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Five Steps for the Introduction to Lower Limb Amputee Running
By Robert Gailey, PhD, PT  Learning how to run with a prosthesis can be very
challenging, yet, when simplified into series of relatively basic
elements, it can be much easier to learn. The following are the
five easy steps that have made it possible for me to teach hundreds
of people to relearn the skill of running, and enabled them to
benefit from the ability to move fast when necessary. Initially,
for safety reasons, I strongly suggested that skilled clinicians
work with their clients and use a gait belt.
Step 1: Prosthetic Trust
Step One requires gaining trust in the prosthesis, or instilling
the confidence of knowing that the prosthetic limb is going to be
there and not collapse when the amputee's prosthetic limb strikes
the ground. This is accomplished by reaching out with the
prosthetic limb and landing squarely on the foot. The runner
should ignore everything else and know that the prosthetic limb
will be there.
Step 2: Backward Extension
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Figure 1. Prosthetic Thrust—reaching out with the prosthetic limb and knowing it will be there |
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Step Two, the runner reaches out with the
prosthetic foot during swing. Just prior to striking the ground,
the prosthetic leg pulls back forcefully creating a backward
force. As a result, the ground will produce a forward force
accelerating the body forward. This movement has two effects:
First, it will accelerate the body forward causing an increase in
speed and, second, this movement will give you the power to shift
your body weight over the prosthesis and fully load your prosthetic
foot resulting in maximum prosthetic foot performance as you load
the forefoot.
Step 3: Sound Limb Stride
During Step Three, the focus now shifts to the sound limb. The
runner should concentrate on taking a longer stride with the sound
limb. This can be easily accomplished by continuing to pull down
and back through the prosthetic limb. Pulling back during the
prosthetic foot's initial contact with the ground initiates the
movement pattern. The runner should continue to extend the hip by
pulling down and back into the socket. This will generate more
power and a stronger push off with the prosthetic limb, which will,
in turn, enable the sound limb to reach out to complete a full
stride.
Step 4: Stride Symmetry
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Figure 2. Backward Extension— pushing back against the socket wall exerting a forward force |
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Step Four is really a phase designed to decrease
the enormous effort that is being exerted and to simply relax and
jog a little. Therefore, the runner should choose a comfortable
jogging pace that produces an equal stride length for both limbs.
There should not be any concern for the arms, concentration should
be focused on maintaining stability over the prosthetic limb using
the muscles of the hips to create equal and relaxed strides.
Step 5: Arm Carriage
Finally, Step Five is focused on arm swing. The arms and legs
move in opposition to each other, so, as the right leg moves
forward, so will the left arm. The elbows should flex to about 90
degrees and the hands should be loosely closed and rise to just
below chin level when brought forward. Just as in walking, arm
swing is really the result of trunk rotation, as the trunk and
pelvis rotate in opposition to each other for balance, momentum and
economy of effort.
Putting It All Together
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Figure 3. Sound Limb Stride—reaching out with sound limb for an equal stride length |
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Finally, the runner should be ready to put all the
individual elements of running together. The runner should relax
and think about only a couple of elements of running with each
pass. Many long distance runners augment their endurance training
program by utilizing low impact activities such as swimming,
stationary biking or stair climbing machines. In time, the runner
will develop his/her own comfortable running style, depending on
the sports or recreational activities chosen for participation.
Learning to run can take place on just about any type of
prosthesis, and initially the prosthetic foot is not critical.
However, if the amputee decides that running is going to be a part
of his active lifestyle they should discuss with their prosthetist
the various available prosthetic options. Classically, the
Flex-Foot has been considered the foot of choice for higher level
activities, with the Flex-Sprint foot worn by most competitive
athletes. Currently, there is also a relatively new design, the
C-Sprint, which is engineered for recreational jogging and longer
distance training. The same principles of running apply regardless
of the prosthetic foot; however, prosthetic feet designed for
running can reduce the effort and improve performance.
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Figure 4. Arm Carriage—moving the arms in opposition to the movement of the legs |
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To learn more about these basic running techniques
and many others, the Functional Training and Running Series for
Transfemoral and Transtibial Amputees video and book series can
assist clinicians and amputees alike.Robert Gailey, PhD, PT, has specialized in the rehabilitation of lower-extremity amputees for about 20 years. He has done extensive research, writing, and lecturing. In addition to teaching at the University of Miami, Florida, he also operates Advanced Re 
Table Of Contents - December 2003
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