Physiotherapeutic treatment considerations specific to the through-knee

amputee are presented. Treatment is determined by the assessment findings.

The physiotherapy programme includes post-operative exercises, early weight-
bearing, bed to chair transfers, bandaging techniques, the counteracting of
contractures and gait training. Physiotherapy is a vital part of the rehabilitation
of through-knee amputees. Principles of treatment are based on normal human
locomotion, the individual patient's health status, biomechanical changes and
expected stump functions. The through-knee stump is generally problem free,
functional and end-bearing, allowing for a high rehabilitation rate in independent
ambulation. It is therefore well suited for the geriatric amputee.

Mobility was significantly better in those patients with a unilateral BKA compared with a
unilateral AKA (34/43 or 79% versus 10/27 or 37%, respectively, chi-squared analysis
p=0.001). Univariate analysis found that no other factors affected mobility, in particular age,
sex, diabetes, emergency admission, indication for amputation and previous vascular surgery.

Table 1: Summary of the Wood/Stanmore classification of mobility

Grade Description
Use of cosmetic limb
I Cosmetic
only
Wears prosthesis only for
transfers or to assist
II Therapeutic
nursing; walks only with
therapist or carer
Indoor walker only,
using walking aids e.g.
III Indoor
sticks, crutches or
Zimmer frame
IV Outdoor with walking Indoor and outdoor
 walking, although with
aids
the use of walking aids
Independent indoor and
outdoor walking with no
walking aids, except
V Independent
occasionally for covering
difficult terrain or
weather conditions.

DISCUSSION

Above Knee Amputee Exercises After an above the knee amputation,

it is important to prevent the hip from staying in a bent or flexed position for a long period of time.

To prevent this from happening you need to do the following:

Frequently change the position of your hip. Do not sit in a chair for long periods.

Lie on your stomach for 20 minutes 2 or 3 times a day. Do not place a pillow under your
stomach.

Do not put your amputated leg on a pillow when lying down, unless otherwise told to do so. Do
not place a pillow under your hips, knees, or between your thighs.

Do not hang your stump over the side of the bed.

The following exercises should be done every day, as recommended by
your therapist. Stretching Exercises: Do not bounce back and forth when doing
stretching exercises. Hamstring Stretch: Lie on your back.
Bring your non-amputated limb toward your chest.
Put your arm around your thigh and pull even closer.
Hold for 20 seconds.
Bring your non-amputated knee toward your chest.
Straighten your leg until you feel a stretch in the back of your thigh.
Hip Flexor Stretch Lie on your back.
Bring your non-amputated leg up to your chest and hold it with your arms.
Have someone push your amputated limb down to the bed and hold it for a count of 20.
Relax and repeat.
When your leg can easily lay on the bed, scoot to the side and dangle your amputated limb over
the side of the bed.

Repeat the above exercise.

Alternative Stretch Lie on your stomach.
Place a rolled towel under your amputated limb.
Lie in this position for 20 minutes.
As you stretch the hip flexor muscle,

you may increase the size of the towel roll.

Adductor Stretch Sit with your back against a wall or

against the head of your bed.
Put your amputated limb out to the side and bend the other leg slightly.
Push on the thigh so you feel a stretch in your inner thigh.
Make sure that both buttocks remain on the floor.
Do not lift one up in the air.

Strengthening Exercises Hip Extension 1 Lie

on your stomach.
Lift your amputated limb off the bed towards the ceiling.
Return to the starting position.
Use a weight, if instructed by your therapist.

Repeat the recommended number of times.

Hip Extension 2 Lie on your back.

Place a rolled towel under the end of your amputated limb.
Push down into the towel, and lift your hips off the floor.

Repeat the recommended number of times.

Hip Abduction Lie on your back.
Fasten a belt or stretch band around your thighs as low as it is comfortable.
Try to pull your legs apart by pushing outward against the belt or band.
Push for a count of 5.
Relax.

Repeat the recommended number of times.

Alternative Hip Abduction Exercise Lie on your side

and lift your top leg towards the ceiling.
Keep your knee pointed forward.
Return to the starting position.

Repeat the recommended number of times. Repeat this

exercise with the other leg on top.
Hip Adduction Lie on your back.
Place a rolled towel or pillow between your legs as low as is comfortable.
Squeeze the towel between your legs for a count of 5.
Relax.

