9

LEGS

People with lower limb amputation may tend to rectly through weight training . Training the
focus on developing only upper-body strength . They quadriceps muscles will help to strengthen the
often do not understand the importance of develop- tendons and ligaments in a secondary fashion, but
ing strength in their sound leg and residual limb. not directly . The stronger the muscles, the more the
Leg conditioning helps to retain symmetry of the muscle structure can give support to the tendons and
body, improve the walking gait, and combat the ligaments . Strength of the knee muscles and stability
natural process of atrophy that takes place in the of the knee joint structure via its ligaments is vital to
residual limb . Weight training helps keep the mus- the physical abilities of individuals who wear below-
cles of the legs strong and protects the joints from knee prostheses . For those with an above-knee
injury . Strong leg muscles reduce the stress placed amputation, a strong knee on the sound leg is
on the sound limb of the person with a unilateral important in maintaining mobility and agility.
amputation during walking, running, and sports Weight training exercises that require standing
activities. may be difficult for some people with lower limb
Each person's residual limb is unique in struc- amputation because standing exercises require bal-
ture . For this reason, the way one person with AK ance. Also, additional weight is placed on the
amputation accomplishes a particular exercise while residual limb when lifting weights . In turn, this
wearing a prosthesis may be quite different from the weight is transferred through the socket . For weight
way another person with AK amputation does the lifting exercises from a standing position, extra
same exercise . Method greatly depends on the socks may be necessary to help withstand the added
structure and length of the residual limb . However, strain on the residual limb . Seated leg exercises,
a variety of weight training and resistant exercises using equipment such as Nautilus or Universal, are
are available, and one may select those which best preferred for many individuals with lower limb
suit the conditions of the residual limb and pros- amputation because they are better able to isolate
thetic fit . It is a good idea to switch exercises the muscle group they want to work, as well as
periodically to work the muscles at different angles. eliminate balancing problems.
The knee is one of the largest and most complex The following exercises strengthen the
joint structures of the body and is surrounded by adductor/abductor, hamstring, gluteus maximus,
numerous tendons and ligaments . Tendons connect quadriceps, and gastrocnemius/soleus muscles . This
muscle to muscle ; ligaments connect bone to bone. type of program should be performed every other
You cannot strengthen tendons and ligaments di- day on a regular basis.
90
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Conditioning Exercises : Legs

LEG EXERCISE ROUTINE

Muscle Exercise Title

Quadriceps/Lower Thighs 36 Single Knee Extension

Quadriceps 37 One-legged Low Wall Pulley Knee
Extension
Quadriceps 38 Seated Knee Extension
Quadriceps/Thighs 39 Skier's Position
Quadriceps/Gluteus 40 Moon Bench Leg Press
Maximus
Upper Thighs/Hips 41 Nautilus Double Leg Press
Quadriceps/Hip Extensors 42 Alternating Leg Press
(Nautilus Duo Squat Machine)
Quadriceps 43 Half Squats
Hip Extensor/Hamstrings/ 44 Nautilus Hip and Back Machine
Gluteus Maximus
Hamstrings 45 Leg Curl
Hamstrings 46 Standing One-legged Low Pulley Leg
Curl
Hamstrings/Gluteus 47 Standing Pulley Hip Extension
Maximus
Abductor/Adductor 48 Nautilus Hip Abduction/Adduction
Machine
Abductor 49 Low Pulley Single Hip Abduction
Hip Adductors 50 Low Pulley Single Hip Adduction
Gastrocnemius 51 Weighted Standing Calf Raise
Gastrocnemius/Soleus 52 Seated One-legged Toe Raise
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

INCREASING Always do warm-up exercises before lifting weights.

THE
Start with a minimum of 8 repetitions with a given weight . If a minimum of 8
NUMBER repetitions cannot be completed, the weight is too heavy for you and the
OF resistance should be lowered until 8 repetitions can be completed.
REPETITIONS
When 12 repetitions can be successfully completed, the weight should be
increased by 5-10 pounds . When 12 repetitions can be completed with the
increase in pounds, the weight may be increased again.

Work up to 15'20 repetitions per set for muscle maintenance, endurance, and
tone.

When performing exercises with free weights, it is recommended that 2-6

sets for each particular muscle group be used.

CAUTION
Beginners are encouraged to use free weights with a spotter present . Certain
exercises will require a spotter regardless of skill level (e .g . ' squats) .
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Conditioning Exercises : Legs

EXERCISE 36 . SINGLE KNEE EXTENSION

PURPOSE
Develops the quadriceps muscles.

PROCEDURE
U~ Sit on the bench so that the back of the knee of the sound leg is touching the edge of
the bench and the foot is on the floor.
IN Place the top of the foot and ankle under and against the foot pad.
• Sit with the back pressed against the back support . Secure the seat belt and grasp the
handles on the sides for support.
n Extend the knee until the leg is nearly parallel to the floor . Slowly lower your leg back
to the starting position.

