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The War Amps
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Posture & Back Problems

Posture is the position of your body at rest and during activities. Maintaining good posture and taking care of the back is important for everyone, but especially for amputees to prevent back problems. Arm amputees must have strong back muscles to help them support an artificial limb and to get the best use from it. For leg amputees, using an artificial leg places extra strain on the remaining weight-bearing leg and on the back.

For both arm and leg amputees, back muscles work harder to enable the amputee to use an artificial limb or to compensate for a missing limb. Therefore, simple back exercises can improve an amputee's comfort and ability to function, and prevent future problems. Again, you should consult your doctor before starting a new exercise program.

The Causes of Back Pain

Back pain can occur for a number of reasons - injury, improper posture or weakness of certain muscles. The onset can be sudden (the result of some unusual stress or injury) or it can be cumulative (small stresses over a long period of time).

There are different kinds of spasms, which require different kinds of attention. Some spasms, usually caused by injury, require immobilization to allow the muscle to recover without the aggravation of movement (these types of spasms should not be treated with heat or massage). Others spasms caused by improper posture or tension may be helped by heat and/or massage to increase the flow of blood to the area

Scoliosis

For arm amputees, particularly those with high level amputations, there is less body weight on the side of the amputation. Therefore, there may be a tendency, due to the weight imbalance, for the amputee's spine to curve (scoliosis). Wearing an artificial limb may help to even out the imbalance. For example, one above-elbow amputee who did not wear an artificial arm started to develop scoliosis. His prosthetist fabricated a special socket to which additional weight was added over time. The socket served two purposes, to counteract the scoliosis and to accustom the amputee to wearing a socket  eventually the amputee wanted a prosthetic fitting. Scoliosis can lead to discomfort, pain, and other problems, so it is important for your doctor to monitor your back. Since what is best for one amputee may not be for another, together you can determine the best way to deal with any problems that may arise, whether it be through a prosthetic fitting and/or an exercise or therapy program.

Leg amputees should also have their backs regularly checked by their doctors, as problems like scoliosis can develop due to the continued imbalance of walking patterns like limping. It is also important that the prosthetist check the height of the artificial limb to make sure it is correct, as wearing a leg that is too long or too short can cause back and spine problems that over time might require extensive therapy to remedy.

Back Exercises to Prevent Pain

If an amputee has poor gait habits and limps excessively, a greater strain is placed on the back - exercises, like side leg lifts and leg lifts when lying on your stomach, and many others, strengthen the appropriate muscles of the stump used in operating an artificial leg. Your clinic team can devise a "custom" exercise plan which will strengthen all the muscles in your stump (to prevent an imbalance in strength).

Exercise increases energy which you need to operate your artificial limb. All exercise that strengthens the muscles used for operating artificial limbs will also be beneficial to your back. Your fitness regimen may work best for you in the gym setting where a variety of equipment is available, or you may prefer to consult with a personal trainer to learn good techniques or to design an exercise program for you. However, many simple exercises can be done at home at little or no cost (a couple of examples are shown below). The route you take is one of personal preference but consulting your clinic team is always a good place to start.

The Bridge

The Bridge – lying flat on your back with your knees raised, lift your pelvis and lower back and hold for a few seconds. Adding weights is optional (for instance 10 lbs as demonstrated in the picture) on your stomach to give your back muscles a harder workout if desired.

The Plank

The Plank – lying flat on your stomach, raise up on your forearms and the tips of your toes and hold your body straight for as long as you can.

Before You Start Working Out

  • If you have not exercised for some time, consult your doctor before starting.

  • Do not undertake any back exercises if you are currently experiencing back pain. See your doctor who can set you on the right path to keep your back healthy for life!

  • Aching or soreness is a sign that lactic acid is accumulating in the muscles, so if you take the time to stretch before and after you exercise, muscles will recover more quickly.

Tips for Your Exercise Program

  • Exercise regularly  A now-and-then program will not give the same results as a regular program.

  • Set aside a regular time for your program  before starting your day, or in the evening.

  • Select a comfortable, firm surface, such as a carpeted or padded floor. Wear loose clothing.

  • Begin by relaxing and doing stretches to warm up your muscles.

  • Do each exercise slowly and smoothly. Use no jerky movements.

  • Progress gradually at your own pace. One example program is to start with only three repetitions of each exercise and continue with three for the first two or three days. Then add one repetition to each of the exercises you are able to do with ease and comfort. When you are able to easily complete those repetitions, move on to the next level.

  • It is better to do a few repetitions well, than to do many poorly.

  • At the end of your exercise program you should also do stretches to slowly cool your muscles down.

Tips for Good Posture & Back Health

If you slump while sitting, your head (which actually weighs about 5.5 kilograms) exerts a weight of approximately 16 kilograms on your neck and back! This extra weight means that the muscles in your neck and back have to work much harder and tire more quickly.

Good posture does not mean standing at attention  you should instead hold your head high with your chin tucked in as far from your feet as possible. This will straighten your entire back including the neck area.

  • Swayback, a condition where the top of the pelvis leans forward, is an example of poor posture. It causes the muscles, ligaments and other back tissues to become shortened and tight. Good posture can be achieved by tilting the pelvis upward and backward, thus reducing, or flattening the curve in the lower back.

  • When seated, ensure that the lower back is flat or slightly rounded outward never with a forward curve. This position can be ensured by having the knees a little higher than the hips.

  • When lifting objects, bend your knees, going down as far as possible with the legs, not the back. Hold the object close to your body. Lift with your legs, using the large muscles of the thighs, rather than the small muscles of the back.

  • The best position for sleeping is on your side, both arms in front, with your body partially curled. Sleeping on your stomach should be avoided because it increases swayback and strains various tissues. Sleeping on your back should also be avoided unless your legs or knees are supported in a raised position. A firm mattress also greatly improves your back position while sleeping.