Repeat recommended number of times.

Alternative Hip Adduction Exercise Lie on your
side.
Bring your top leg forward and let your foot rest on the floor in front of you.
Lift your bottom leg toward the ceiling.
Return to the starting position.
Repeat recommended number of times.
Pelvic Tilt Lie on your back.
Bend your knee so the foot of your non-amputated leg is resting flat on the floor.
Place your hands in the small of your back.
Push your low back into your hands.
Hold for a count of 5.
Relax.

Repeat recommended number of times.

Partial Sit-up Lie on your back.
Bend your hips so the foot of your non-amputated leg is resting flat on the floor.
Rest your hands on your thighs.
Slowly curl up until your head and shoulder blades are off the floor.
Look up to the ceiling as you do this exercise.

Repeat recommended number of times.

Excerpt from patient education handout,
The Ohio State University Medical Center, Department of Physical Therapy
Copyright, (1/2002)

8888888888888888888888
PHYSIOTHERAPY EXERCISES
FOLLOWING
TRANSFEMORAL (ABOVE KNEE)
AMPUTATION
Produced by P.I.R.P.A.G. (Physiotherapy Inter Regional Prosthetic
Audit Group,
London, United Kingdom)
Introduction
• This sheet has been designed to help you remember the
exercises that you have been taught by your physiotherapist.
All of the exercises should be done slowly and smoothly. If
you feel any pain, stop and tell your physiotherapist or doctor.
• Exercise helps to keep your strength and mobility as well as
improve your blood flow.
• These exercises will help to keep you independent either in a
wheelchair or using an artificial leg (prosthesis).
• Try to keep doing these exercises, even after you have been
discharged from treatment.
❑ [1] Static Gluteal Contractions
• Lie on your back
• Keep both legs straight and close together
• Squeeze your buttocks as tightly as
possible
• Hold for 5 seconds
• Repeat ___ times
❑ [2] Hip Flexor Stretch
• Lie on your back, preferably
without a pillow
• Bring your thigh towards your
chest and hold with your hands
• Push your opposite leg down flat
on to the bed
• Hold for 30 – 60 seconds, then
relax
• Repeat ___ times
Repeat the above with the other leg.
❑ [3] Hip Hitching
• Lie on your back
• Keep both legs flat on the
bed
• Hitch one hip up towards
you on one side and push
away on the other
(shortening one side and
stretching the other)
• Hold for 3 seconds
• Repeat ___ times
Repeat on the other side.
❑ [4] Bridging
• Lie on your back with your
arms at the side
• Place a couple of firm pillows
or rolled up blankets under
your thighs
• Pull in your stomach, tighten
your buttocks and lift your
bottom up off the bed
• Hold for 5 seconds
• Repeat ___ times
To make this exercise more difficult, place your arms across your chest
as shown in the picture.
❑ [5] Hip Flexion and Extension in Side
Lying
• Lie on your side
• Bend the bottom leg
• Lift your top leg slightly
• Bend your thigh fully towards
your chest
• Push your leg backwards as far
as you can
• Repeat ___ times
NB Try not to let your hips roll
forwards or backwards.
Repeat the above with the other
leg.
❑ [6] Hip Abduction in
Side Lying
• Lie on your side
• Bend the bottom leg
• Keep hips and top leg in line
with your body
• Slowly lift your top leg up
• Slowly lower
• Repeat __ times
NB Try not to let your hips roll
forwards or backwards.
Repeat the above with the other leg
❑ [7] Hip Extension in Prone Lying
• Lie flat on your stomach
• Lift your leg off the bed as
far as you can
• Be sure to keep hips flat
on the bed and do not roll
your body
• Hold for 5 seconds,
slowly lower
• Repeat ___ times
Repeat the above with the
other leg.
❑ [8] Hip Adduction With Resistance
• Sit with both legs out in front of you
• Place a pillow or rolled up towel between
your thighs
• Squeeze your legs together
• Hold for 5 seconds
• Repeat ___ times
NB This exercise can also be performed when
sitting in a wheelchair or at the edge of a bed.
This exercise sheet has been produced by representatives of P.I.R.P.A.G.
(Copyright _ PIRPAG 2004)