MODIFICATION
For those with AK amputation, the prosthetic knee may be locked in extension and the leg
placed on a bench or chair off to the side, or the knee may be left in a flexed position over
the edge of the bench, because the prosthetic leg cannot be used effectively in this exercise.

SKILL LEVEL
Intermediate.

Linda Pedersen demonstrates this knee extension exercise on the Nautilus equipment .
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n*oaClinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 37 . ONE-LEGGED LOW WALL PULLEY KNEE EXTENSION

PURPOSE
Develops the quadriceps muscles.

PROCEDURE
U~ Position a fairly tall flat bench sideways in front of the weight stack.
El To exercise the prosthetic leg, pull the cable underneath the bench and attach the cuff
strap around the prosthesis in the middle of the socket . The position will vary
depending on the length of residual limb and individual preference (see NOTE below).
NI Start with both feet on the ground with the lower legs vertical to the floor . Adjust the
position of the bench far enough away from the machine so the weights are slightly off
the stack before beginning to lift the leg.
NI Hold onto the bench for support and extend the prosthetic leg until it is at full
extension . (Full extension may be difficult to obtain with certain prostheses that have
cuff suspension or joints and lacer .)

MODIFICATION
For those with short residual limbs, moving the cuff strap proximally on the leg rather
than placing it distally at the ankle should prevent anterior distal tibia pressure.

SKILL LEVEL
Intermediate.

NOTE
To obtain full extension of the knee, sleeve
suspension works well for the BK prosthesis.
This is a good exercise to accommodate the
prosthetic !inmb, but when you want to train
the sound side it is easier to use the conven
tional Leg Extension Machine seen in Exercises
3Sund38 .

Albert Ra pp o p o rt demonstrates leg extensions us-

ing a pulley attached to a leather cuff strap and
D-Ring on his axoake!etal prosthesis.
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Conditioning Exercises : Legs

EXERCISE 38 . SEATED KNEE EXTENSION

PURPOSE
Strengthens the quadriceps.

PROCEDURE
• Sit on the edge of the bench with the back of the knees touching the edge of the bench.
M Place the top of both feet and ankles against the foot pad . Sit with the back flat against
the back support.
II Secure the seat belt, if available, and grasp the support handles or the sides of the
chair.
• Extend the knees until both legs are nearly parallel to the floor . Hold the position
briefly and then slowly lower the legs back to the starting position.

SKILL LEVEL
Intermediate.

CAUTION
In this exercise, resistance is placed against
the ankles and can be tolerated by those with
long residual limbs . Some machines allow the
foot pads to adjust upward, which will provide
greater comfort for people with short residual
limbs . However, people with short residual
limbs may experience anterior distal pressure.
In such a case, this exercise may be used for
the sound leg only, or the One-legged Low
Wall Pulley Knee Extension (Exercise 37) may
be substituted, since it allows the resistance
to be placed at a mid-socket point to relieve
anterior distal pressure.

John Everett demonstrates the knee extension exercise

from a seated position .
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 38 . SEATED KNEE EXTENSION (Continued)

Albert Rappoport demonstrates (on a slightly different

type of equipment) the knee extension exercise from a
seated position .
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Conditioning Exercises : Legs

EXERCISE 39 . SKIER'S POSITION

PURPOSE
Develops quadriceps muscles through static muscle contraction, including the muscles of
the residual limb.

PROCEDURE
n Stand against a wall . With the back pressed to the wall, lower the body until the
position shown in the photo is achieved.
n The hands may be used against the wall while lowering the body into position . Both
feet should be flat on the floor and far enough away from the wall so that the upper
portion of the legs are parallel to the floor and the lower portion of the legs are in a
vertical position to the floor, as shown in the photo.
n Keep the hips positioned at the same height as the knees.
n Keep hands loose and shoulders back against the wall.
n Work up to holding this position for 30 seconds, and then relax for 30 seconds . Repeat
three times every other day . Increase the time spent in the Skier's Position by 15
seconds each week.

VARIATION
Beginners should start with the buttocks higher than
the knees, while keeping the back against the wall.
More advanced individuals can gradually maintain a
position where the hips are parallel to the floor . If
this position is difficult to maintain, you may ease
tension on the thigh muscles by placing your hands
on your knees . Gradually increase the length of time
spent in the Skier's Position and shorten the length
of the rest periods to make the exercise more
difficult.

SKILL LEVEL
Advanced.

Linda Pedersen demonstrates this static muscle contraction

exercise .
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 40 . MOON BENCH LEG PRESS

PURPOSE
Strengthens the quadriceps and gluteus maximus muscles.

