Amputee: Core Stability

What is core stability?

Core stability describes the ability to control the position and movement of the trunk. Training targets the muscles deep within the abdomen which connect to the spine, pelvis and shoulders. This improves walking, balance and lower back pain. These are all common problems for people who have had an amputation.

The core is made up of:

• Transversus Abdominus - which is the deepest abdominal muscle
• Multifidus - which runs down either side of your spine
• Pelvic floor muscles

Together these muscles:

• Form an internal corset that assists in the maintenance of good posture
• Provides the foundation for all arm and leg movements and through stabilising the joints of the spine, pelvis and shoulders
• Are postural muscles and therefore designed to work at low levels throughout the day

Benefits of core stability exercises:

Core stability exercises are designed to improve the strength and endurance of your core muscles by gently contracting them.

It is widely accepted that mobilising with a prosthesis (artificial limb) places an increased demand on your core.  It follows therefore that core stability exercises should:

• improve your ability to maintain good posture and produce well controlled limb movements while mobilising with your prosthesis.
• improve the stability of your spine, pelvis and shoulders and therefore decrease the risk of injuring these joints.

This leaflet includes useful exercises for people who have had above or below knee amputations as well as those who have had bilateral amputations or indeed non-amputees.

If you have any questions about the information in this booklet please speak to your physiotherapy team at the limb centre.

Correct Positioning

You need to position your back, shoulders and neck in its neutral position as it is easier to specifically activate the core muscles in this position.

A good way of finding your spine’s neutral position is:

• Place your thumbs and forefingers together into a diamond shape.
• Place the thumbs on your belly button and point your fingers towards your pelvic bone. 
• Tilt the diamond away from you, feeling your lower back arch off the mat or imagine that your pelvis is a bucket of water. Tip it forwards and ‘spill some water out the front of the bucket’
• Now tilt the diamond towards you, feeling your lower back flatten against the matt. Tip the bucket back to ‘spill some water out the back of the bucket’.
• Repeat these movements and settle in a position between the two extremes.
• Now try and maintain this position – a good idea is to imagine a tray of drinks lying on your stomach that you don’t want to spill.

To position your shoulder blades correctly, gently pull your shoulder blades downwards and inwards in the shape of a small V.  You should feel your collarbones widen across the front of your chest. As you do this make sure that you are not flaring your ribcage up – your upper back should stay flat against the mat.

Now gently lengthen your neck, feeling the bony part of your head gently pulling away from the base of your neck.  This should be a subtle, gentle feeling.  Feel the muscles at the front of your neck and check that they are soft and relaxed (not straining). 

Activating your core muscles

There are several ways of doing this.  Try the following and then choose the one you feel works best for you.  To check if you are activating the correct muscles, place your fingertips on your pelvic bones and then come in 2cm and down 2cm to a natural hollow  ( your therapist will show you this).You should feel a gentle tightening under your fingers.  If it bulges you are working too hard. 

• Imagine you have a low belt positioned below your belly button with 10 notches in it. Breathe in and out again, and then imagine that you are tightening the belt by just 3 of the notches.
• Imagine that you are desperate for the toilet and are trying to save yourself from an embarrassment.
• Men can imagine that they are pulling up the crown jewels!

Once you have chosen the best way for you, set your core and then stay in this position for around a minute.  Don’t forget to keep breathing!

Find your neutral spine, ribcage, shoulder blade and neck position.

Gently activate your core muscles, remember to breathe!
 

Core stability exercises
 

Abdominal Hollowing

Lie on your back with your knee bent and foot on the bed. You may find it comfortable to place a rolled up towel under your amputated leg  [note: the picture shows a foam support instead of a rolled up towel]  Gently pull in your stomach muscle, your back should not move at all. Watch you don’t hold your breath

• Slowly lift your foot, then lower it back to the bed
• Repeat on the other side by slowly lifting and lowering your amputated leg
   

Abdominal Hollowing Progressiony

This exercise is almost identical to the previous exercise.

The key difference is that once the leg is lifted off the bed you should straighten the leg slowly before returning it to the starting position.
 

