Initial preparation for standing balance and tolerance

Posted: August 5, 2015 in Recovering from Injuries
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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!
Comments
  1. […] 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 […]

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