STEP 2: WALK BEFORE YOU RUN
It is an age old saying that you need to learn to walk before you can run - The same holds true now: you should learn to walk properly on a prosthesis before you learn to run. Before you attempt running, you want to make sure that you have minimized any gait deviations, or abnormal patterns, you may demonstrate while walking.
The majority of individuals walking with a prosthesis demonstrate at least one gait deviation. Causes for these deviations vary person to person and can include improper fit of the prosthesis, lack of proper gait training, compensations for limitations such as weakness, and even just due to the development of bad habits over time.
Talk with your prosthetist and/or physical therapist if you are unsure as to whether or not you are walking with deviations. Additionally, if you know that you are demonstrating some of the deviations listed below, contact a health professional to begin gait training and/or your prosthetist in order to determine if it the prosthetic fit may be a cause. Listed below are some of the common deviations that may occur but please note that this is not a complete list.
Most Common Gait Compensation for all levels of amputation
The most common compensation that individuals with lower limb amputations tend to demonstrate with walking and running is a tendency to favor the unaffected leg. Spending more time on the unaffected leg may be an attempt to protect the residual limb from injuries such as blisters or abrasions or may be due to a lack of trust in the prosthesis. The problem is this compensation leads to higher loading forces in the sound leg which over time can lead to overuse injuries and joint pain.
Common gait deviations for those with above knee amputations include:
lateral trunk flexion
Individuals tend to lean toward the side of their amputated limb when their weight is on the prosthesis. One reason for this is to make up for weak hip musculature - when the weight of the body is shifted so that it is directly over the limb, the demands on the muscles are decreased. Although this may make walking easier, over time it can lead to back pain and other injuries due to the unnatural stresses it places on your muscles and joints.
Individuals walk with a wider stance, or a wider base of support. This may be used to provide more stability for those who feel unsteady on their prosthesis. Although this way of walking may make you feel more stable, it requires your muscles to work in a different way than they normally would to walk and can result in injuries over time.
During swing, the prosthetic limb curves around to the side instead of swinging straight through. This can be due to a lack of knee flexion (knee bending) on the prosthetic side. In order to clear the leg, it is brought around to the side so that the foot does not drag and result in stumbling or falls. This can result in increased demands on the back and hip as well as the sound limb and can result in injuries over time.
Individuals come up on the toes of their sound limb in order to create more height for the prosthetic limb to swing forward. This could be due to a prosthesis that is too long or one where the knee does not bend easily. This is another method of compensation used to safely clear the prosthetic limb in order to prevent stumbling or falls. This gait compensation greatly increases the demands placed on the sound limb and can result in injuries over time.
Common gait deviations for those with below knee amputations include:
Uneven step length
Individuals tend to take a shorter step with their sound leg, which allows them to spend as little time as possible putting weight through the prosthetic limb. A normal sized stride will be taken with the prosthetic limb as the individual is comfortable spending time on the sound leg but once weight is placed through the prosthetic limb, the person may take as short a step as possible in order to get off of the prosthesis. This results in overloading of the sound limb and injuries can occur over time.
excessive knee flexion at heel strike
When the heel of the prosthetic foot hits the ground, the knee bends more than normal. This can be due to a lack of quadriceps strength resulting in a lack of control over the joint and an inability to prevent the knee from bending too much.