Before you begin running, talk with your physician, prosthetist, and other clinicians involved in your rehabilitation/health care treatment. Learning to use a prosthetic takes time and practice. Individuals that meet the minimum recommendations for running and have mastered walking on a prosthesis can begin running. The world of sports prosthetics has realized technological advancements to become highly refined and targeted for all levels of competition.

Before Running Recommendations

Every individual has specific healthcare needs, and guidelines should be considered to prevent injuries.

• To become a runner and progress to a good runner, individuals need to focus on strengthening their legs to build endurance levels to meet the energy demands.
• Working with a sports chiropractic and physical therapy team is recommended to build, strengthen, and condition the muscles and develop healthy posture and walking habits.

Skin Health

Talk with your healthcare team to ensure the skin can withstand the forces while running. If limb skin quality is insufficient, running can result in sores and blisters that prevent wearing a prosthesis until they heal. Other considerations include the following:

• The incision should be healed.
• All stitches and staples have been removed.
• There should be no drainage.
• Ensure there are no open wounds or blisters.

Bone Health

• Research suggests in some cases that a decrease in bone density/osteopenia or osteoporosis of the residual limb can occur after amputation.
• This can result in pain when applying weight through the residual limb.
• Some amputations can result in heterotopic ossification – bone growth in the soft tissues outside the normal skeleton.
• If heterotopic ossification is causing symptoms, it is not recommended to run and talk to your physician and prosthetist about options.

Proper Fitting of Prosthetic

• Suboptimal socket fit can result in an altered gait.
• If there is any compensation when walking, the gait deviations will be exacerbated when running.
• Gait deviations can result in abnormal loading, resulting in injuries.
• Talk to your prosthetist about the fit if it is less than optimal.
• It is recommended to participate in gait training with a chiropractic physical therapy team to learn to walk with proper form.

Balance and Agility

Agility drills are recommended to transition from walking to running.

• They help coordinate the limbs and can be done with a regular prosthesis.
• Agility and balance exercises promote stability in the socket to become more stabilized during quick movements.
• They can help to prevent balance-related falls.
• When working on balance, do it in a safe environment with a friend, family, or something to hold on to.

Strength Training

• The unaffected leg will now be the main powerhouse, so the focus needs to be on strengthening all the muscles in that leg.
• If you have bilateral amputations or both legs, the hips will be the powerhouse for running. It needs to generate all the force to propel the body forward.
• Individuals with a below-knee amputation will also have the hamstrings to help out.
• Hip musculature needs to be strong to meet running demands.
• Without proper strength, the body will compensate in various ways, which can lead to injuries.

Endurance

• Endurance training is essential.
• A high level of endurance is required before training to run to meet the energy demands.
• One study showed that running with a SACH/Solid Ankle Cushion Heel Foot requires 28-36% more energy than individuals without amputations.

Running With Prosthetic

Energy

Running on a prosthesis requires more energy. It could be recommended to use a running prosthesis instead of the everyday prosthesis. The energy needed to run is:

• Greater for individuals with amputations above the knee than those below the knee.
• Even greater for those with amputations on both sides.

Asymmetry

Asymmetrical loading is a common problem when running with a prosthesis. Runners want to use the unaffected limb more than maintain balance for reasons that include:

• Not trusting the prosthetic.
• Discomfort when loading the residual limb.
• Not enough strength in the residual limb.
• Unbalanced amounts of force from impact can result in injuries.

Practice Schedule

• In the first week, asses how the socket fits and if there is any discomfort.
• If something does not feel correct, check with your prosthetist.
• Don’t run for more than 10 minutes in the beginning without stopping to check the skin to see if any red spots appear.
• The pressure will be increased, so be aware of anything irritating or rubbing the skin.
• Individuals who had their amputations some time ago may be able to tolerate the load more easily at the beginning than individuals who recently had an amputation.
• Too much too soon can result in injuries.
• Slowly ease into running and give the limbs and body time to adapt to the physical and mental stress.

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Running With A Prosthetic Limb

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References

Beck, Owen N et al. “Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations.” Journal of applied physiology (Bethesda, Md.: 1985) vol. 122,4 (2017): 976-984. doi:10.1152/japplphysiol.00587.2016

Bragaru, Mihai, et al. “Sport prostheses and prosthetic adaptations for the upper and lower limb amputees: an overview of peer-reviewed literature.” Prosthetics and orthotics international vol. 36,3 (2012): 290-6. doi:10.1177/0309364612447093

Kanas, Joanne L, and Mark Holowka. “Adaptive upper extremity prostheses for recreation and play.” Journal of pediatric rehabilitation medicine vol. 2,3 (2009): 181-7. doi:10.3233/PRM-2009-0082

Matthews, D et al. “Return to sport following amputation.” The Journal of sports medicine and physical fitness vol. 54,4 (2014): 481-6.

Meyers, Carolyn, et al. “Heterotopic Ossification: A Comprehensive Review.” JBMR plus vol. 3,4 e10172. 27 Feb. 2019, doi:10.1002/jbm4.10172

Morgan, Sara J et al. “Mobility with a lower limb prosthesis: experiences of users with high levels of functional ability.” Disability and rehabilitation vol. 44,13 (2022): 3236-3244. doi:10.1080/09638288.2020.1851400