Sometimes in my gym, I will be ready to treat an amputee and they will arrive unable to don their prosthetic leg, which is a frustrating outcome for everyone.

An increase in stump volume can be caused by many things and some common ones include:

• Leaving your stump unbandaged overnight.  In the initial 12-18 months after leg amputation, an elastic bandage or shrinker sock must be worn overnight or whenever the prosthetic leg is not being worn to prevent swelling of the stump.  If you have heart or kidney problems you may need to keep bandaging always, to prevent your stump swelling overnight.

• Sitting for long periods with your residual limb hanging down (for below knee amputees) may cause swelling because there is no muscle pump and your lymphatic drainage system has been disrupted by your amputation.

• Meals high in salt and/or alcohol content can cause your stump to swell, especially if combined with the above factors.

• Some ladies experience stump swelling at certain times throughout their menstrual cycle and may need to bandage at those times to ensure continuity of fit of their prosthesic leg.

• Prolonged periods of inactivity or bed rest (for example a hospital admission) may cause an increase in stump volume because by not wearing your prosthestic leg fluid accumulates in your stump and is not pumped out by weight bearing.  In cases like these, always have your bandage or shrinker sock at the ready to avoid fitting problems when you are ready to be back on both feet

I hope you have found this checklist for prosthetic leg fitting challenges useful.

Let me know what you think.

Until next time…. Cathy… The Amputee Coach

There can be many reasons for this, but here are some of the common ones for you to look out for:

• Your stump has been shrinking and the socket has become too loose and your stump may now be pistoning in it, causing discomfort. This is normal especially in the first 12-18 months after your amputation surgery and you will need to add another sock underneath or over the top of your liner (depending on your type of liner) to take up the extra room available.

• If your stump has a bluish tinge your socket may be too tight.

• If you have an uncomfortable roll of soft tissue over the brim of your socket that hurts when you weight bear, you may have put on weight and your socket has become too tight.

• Sudden problems with controlling your knee (that is, the knee is buckling or is being forced backwards) may be due to changing your shoes to a pair that have a different heel height to the original pair your prosthetic leg was aligned with.  A heel that is too high will force your knee to give way, especially when coming down slopes and for transfemoral amputees a fall could result.

• The onset of back pain with prosthetic leg usage is often associated with a change in leg length.  Sometimes this happens when you get a new prosthesis and the problem is easily identified and rectified by your prosthetist.

As with all issues with your prosthetic leg a quick call or visit to your prosthetist will keep your prosthesis fitting optimally and you “Walking well, Being Fit and Enjoying Life.”

Until next times… Cathy…The Amputee Coach

Before putting your prosthetic leg “on” and after taking your prosthetic leg “off” at the end of the day, it is essential to examine your stump thoroughly for any areas of excessive redness, blisters or rubbing.  By doing this you will be alerted to any potential fitting problems with your socket and avoid incidences of broken areas on your residual limb which could lead to infection and an inability to continue wearing your prosthesis.

When starting to walk, especially if you are an above knee amputee, you should step off with your intact leg first.  This is because you have the most efficient control of the prosthetic knee joint (or your own knee if you are a below knee amputee) when it is directly underneath you as you bear weight on it.  Stepping off with the prosthetic leg first puts your knee in front of your weight bearing line and requires much harder work from your bottom (gluteal) muscles to prevent it from buckling.  Additionally once you have stepped off with your intact leg you will have the momentum of the prosthesis to assist you in swinging it forwards, thus requiring less energy as you walk.

The principle of keeping your prosthetic leg underneath you has particular relevance when you are turning around, for example to sit in a chair.  If you turn and put your prosthetic foot out to the side, using it like a strut you risk losing control of your knee joint and falling.  I encourage all amputees to keep control of the knee joint by keeping the prosthetic leg underneath them and using the intact leg as the one doing the turning.  Note that it is important never to spin on your prosthesis as the knee may also buckle in this situation and the rotation it causes between your socket and the skin of your stump can be quite uncomfortable.