Arm openings

• Lie on your side with your knees bent and your feet in line with your hips and shoulders.
• Arms reaching in front of the body and resting one on top of the other
• Slowly reach the uppermost arm towards the ceiling
• Continue to reach this arm out to the side, allowing the upper torso to rotate and front of the chest to open towards the ceiling.
• Allow your head to follow the movement of your arm
• Control the movement back round again
• See if you can achieve a greater stretch with each movement.
   

Mat exercises

Place a wedge or low stool under your thighs - or to make the exercise harder, a core ball.  Whatever you use, make sure that your thighs are level with each other.
 

One leg stretch

• Raise your leg up to table-top position - 90 degrees at your hip and 90 degrees at your knee
• Straighten your leg as if you are pushing a peddle
• Bring your leg back to table-top position
• Control your leg back down to the wedge
• Alternate sides
• Try to keep your pelvis still throughout the exercise.
    

Mini sit-ups

• Place your hands on your thighs
• Slide your hands up your thighs gently raising your shoulders off the mat
• Then control your shoulders back to the mat, sliding your hands back down your thigh.
• To position your neck correctly imagine you are holding a tennis ball between your chin and your chest.
   

Hamstring Stretch

• Sit up with your legs out wide apart in front of you
• Try to keep your knees straight
• Place your hands on rehab  ball or any ball
• Roll ball forwards and stretch forwards with your trunk
• When you feel a stretch at the back of your legs, hold the stretch for 15-20secs
• Vary the angle as you come forwards to vary the stretch
   

Hip Twist – Using Prosthesis

• Keeping one leg still, allow the opposite knee to drift out to the side
• Do not let your pelvis rotate
• Control your knee back to the middle
• Throughout the movement keep the opposite knee still
• Alternate sides
   

Superman

• Lie on your front with your arms straight out in front of you and your head looking down
• Raise your opposite leg and arm together - left arm with right leg and right arm with left leg
• If this exercise is too difficult then move just one limb at a time
   

4-Point Kneeling

Below knee amputees only !

This exercise should be done on a firm surface.Kneeling on your hands and knees. Pull in your abdomen.Keeping your back level, lift one leg off the floor and if you are steady then at the same time lift the opposite arm.Hold the position for 2 seconds

It is very important that the opposite arm and leg should be lifted together.
 

Hip Twist

• Rest both legs on exercise ball
• Place your arms out to the side
• Rotate the ball from side to side using your legs and your trunk to control the movement
• Look to the opposite direction to your legs to increase the stretch
• Can also be done with prosthesis on 3rd photo
   

Bridging

• Tighten core and buttocks muscles and tilt your pelvis back, flattening your lower back against the mat.  Carry on this motion, rolling your bottom and then spine off the mat until your trunk is in line with thighs
• Try to use the Pilates technique of peeling each back bone off the mat one segment at a time
• Hold this position for 5 seconds and then gently peel your trunk back down to the mat, again one back bone at a time.
   

Hip abduction

• Lie on your side
• Try to keep your hips and top leg in line with your body - do not let your top leg come forwards
• Raise leg up towards the ceiling and then control back down again
• Try to make sure your pelvis doesn’t rock backwards as your leg moves up
   

Clam Shells

• Lie on your side with head supported on a small pillow or rolled up towel.
• Keep the bottom arm straight reaching above your head and rest your top hand on the floor in front of you. Bend your hips to about 45 degrees and knees to about 90 degrees.
• Shoulders and hips should be stacked on top of each other – don’t let your shoulders or hips roll back and keep them both facing forwards.
• Draw the top hip downwards as if trying to push it towards your feet – this will create a small space between your waist and the mat. Imagine a space small enough for a mouse!
• Exhale and slowly lift the top knee upwards keeping your feet together, imagine a shell opening. Keep the upper body still and don’t roll backwards from the hips.
• Inhale and lower the top knee back to the start position.
• This can be progressed by using a band around the knees. Your Therapist will progress this as appropriate.

If you have any questions please contact us:

Disablement Services Centre
Rehabilitation Department
Lower Ground Floor
Cumberland Infirmary
Carlisle
CA2 7HY

Tel: 01228 814783
Mon – Fri 08:30 – 16:30

Transport is available, if you meet the eligibility criteria Otherwise you will need to make your own way to the DSC.  Please phone 0800 032 3240 to book your own transport.

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