valstrengthtraining

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.

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.

 

   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.

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.

 

   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.

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!