I always say to amputees that I see,”You have 2 legs now, think of and use your prosthetic leg as a leg, not just a strut”.  This will help to keep you moving safely.

Until next time… Cathy… The Amputee Coach

The whole day really fitted in nicely with the theme of A New Year, A New You. The amputees involved were not actually seeing me because it was a new year.  They came because as amputees their lives are continually opening up due to their hard work and prosthetic technology.

Of course all the names have been changed to protect the guilty.

“Bob” from Port Adelaide arrived for a two week stay.  He was to be fitted with the latest in micro-processor knee joints.  Roughly an hour after getting his new leg, he walked up stairs (leg over leg) for the first time in all the years since he had become an above knee amputee.  It wasn’t pretty, but he did it.  Improving that technique amongst others is my job over the next week or so.  As long as I stand far enough back I won’t lose any teeth and Bob will definitely enjoy a smoother and safer walking pattern.

Then I saw “Jenny” whom I had seen as a shy young thing at the end of last year.  She was unable to walk for any length of time without a limp.  She wanted to get back to playing sport but she was using her prosthesis as a strut not a prosthetic leg.  Unfortuantely, an inappropriate prosthetic prescription had left her with a significant muscle and core imbalances.   On a new prosthesis (with a new foot) we were able to change her gait pattern completely.  Alot of this came about because she had worked on her exercises over the Christmas/New Year holiday break.  She began to use her muscles to walk dynamically and she was virtually limp free.  She was definietly on her way back to her dance classes she enjoyed so much.

And  finally but by no means least, lets talk about “Matt.“  He’s a strapping young lad whom I had taught to walk a few years ago.  He is a natural athlete with a flawless walking pattern and an easy going attitude with a love for playing footy.  For some time (actually, from the first time I met him) I knew that he would be a gift to the Australian Paralympic team but he wasn’t interested in this challenge.  Every time I caught up with him we would banter about the difference between what I saw as his potential and what he claimed was his contentment with his ability.

This week Matt was in getting fitted for his running leg because he had attended a talent scouting weekend for the Paralympics.  He was starting to be groomed as a javelin thrower.  I saw him run on his prosthesis out the back of our prosthetic clinic in the rough.  He’s not only going to be a javelin thrower, I thnk he’s going to force his way into the relay team.  I can feel it.  And from the smile on his face when he left, (even though he won’t admit it yet) I think he might just feel it too.

So what’s the moral of this diamond day?  We should never sell ourselves short.  And should definitely never give up.

Until next time…..Cathy…. The Amputee Coach

Hopefully you have committed your plan to paper, which means you are seriously setting out to achieve it.

In order to know at the end of your timeframe, whether you have achieved your goal or not, you need to know where you are starting from.  This sounds strange but a lot of people start out on a new program without an adequate initial assessment.  If you are living with leg amputation some of your goals may be physical ones and therefore some form of physical baseline needs to be established.  This means that not only will you know if you have achieved your goal but you will be able to use re-assessments over the long term timeframe of your goal, to maintain your motivation.

There are some ideas in Chapter 14 of The Amputee Coach Book on baseline measures or you could also use the assessment guide at the beginning of the Advanced Exercise Chapter in the Reader Only Resource section of the Amputee Coach website.

Many people with leg amputation want to improve their gait as a goal.  In order to get a good assessment of the “quality” of your gait, you may find it useful to make an appointment with your Clinic Physiotherapist.  After assessing your gait, your therapist will be able to guide you with your plan of attack towards improving your gait.  For example, which joints need to move through a greater range, which muscles need specific strengthening and how to incorporate this into your gait pattern.

It is particularly useful to have your gait videoed.  I use this tool a lot at APC Prosthetics in Sydney NSW and have found it very effective in modifying an amputee’s gait.  It will also provide you with an exact picture of your starting point so that you can compare it with your performance after you have been on your exercise program.  Alternatively you could have a relative or friend video you whilst walking.  This will provide you with an excellent picture of your starting point.

So choose an assessment measure that is relevant to you, only then will you be able to see how far you have come.

