Amputation Preparation and Recovery

Piedmont’s Physical therapists help people who receive an amputation prepare for surgery, and regain strength, movement, and function following surgery.

Prior to Surgery:

Before your surgery, your physical therapist may:

Prescribe exercises for preoperative conditioning, and to improve the strength and flexibility of the hip and knee
Teach you how to walk with a walker or crutches
Educate you about what to expect after the procedure

Immediately after Surgery:

Your hospital stay will be approximately 2 to 10 days after surgery. Your wound will be bandaged, and you may also have a drain at the surgery site—a tube that is inserted into the area to help remove excess fluid. Pain will be managed with proper medication. Physical therapy will begin soon after surgery when your condition is stable and the doctor clears you for rehabilitation. A physical therapist will review your medical and surgical history, and visit you at your bedside. Your first 2 to 3 days of treatment may include:

Gentle stretching and range-of-motion exercises
Learning to roll in bed, sit on the side of the bed, and move safely to a chair
Learning how to position your surgical limb to prevent contractures (the inability to straighten the knee joint fully, which results from keeping the limb bent too much)

When you are medically stable, the physical therapist will help you learn to move about in a wheelchair, and stand and walk with an assistive device.

Rehabilitation:

Your physical therapist will work with you as you heal following the amputation, help to fit your prosthesis, and guide your rehabilitation to ensure you regain your strength and movement in the safest way possible. Your treatments may include: Prevention of contractures: A contracture is the development of soft-tissue tightness that limits joint motion. The condition occurs when muscles and soft tissues become stiff from lack of movement. The most common contracture following transtibial amputation occurs at the knee when it becomes flexed and unable to straighten. The hip also may become stiff. It is important to prevent contractures early; they can become permanent if not addressed following surgery, throughout recovery, and after rehabilitation is completed. Contractures can make it difficult to wear your prosthesis and make walking more difficult, increasing the need for an assistive device like a walker. Your physical therapist will help you maintain normal posture and range of motion at your knee and hip. Your therapist will teach you how to position your limb to avoid the development of contracture and show you stretching and positioning exercises to maintain a normal range of motion. Compression to reduce swelling: It is normal to experience postoperative swelling. Your physical therapist will help you maintain compression on your residual limb to protect it, reduce and control swelling, and help it heal. Compression can be accomplished by:

Wrapping the limb with elastic bandages
Wearing an elastic shrinker sock

These methods also help shape the limb to prepare it for fitting the prosthetic leg. In some cases, a rigid dressing, or plaster cast, may be used instead of elastic bandages. An immediate postoperative prosthesis made with plaster or plastic also may be applied. The method chosen depends on each person’s situation. Your physical therapist will help monitor the fit of these devices and instruct you in their use. The main goal of your care during this time is to reduce swelling. Pain management: Your physical therapist will help with pain management in a variety of ways, including:

Manual therapy, which may include “hands-on” treatments performed by your physical therapist, including soft tissue (ie, muscle, tendon) mobilization, joint manipulation, or gentle range-of-motion exercises, in order to improve circulation and joint motion
Stump management, including skin care and stump sock use
Desensitization to help modify how sensitive an area is to clothing, pressure, or touch Desensitization involves stroking the skin with different types of touch to help reduce or eliminate sensitivity
Mirror therapy and/or graded motor imagery

Approximately 80% of people who undergo amputations experience a phenomenon called phantom limb pain, a condition in which some of their pain feels like it is actually coming from the amputated limb. Your physical therapist will work with you to lessen and eliminate the sensation. Please see our guide on Phantom Limb Pain for more details.

Prosthetic fitting and training:
Your physical therapist will work with a prosthetist to prescribe the best prosthesis for your life situation and activity goals. You will receive a temporary prosthesis at first while your residual limb continues to heal and shrink/shape over the first 6 to 9 months of healing. The prosthesis will be modified to fit as needed over this time.
Most people with transtibial amputations learn to walk well with a prosthesis. Physicians use the following criteria to determine when you are ready for a temporary prosthesis, or your first artificial limb.

Your incision should be almost healed or completely healed.
Your swelling should have decreased to an acceptable amount.
You will have regained sufficient overall strength to be able to walk safely.

After the limb has reached a stable shape, and your physician approves your condition, you will be fitted for a permanent prosthesis.

Functional training:
After you move from acute care to rehabilitation, you will learn to function more independently.

Your physical therapist will help you master wheelchair mobility and walking with an assistive device like crutches or a walker. Your therapist also will teach you the skills you need for the successful use of your new prosthetic limb. You will learn how to care for your residual limb with skin checks and hygiene and continue contracture prevention with exercise and positioning.

Your physical therapist will teach you how to put your new prosthesis on and take it off, and how to manage a good fit with the socket type you receive. Your therapist will help you to gradually build up a tolerance for wearing your prosthesis for increasingly longer times while protecting the skin integrity of your residual limb. You will continue to use a wheelchair for getting around, even after you get your permanent prosthesis, for times when you are not wearing the limb.

Guided rehabilitation:
Prosthetic training is a process that can last up to a full year. You will begin when your physician clears you for putting weight on the prosthesis. Your physical therapist will help you learn to stand, balance, and walk with the prosthetic limb. Most likely you will begin walking in parallel bars, then progress to a walker, and later as you get stronger, you may progress to using a cane before walking independently without any assistance. You will also need to continue strengthening and stretching exercises to achieve your fullest potential, as you return to many of the activities you performed before your amputation.

Return to Recreational and Sports Activities

If you are active or have a favorite sport you may also want to consult with a recreational physical therapist, who can help you choose appropriate adaptive recreation equipment. Depending on your personal goals and preferred leisure activities, the recreational physical therapist can help you return to sports such as golf, hiking, running, swimming, or cycling. A prosthetist can help you choose the best prosthetic device for taking part in these types of activities. You also may gain valuable advice from other individuals with amputations; your physical therapist can help you find support groups for people with amputations in your area.