A different approach to physio and prosthetics

Today I met Liam, who is another of the physiotherapists at the Limb Centre in Dunedin. He doesn’t know me, has never met me before and is only basing his information on the medical records that the limb centre have created on me. But, todays approach was quite quite different to in previous visits.

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The prosthetist approach this time was, as I have mentioned before, quite quite different to those of previous visits. We regularly use laser beams to check leg alignment, Ryoji the prosthetist was there for the entire physiotherapy session whereas this was never the case with my previous prosthetist.

We started with trying the new leg. Immediately I knew it was completely the wrong length, considerably so. So off Ryoji went to saw some off in the workshop next door and we tried again. As per usual, this incredible vanishing leg has been doing its tricks again and the socket – whereas it was tight two weeks ago – now needed an extra sock layer from the beginning, plus some additional bits and bobs stuck into the inside of the bottom of the socket!

But – from the beginning, I strutted off across the room leaving the crutches right where I put them when I arrived. This was the first time in well over 18 months that I have been able to walk without any walking aids at all. This leg also felt a lot more like ‘my leg’ if that can ever be with a prosthetic, than either of the previous two. It also immediately felt lighter in weight. Ryoji was right once again!

Then, in came Liam the physiotherapist.

He asked me to walk back and forth up and down the room for a while. Liam studied how I was walking, while Ryoji was crouched down looking at how I was moving in the prosthetic.

All three of us notice that my left knee was not tracking correctly in the stride. I wiggled my leg in a certain way and said that the socket felt like it was doing this. I didn’t necessarily expect Ryoji to fix it with a spanner, I was just saying! Ryoji asked Liam about the fact that I was heel striking with my left leg and almost hyperextending. I did point out at this stage that was how I had been TOLD to walk, but was not how I would have walked prior to that. We immediately decided that my first job was to un-teach myself that bad habit! (Thanks whoever it was that started that with strange advice post-op!) Task one, soften the knees when I walk.

Sill on the heel strike topic, Liam decided that perhaps it was also a problem or weakness of the adductors and went to get a theraband to start me on some more exercises.

Liam asked me about a note that had been made about me struggling with steps. Downward steps are a giant problem, not because of the amputated leg, but because the knee replacement is required to hold me up as I lower myself down. I was perching on the parallel bars at the time and I showed Liam a new exercise that my physio Joel had given me, sitting to standing from the perching height on one leg. Liam immediately asked could I sit to stand just using the left leg. I scoffed and reminded him I did actually only have this amputation 4 month ago! He said yes, I know, but I also know what else you have achieved, along with a small wink!

A few attempt later, yes, I can do it on the left as well (just!!).

In this new leg, I definitely felt that the knee had become unstable due to loss of muscle strength around the joint because had been walking with a heel strike. Cue exercise number 3. Standing on my LEFT leg, I was told to roll a tennis ball around on the floor under my right foot. Meanwhile Ryoji was back down in a squat position checking out the prosthetic at work! I complained about my poor knee working overtime. ‘Well, that’s what you asked for’ Liam said! Touche!

The last exercise I was given was what I nicknamed the gangsta shoulder! Apparently my upper body was looking a bit stiff so I was told to loosen up. But, in doing so, my left shoulder was moving better than my right. On reflection I think this is because I was still walking using the right crutch on its own. So he told me to roll that shoulder forward a bit more while extending the hip! Like I say, the gangsta walk! I am still trying to perfect it!

The last thing he said about exercises was better using my ‘toes’. Erm… I do not have toes?! What he meant was moving the joints further up my leg differently in order to maximise the use of the slight flex in the prosthetic foot. Oh my goodness I feel like my head is about to explode with all these different things I have to work on.

You know the term ‘learning how to walk again’? Well, I don’t believe I have ever used that phrase correctly until today!

Liam finished up by then asking me something that I have never been asked before. What were MY plans from here forward from a fitness point of view.

This immediately told me that in the short time I had spent with Liam, he clearly had worked out that I knew what I was talking about, had specific ideas that were way beyond the usual goals for a slightly older amputee and that he respected me and what I had to say.

I detailed my plans to extend walking distance starting with slightly shorter distances again. Then I moved on to my hope to get cycling again, and talked about how I was hoping to go about that. He agreed with everything I was saying and said it seemed like good plans. This was reassuring because I know that I do tend to set myself slightly lofty goals!

I finished up by asking Liam about running. I expected him to tell me I was being ridiculous at this point. Nope. He simply reminded me that I should start with restoring knee stability and how long that takes will determine how far down the track running would be.

Thank you Liam. You were amazing, you can come back!

My final question for Ryoji

A leg shaped leg that did not necessarily mimick a leg. Having thought about this a LOT during the last weeks on both of the previous prosthetic legs, I have decided I would like a prosthetic cover to make the lower leg calf and ankle shaped so I can wear leggings and so on, but so that it still stands out as a very cool prosthetic leg. I had been doing some research, and as soon as I started explaining Ryoji produced this.

They had recently been sent it as a prototype but had never used anything like this with any other customers. So, we browsed the hydrodip designs and picked a few out and I left him to place the order. Since this has not been done before in the Dunedin limb centre we are not quite sure how long this will take to arrive.

I already feel more confident and less self conscious about the leg, which is ridiculous considering it now looks even more obvious as an artificial leg than the others did and is getting more stares than before. I cannot WAIT to get the final piece and pimp my new look!