Until next time… Cathy… The Amputee Coach

In a nutshell, did you have a goal last year?  And was it achieved to any degree?

If you did have a goal, was it written down somewhere?

Writing your goal down demonstrates a commitment to it and means that you are more likely to achieve that goal.  In The Amputee Coach Book, I recommend that you write your goal down in a certain way.  It starts with a date (when you want your goal to be achieved by), followed by the outcome (what you want to have achieved) and then the benefit (how the achievement of your goal has affected you).  In this way you are thinking about the process of achieving your goal.  Thus changing it from a mere wish to something you really want to achieve.

Remember the quote from Antoine de Saint Exupery(1900-1944), “A goal without a plan is just a wish.”  Perhaps if you didn’t achieve your goal last year, you  may not have committed to it meaningfully by putting it in black and white. So to make sure you are not wishing your time away, have your goal noted down in the space reserved for it in Chapter 5: How to Guarantee Your Success.

If you had a goal did you achieve it?

To answer this question you need to have been able to measure your outcome in some way.

For example, for someone with a leg amputation whose goal may have been “to walk better this year”, it is easier to assess the outcome of that goal by using some form of performance measurement.  Essentially you need to be more specific about your goal other than “better”- you need to be able to quantify it.

Walking better may mean being able to walk further than you can now, so state a distance that would be relevant to you.  You may want to walk faster, so state a time in which want to be able to cover a certain distance.

So see how you did last year:

I had a goal written down using The Amputee Coach guidelines: Y/N

I achieved my goal: Y/N

I was able to measure my achievement: Y/N

Achieving my goal has made me feel……

Finally, if you achieved your goal, make sure you have rewarded yourself!

Until next time… Cathy… The Amputee Coach

At the beginning of each New Year we are swamped by talk of New Year’s Resolutions.  What do we want to do, lose, give up, start, achieve and so on.  This sort of talk is commonly carried on with a celebratory beverage in one hand, after an excellent feast, whilst anticipating the fireworks display.  Then on approximately the second day of the New Year we are besieged by media telling us that most of us have already broken our New Year’s Resolutions so why do we bother to make them anyway?  Indeed.

The point of a New Year’s resolution is not to keep it in the first week, but to keep it for 80% of the time.  Think about it, if you changed a certain behaviour 80% of the time would this not make a significant difference to your desired outcome?  But how to maintain those changes?

New Year’s Resolutions are really a bit of fun, but could we capitalise on the buzz around them and turn them into something beneficial?  If you really want to keep them then they should be treated more seriously and given the term “Goals”.

After leg amputation, most amputees have the goal “to walk again”.  But what next after you have achieved this?  This is where the processes of goal re-evaluation, self assessment and setting your new goals come in.

The point of the “New Year, New You” blogs is to re- examine the guide to guaranteeing your success as outlined in Chapter 5 of The Amputee Coach Book and applying it to moving on further with life after leg amputation.  And is there a more opportune time to pause, reflect and re-direct ourselves after slogging through a busy year, than at the beginning of a brand spanking new one?

Happy New Year for 2012.

Until next time…Cathy….The Amputee Coach

What we do changes as we change and age.

It dawned on me one day as I was on the treadmill in the gym.  I had recently turned forty, as you do, and everything was succumbing to gravity, as it inevitably does.  And I realised, “I have to do this for the rest of my life.”  Now given that I was staring down the barrel of another (statistically speaking) 40 or so years of this,  I was alarmed that 40 years of feeling like a rat in a wheel might get to be a bit repetitive, a bit of a bore.

What to do?

I  joined the gym because as 40 loomed large, I decided that it was time to do something for myself and getting back into some exercise seemed like a good start.  I soon realised that to take the most of this opportunity and time that I was allotting myself, I would have to examine my exercise goals and exit the comfort zone, that is try some things I had never considered before.

I thought that “toning up” was desirable and so went to a “bodypump” class. Having never contemplated lifting a barbell before, for me this was out there. Obviously I started with the minimum recommended weight for women and squatted, lunged and shoulder pressed my way through 60 minutes of repetitions set to music.  It was fabulous and doing weights really made me feel empowered.

