing Balance 3 to 4 1minute 2

Week 4 and until able to use crutches easily:

Exercise Set Repetition (rep) Rest between sets (minutes)
Dips 4 15 1
Shoulder pressdowns 4 15 1
Supported Squats 4 15 1
Standing Balance 3 As long as tolerated 2

The above tables are suggested guidelines to show how to progress. Many factors interfere with progress and sometimes it feels like you are not improving. But be patient and persistent. Do it for yourself and for those around you. Train Better, Live Better!

The main reason for this blogsite is to share useful information to improve one’s quality of life by improving health and fitness. This particular blog is for a friend who is willing to get past big challenges and improve her quality of life.  It is also for anyone who had lower limb amputation and wants to be able to stand up and move around again with independence using walkers or crutches. Many would be able to progress to using prosthesis but it is beyond the scope of this blog to determine prosthesis use. That is best discussed with your physician and other allied medical professionals.

The first steps start with your will to get better. After the surgery, let the natural process of wound healing take place and at the same time try to prevent infection of the wound and the development of sores. And during the first few weeks while you  are still limited in bed, you can do these:

Set and act on your goals Set small goals which will help you to progress and helps to keep you focused on recovering. Your recovery takes time. It is best to approach it as a step by step process which usually coincides with the natural healing process. Sometimes the stages take longer time than expected. Each situation is unique and these are just “guidelines” which provide some direction. Sometimes you and your caregiver may have to adjust depending on your ability. But remember, it is not easy. If it is easy, it may not be enough to trigger positive changes that leads to recovery and adaptation to your new situation. Here are a few goals with some plan of action on how to achieve them:

Goal #1: To be able to prevent pressure sores.

  • Pressure sores form when the skin over the bony parts of the body are pressed against the bed or chair for a long time. This is when you stay in only one position for an extended period of time. They start as red sores and if not addressed would progress to blisters then to open sores which require additional care and attention.

What to do:

  • Always check for pressure sores on the back of the head, the skin over the shoulder blades, the elbow, the sacrum, the buttocks, inner side of knees,and the heels. See the illustration on where to check. Take note that you may not feel anything on these areas so it is best to visually inspect and also run your hands on the areas that you can reach like the lower back and buttocks. Running your hands around these areas also acts as a mild form of exercise.

    pressure sores

    Image from google

  • If there is redness, or blister, or open wound on any of these areas, wash it with antiseptic. Keep it clean. It is best to tell it to your doctor as soon as possible.
  • If there are no sores, that’s great! To keep it that way, change position as often as you can. When sleeping, try sleeping on right side, left side, and on your back. On your waking hours, sit upright, shift weight side to side, and practice transferring from bed to wheelchair. Doing exercises below also lets you change position and redistribute pressure on the weight bearing areas of your body. And it helps you develop strength gradually as well as develop skills you need to be more independent in your activities of daily living.

Goal #2: To be able to recondition the body and maintain joint and trunk mobility.

  • After a few weeks or months of being confined in the hospital and being bedbound, the muscles surrounding the joints lose strength and flexibility. We need to recondition them again before subjecting them to more intense training later on. Depending on your current condition and level of motivation, it takes 1-2 weeks of doing these exercises before we can progress to the next level.
  • The following are mobility and breathing exercises to prepare your ribcage and other joints for strength exercises. You can do these exercises in bed as well as on chairs.

What to do:

1.1. Deep Breathing. Breath your stress out and breath in energy. Sit up straight and breath in for 3 counts. Hold the air in for 3-4 counts, and breath out for 3-5 counts. You can press the palm of your hand on your belly to feel its movement as you breath. Repeat for 10 to 15 times. Do breathing exercises before and after your exercise sessions.breathing exercise 1.2. Shoulder rolls. In the upright sitting position rotate your shoulders backwards by pulling them up as close to your ears as possible, then backwards by pulling your shoulder blades together, then downwards by pushing your shoulders a low as you can like trying to touch both hips with both elbows at the same time without hunching the back. You can also reverse the movement to roll the shoulders forward. Do 10-15 reps forward and 10-15 backwards. Do 1-2 sets. shoulder roll 1.3. Reaching upwards and to the sides. This is an exercise that involves almost all joints in your arm as well as the  shoulder complex, neck, and upper trunk. It also helps to develop and improve upright sitting balance and tolerance as well as improving overall trunk and arm mobility. Refer to the photos. Do 5-10 reps per side for 1-2 sets. upward reach up to sideward reach1

side lying hip abduction

Hip Abduction

1.4. Hip Abduction Lie on your side. You can use your arms as support for your head or you can use a pillow. If you are lying on your left side, you can slightly bend your hip and knee so as to be able to balance in this position. Now raise your right leg to the side. Do it slow and under control. Do it 10-15 reps. Then change position and lie on the other side (right side). Repeat the same process like you did on the other side. Do 2-3 sets per side.

knee extension

Knee extension

1.5. Knee extension Sit upright on the side of the bed with the edge of the bed almost on the edge of your knees and allow your legs to dangle. The bed is better since it is usually higher than a bench and allows your legs to move freely. While keeping a good straight posture, straighten one knee in a smooth controlled motion before lowering it to the bent knee position. All the while keeping the other leg relaxed in a bent knee position. Repeat 10-15 times before doing the same for the other leg. Do 2-3 sets for each leg.

prone hip extension

Prone Hip Extension

1.6. Prone hip extension Lie face down on your bed. Extend one hip up. The lower front of your thigh will be lifted off the bed. Hold on the highest position for 1-2 seconds before slowly lowering your thigh. Do 10-15 reps on one side before doing the same exercise on the other side. Do 2-3 sets for each leg.

Important things to know:

  • One complete movement of an exercise is called a “rep” (shortcut for repetition).  A group of repetitions is called a “set”. Rest for 1-4 minutes after every set and exercise or until your breathing has returned to normal.  Follow the accompanying chart for the number of repetitions and sets per exercise.
  • After a week or so, proceed to the next level if you do not feel dizzy doing these exercises. (Click here: Practical Strength Training for Standing Balance and Tolerance). Another sign that you are ready to progress to the next level is when these exercises feel boring and too easy! Congratulate yourself if you are able to do the above exercises with good control. You are a step closer to the bigger goal of being able to move around with greater ease and control! Train Better, Live Better!