The rehabilitation process after amputation is a long one. You deal with a multidisciplinary team that includes surgeons, prosthetists, physical therapists, occupational therapists, and psychologists.
Each team member has a role and you need all of them to have the best outcome.
In this article, we’ll look at the 14 most common reasons for physical therapy for amputees. And briefly touch on the two main stages of physical therapy after amputation.
Stages of Physical Therapy After Amputation
Physical therapy rehab for amputees is divided into two main phases:
Pre-prosthetic Rehabilitation
This is the immediate post-surgery phase. Our goal here is to ensure that the wound heals properly and the stump is correctly shaped so it’s ready for a prosthesis in a few months.
Your job during this stage is to do general activity and strengthening exercises of the remaining limb and also add full body exercises. The rehab starts in the hospital and continues for months after you’re discharged.
Post-Prosthetic Rehabilitation
This stage begins after you’re fitted with a prosthesis.
Here, we teach you to perform functional activities, walk, do job-specific activities, and gain independence.
14 Most Common Reasons for Physical Therapy for Amputees
Having a limb amputated means you have to relearn not only the functional movements but also balance, coordination, and pain management, and undergo skill training to utilize your prosthesis.
All those are things that physical therapy can help you with. Here are some additional most common reasons for physical therapy for amputees:
1. Gait Training
Lower limb amputation almost always requires relearning to walk. Even if the amputation is for a relatively small area such as a toe or midfoot, you should still get a prosthesis fitted and undergo gait training with a physical therapist.
If you have had a below-knee amputation, above-knee amputation, and hip joint disarticulation, then you have to spend a longer time in gait training.
Some patients spend a couple of weeks before they move on to stair climbing, navigating uneven surfaces, and even running, while others take a few months to get there.
Physical therapists train you to walk while keeping in mind limiting factors such as reduced endurance, obesity, sensation or feedback problems, and balance issues.
Teaching you to maintain proper posture while walking is an important aspect of gait training with walking aids or prostheses.
2. Using Assistive Devices
Prosthesis and assistive devices feel heavier than your biological arm or leg because you don’t have any muscles helping you move it.
You have to move it with the muscles in the remaining healthy part of your limb.
Hence you need to seek physical therapy for learning to use assistive devices and prostheses because you’ll likely need to build strength in your limbs for it.
We can teach you ways that’ll help you optimize your energy while using the limb.
Assistive device training is helpful for both upper-limb and lower-limb amputees.
The training includes performing activities of daily living in a safe and controlled environment of a physical therapist’s office. Progression includes completing complex tasks and performing recreational activities without injury.
3. Learning Functional Skills
Getting used to the lack of a hand, arm, leg, or even a toe takes time. Learning functional movements is a great way to familiarize yourself with the change and the presence of a prosthesis later.
Functional activities are those that help you navigate the world around you and fulfill your needs.
Some of the activities that physical therapists can help amputees with include:
- Moving from a sitting position to standing and vice versa
- Transferring from bed to chair/ wheelchair, or car
- Dressing independently with and without prosthesis
- Navigating crowded spaces
- Getting on and off a public bus
- Using utensils and navigating hazardous areas such as stove
- Using elevators, escalators, and stairs
- Carrying objects while walking
We usually have models of stairs, uneven walking surfaces, and closed spaces so you can learn to confidently navigate such challenges in the real world when you’re discharged from physical therapy.
4. Range of Motion Maintenance
One of the most common reasons for seeking physical therapy for amputees is for maintaining the range of motion of the remaining limb immediately after amputation.
Patients often suffer from poor psychological health after an amputation. That can lead to them neglecting the amputated limb and not moving it. Such avoidance causes long-term damage hence physical therapists encourage movement in it and ensure that its range of motion is maintained.
We prescribe some low-intensity exercises for it. As a rule of thumb, your physical therapist will ask you to move your remaining joints in flexion, extension, rotation, and any other movements it allows such as inversion and eversion.
For example, we’ll ask a patient with a below-knee amputation to bend their knee and open it again fully, bring the knee to the chest, and bring it back to the starting position (hip range of motion activity).
5. Regaining Independence
A common side effect of amputation is increased dependence on caregivers. Many amputees, especially the young ones, aren’t comfortable relying on others for basic functions.
Since physical therapists are movement experts, amputees come to us to regain their independence and ask us to teach them skills to get there.
Some of the common requests include wanting to take care of personal hygiene, returning to work, or performing their favorite activities again such as being outdoors or baking.
Physical therapists work closely with occupational therapists (OTs) here. OTs are often better equipped to teach you fine motor skills and upper-hand function than physical therapists.
6. Coordination Exercises
Loss of a limb affects the entire body in multiple ways, one of which is the resulting upset coordination.
Your body weight distribution changes after an amputation. The bigger the area that’s amputated, the higher the loss of balance and coordination will be.
A common reason to seek physical therapy after amputation is to do coordination drills that improve your balance, posture, and functional activities.
These exercises include:
- Static standing with upright posture with and without your lower limb prosthesis.