The agony in my muscles the next day was incredible and I had trouble with stairs for the next 3-4 days!  This made me realise what a sorry state my muscles were in and prompted me to return to the class for more punishment before the week was out.

The pain is never as bad as the first time and as I contemplated increasing my weights it became obvious that I was getting stronger.  I may now have detected a triceps ripple where once there were only “canteen lady” arms in evidence.

Who would have guessed?

I’d like to hear about your journeys.  Put your thoughts in the comment box below.

Until next time….Cathy…The Amputee Coach

So this week I’m interested in what gets YOU through that session you have set yourself?  Maybe it’s 15, 20 or 40 minutes of walking and then some resistance work or the new 60 minute dance class you’ve taken up, what gets you there?

For me, there are lots of things/strategies that I use and it often depends on the mood I am in and whether I’m feeling fresh or a bit sore or tired because I did something yesterday, that influences my choice.

For the tough days (when you feel lazy, tired, sore, just don’t want to do it…etc,etc)

• Just do something light and not too strenuous so that you don’t break your exercise habit and anything is better than nothing!!

• You are just going to do a light workout and stretch session to help you workout the tiredness and soreness and relax afterwards while congratulating yourself on your mind over matter toughness.

• Pick your favourite workout/exercises. (For example, mine is usually a latin dance class or zumba class because it is FUN.)

• Put on your motivating music! You know the stuff- it has an awesome beat, great lyrics you know by heart, it’s from your “heyday” and it’s definitely from the eighties. OK so maybe that last one is just me but you know what I mean!

• If you are really desperate just invite a friend out for a coffee, but they have to take you for a nice walk first.

For the good days (when are looking forward to a good workout or there is just nothing wrong with you that could be used as an excuse not to….)

• These are the days in the ZONE.  You know them, exercise feels easy and you find your rhythm quickly.  Delight in just that. Concentrate on the smooth rhythm of your movement.  Feel the power of your body’s machinery.  Marvel at the mastery of movement that only practice brings.

• Maybe there’s a competitive streak in you?  Who will it be today?  Are you going to show you whose boss with a new PB (personal best) or demoralise that young thing in the too short shorts by lasting a few seconds longer in the plank?  Maybe you’re going to shock your trainer Jackie by actually performing your first chin up….but I digress.

• And voila! The session is over, give yourself a good stretch and feel chuffed at a job well done.

Until next time… Cathy – The Amputee Coach

PS To read more, why not check out our book, The Amputee Coach – Empowering YOU To Walk Well, Be Fit & Enjoy Life!  You can buy the physical book or if you want to get started right away, then buy the ebook version.

Exercising regularly has loads of positive effects on our mental and emotional wellbeing as well as our physical bodies.

• Exercise is a mood enhancer and reliever of stress.  It releases your body’s own “feel good” chemicals, called endogenous opiates.

• Exercise improves your quality of sleep and sleep patterns so that you are more refreshed after sleep.

• Exercise has been shown to assist in the treatment of some depressive and anxiety disorders.

• Exercise can help delay the onset of dementia.

So you see that exercise basically makes us nicer to be around and happier in our own lives or maybe it’s just my family trying to get rid of me when they say “why don’t you go off and have a gym session, mum?” I hope not.

A really important benefit of exercise for the psyche of amputees is the boost of confidence that it injects.  People who exercise feel more able, agile and confident in themselves and their physical performance and so they are!

When teaching someone to walk with a leg amputation, I can always tell if they have been an active person prior to their amputation.  Those that have been regular exercisers or sportspeople  generally have a better “body sense” and will be more balanced and seem more co-ordinated when learning new skills such as walking with a prosthesis.

So if you’ve been a bit too busy to find time for yourself lately and are feeling a bit grumpy or sad, maybe it’s time to treat yourself to some exercise.  After all, how it helps you feel is a worthwhile investment isn’t it?

Until next time… Cathy – The Amputee Coach