PROCEDURE
n Sit on the Moon bench so that the buttocks are at the front of the bench.
n Place both feet on the foot pad and space them several inches apart, as shown in the
photo.
n Hold the bench under the buttocks for support, if needed . Push against the foot pad
evenly with both legs until the legs are completely extended as shown.
n Slowly bring the legs back to the starting position.

MODIFICATIONS
Certain prostheses may restrict flexion and extension of the knee for those with BK
amputation . Adjustments may be necessary with suspension, posterior trim lines, or joints
and lacer . Sleeve suspension is helpful in achieving full extension, although flexion may
remain restricted in some cases . Lower posterior trim lines of the socket can help reduce
pressure on the hamstrings.

SKILL LEVEL
Intermediate.
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Conditioning Exercises : Legs

John Everett demonstrates the seated leg press using both

prosthetic legs to achieve a full range of motion .
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 41 . NAUTILUS DOUBLE LEG PRESS

PURPOSE
Develops strength in the upper thighs and hips.

PROCEDURE
n Adjust the back of the seat so that your legs are at a 90-degree angle (or more) when
your feet are placed flat on the footrests . Make sure you secure the seat belt as you
keep your back flat against the backrest.
n Straighten the legs . After the legs have reached maximum extension, bring them back
slowly until the knees are flexed to at least a 90-degree angle.
n Exhale while extending the legs and inhale as the knees are brought to the starting
position.

MODIFICATIONS
If you are breaking suction in your AK socket while flexing the hips, try moving the seat
back so your legs do not go into as much flexion . You may also try lowering the anterior
trimlines of your socket . Additional suspension using a Silesian bandage or Neoprene TES
Belt may be helpful . Training the legs for the bilateral AK amputee should start with low
weights . Those with BK amputation who find it difficult to bend the knee to a 90-degree
angle should move the seat back to a lesser angle.

SKILL LEVEL
Intermediate .
 101

Conditioning Exercises : Legs

Samantha Ellis is in the starting position with knees flexed.

Samantha Ellis pushes both of her residual limbs down in hip extension to extend her
prosthetic legs . Knees are locked out as far as possible to complete the exercise .
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 42 . ALTERNATING LEG PRESS (NAUTILUS DUO SQUAT MACHINE)

PURPOSE
Strengthens the quadriceps and hip extensors.

PROCEDURE
n Lie on the bench with shoulders pressed against the shoulder pads and hands gripping
the support bars.
n Position both feet on the foot pads and extend both legs . Keep one leg extended and
flex the opposite leg, as demonstrated in the photo.
n Press the flexed leg against the foot pad so that it is again extended.
n Continue to alternate legs, as shown in the photo.
n Always bring both legs to a fully extended position before beginning another flexion.

MODIFICATIONS
Because the weight needed to effectively exercise a sound leg is likely to be considerably
greater than the weight needed for a prosthetic leg, it is best to exercise each leg
independently. The legs are worked one at a time, and a lower weight (which can be
gradually increased as strength develops) is placed on the side with the prosthesis . Some
people with AK amputation may feel that they will not be able to do the exercise, but with
practice, most will be able to . The AK-level individual can perform this exercise by
extending the thigh, which extends the prosthetic knee . This works the muscle of the
residual limb inside the socket.

SKILL LEVEL
Advanced.
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Conditioning Exercises : Legs

Undo Pedersen demonstrates the alternat-

ing leg press exercise .
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nRDoonmoal Guide. Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 43 . HALF SQUATS

PURPOSE
Develops strength in the quadriceps muscles.

PROCEDURE
• Take a medium stance with the feet approximately 16 inches apart or a wide stance
with the feet approximately 30 inches apart.
U~ Place your hands on the bar, positioning them wider than the shoulders.
II Rest the bar on the upper portion of the back.
n Keep your head up and your back straight at all times.
• From the standing position, squat until your thighs are parallel to the floor.
• Head is up, back straight, and knees are pointed out . Heels are elevated with the
weight on the balls of the feet.
U~ Inhale while squatting ; exhale as you return to the starting position, keeping legs
extended and placing the heels on the ground.

VARIATION
Use a weight belt to help protect the back from injury . The serious, competitive
powerlifter may benefit from a special prosthesis that accommodates the wide stance and
keeps the foot flat on the ground at all times for greater stability . For lifting light to
medium weights, an everyday walking prosthesis is usually adequate.

MODIFICATIONS
Because Velcro" on the cuff strap suspepull apart when fully flexed,
suspension sleeves are particularly useful . The AcdvSlocvcis pictured
pictured on page 105, Trim
lines may need modification on some prostheses to allow increased range-of-motion,
particularly to medial and lateral walls and posterior trim lines.

SKILL LEVEL
Advanced .