- Holding both your arms out while sitting or standing. Even if an arm is missing, you have to lift the remaining limb in the same way as your healthy side.
Occupational therapists help with coordination exercises of the upper limb. You’ll do drills such as moving small objects from one box to the other and fixing shaped objects in appropriately shaped pegs with the help of a prosthesis.
7. Stump Preparation for a Prosthesis
You can’t have a prosthesis until you have a properly shaped stump. And the process to prepare it begins as soon as your wound heals after surgery.
Some activities that physical therapists will teach you to shape your stump include:
- Wrapping the stump in a bandage in a zig-zag fashion (almost like the shape of the number eight) with appropriate pressure.
- Massaging the area
- Moving the joint closest to if through its full range of motion to maintain muscle tone
- Doing low-intensity exercises to maintain muscle strength
I’ve seen multiple patients wait months or over a year for a prosthesis because they didn’t receive guidance on how to shape and take care of their stump immediately after surgery. Hence this is one of the most common reasons for physical therapy for amputees.
8. Muscle Strengthening
The strength requirement of your body increases after an amputation. Lower limb amputees have to use their arms to move the walker or manage a cane for walking before a prosthesis is fitted.
That requires good muscle strength in your upper body.
But that’s not all. As we’ve mentioned above, prostheses weigh more than your biological limb so you need to build strength in the residual limb to handle the additional weight.
Physical therapists can help with strength training in your upper body, core, and lower body. After an amputation, the healthy limb takes up the duties of the amputated limb so it essentially doubles its workload.
Hence strength training ensures a relatively smooth transition to your new normal.
9. Gaining Specific Skills
Amputees visit physiotherapists if they have specific challenges that they need to overcome.
For example, a job with a lot of typing work might require your elbow to be in a specific position for long periods. That can be challenging for the below-elbow amputee who has an immovable hand prosthesis.
Such a patient can go to a physiotherapist to learn healthy positioning for the elbow and learn some exercises to make it easier to maintain that position.
Similarly, you could be facing specific challenges based on your home environment or working environment that a physical therapist can help with.
10. Preventing Contractures
A contracture is an extreme stiffness in your muscles, skin, or joints to the point that it essentially locks your joint in place or only allows limited movement.
Keeping your body in one position for too long is one of the primary reasons for developing contractures. It’s unfortunately quite common in amputees during the time while they wait for the wound to heal and the prosthesis fitting process to begin.
Preventing contracture development is one of the most common reasons why your surgeon will refer you to a physical therapist.
We use stretching exercises, range of motion exercises, and positioning to avoid contracture development around the stump or anywhere in that limb.
Here’s a scenario to demonstrate to you the importance of contracture prevention.
If you develop a contracture in your hamstring muscles after a below-knee amputation and get a prosthesis fitted in that state, then there’s a high likelihood that the length of your prosthetic leg won’t match the length of the opposite healthy leg when your contracture is resolved.
That’s because the extreme tightness of your hamstring muscles won’t allow the knee of the amputated leg to extend completely and won’t give an accurate reading for the length of the prosthetic leg.
11. Maintaining Fitness Level
Living with a prosthesis is difficult. It becomes even more challenging if you’re obese because that puts excessive weight on your lower limb prosthesis and causes complications.
A common reason for physical therapy for amputees is for weight control, cardiovascular health maintenance, and overall fitness.
It’s especially important for people dealing with hypertension, diabetes, thyroid issues, or other medical conditions.
12. Donning and Doffing of Prostheses
Physical therapists have a big role in teaching you the proper ways to care for your prosthesis.
This includes showing you how to inspect your stump, clean the surface of the prosthesis, wear it (called donning), and take it off (called doffing). In some clinics, however, prosthetists are responsible for this education.
13. Returning to Activity and Sport-Specific Training
The functional activities we teach you in physical therapy after amputation are low-intensity but are appropriate for everyday activities.
High-intensity sports and demanding jobs require specific training. For that, your physical therapist will use advanced skill training and sport-specific drills to prepare you for your specific goals.
14. Treatment of Phantom Pain
Phantom pain or sensation refers to feelings you have in the part of your limb that’s amputated. Although the amputated limb is no longer there, the brain might still receive signals from nerve endings that remain telling the brain that the limb is itching or hurting.
Phantom pain is completely normal but it’s uncomfortable, to say the least.
Several physical therapy modalities can help you manage phantom sensations. These include:
- Acupuncture
- Dry needling
- TENS
- Massage
- Mirror therapy (Reference)
Hence this is one of the common reasons for physical therapy for amputees.
In Summary
Prosthetics is a separate department that deals with preparing and fitting prostheses for amputees. Physical therapists work closely with prosthetists to ensure that the patients receive quality care and return to activity in their most healthy state.
If you’ve had an amputation and never visited a physical therapist, then you might be missing out.
I hope this article has shown you all the benefits of physical therapy for amputees and encouraged you to seek appropriate treatment to improve your quality of life.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.