NOTE
A close stance (feet less than 16 inches apart) is usually not recommended for individuals
with lower limb amputation because it makes it very difficult to maintain balance when
squatting . Although squats generally are performed with a 2 x 4 board underneath the heels
to elevate them through the entire exercise, this is not recommended for those with
prostheses . The elevated position could create instability, throw the amputee lifter too far
forward, and vary prosthetic alignment . It is possible to align a prosthesis just for squatting
when standing on a 2 x4board . However, many prefer a special weight-lifting shoe with
appropriate alignment .
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Conditioning Exercises : Legs

Albert Ra pp o p o rt demonstrates 90-degree half squats with

205 pounds . He performs squats using his everyday walking
leg . Notice how weight is on the ball of the foot (prosthetic
side) because the prosthetic ankle cannot bend as far
forward as the sound side . This still provides adequate
balance and support . Rappoport's heavy workouts include 3
sets of 5 repetitions with up to 275 pounds .

Even though a majority of the weight is taken on the sound

side, squats are an excellent conditioning exercise for the
residual limb.
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 44 . NAUTILUS HIP AND BACK MACHINE

PURPOSE
Strengthens hip extensor . Works the gluteus maximus and hamstrings . This exercise is
good for those with AK amputations because it strengthens the musculature of the
residual limb.

PROCEDURE
n Step 1
— Lie flat on the bench, flex the hips so the thighs are vertical, and place the lower legs
over the pads . Position yourself so that both hips are in line with the cam . (This will
insure that the body's axis of rotation is lined up with the machine's .)
— Strap the seat belt across the waist and grip the handle bars on each side for support.
— Push down on both legs and touch both feet to the floor if possible, as seen in the Step
1 photos below . The extended legs hold down the weights by maintaining a static
contraction on the lower back and hips.

Samantha Ellis and Linda Pedersen demonstrate Step 1 of

this exercise, which gets both legs in position to begin the
repetitions . The Nautilus Hip and Back machine works the
same muscles as does the pulley/cable used in Exercise 47,
but it is not always available in small facilities . Some people
with lower limb loss find it easier to use this machine than
the pulley/cable .
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Conditioning Exercises : Legs

n Step 2
— Keep one foot in contact with the floor and bring
the other leg up (with a count of four) until the
thigh is flexed and perpendicular to the floor, as
seen in the photos on the right.

— As shown, the leg in contact with the floor

maintains static contraction holding the weight
bar down while the other leg is brought up
slowly until the thigh is in a vertical position.

n Step 3
— Push the flexed leg down against the resistance
of the weights by extending the hip until both
feet are touching the floor with a count of two .
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 44 . NAUTILUS HIP AND BACK MACHINE (Continued)

IN Step 4
— Bring the other leg up slowly with a count of four, while the previously raised leg
maintains static contraction against the weight resistance with the foot on the floor
(same as Step 2, but with the other leg).
- Repeat Step 3 in preparation for another full repetition.

SKILL LEVEL
Intermediate to Advanced .

CAUTION
This exercise can be stressful to the lower back . Omit if low back problems are present .
 109
Conditioning Exercises : Legs

EXERCISE 45 . LEG CURL

PURPOSE
Develops the hamstrings.

PROCEDURE
n Lie face-down on a leg curling bench.
n Make sure the knees are off the end of the bench and the legs are straight with the heels
under the foot pads.
n Flex one leg as far as it will go, trying to touch the foot pad to the buttocks.
n Slowly lower the leg back to the extended position.

MODIFICATIONS
For those with AK amputation, working the residual limb from this position is not
feasible because the knee is not controlled by muscles . Exercise 44, the Nautilus Hip and
Back Machine, should be used . Those with BK amputations may not be able to complete
full range of motion due to short residual limb size or flexion restrictions on prosthesis.
Exercise 46 or 47 should be used as an alternative.

SKILL LEVEL
Intermediate.

CAUTION
Avoid arching the lower back.

On the Nautilus equipment, Linda Pedersen demonstrates the Leg Curl using her sound
limb .
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nnomClinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 46 . STANDING ONE-LEGGED LOW PULLEY LEG CURL

PURPOSE
Develops the hamstring muscles.

PROCEDURE
NI Face the weight machine and place a cuff strap around the middle of the socket on the
outside of the prosthesis . Adjust the position of the strap on the leg for maximum
comfort.
Hold on to the support bar and flex the knee on the prosthetic leg while balancing on
the sound leg . Try to flex as much as possible before returning the foot to the floor.

MODIFICATIONS
Many people find it difficult to do leg curls from a prone position with their prosthesis
(Exercise 45) and find the standing position better suited for them . However, the leather
cuff and D-ring pulley should not be attached at the ankle level for those with a short
residual limb because flexing would produce undesired forces and excessive stress on the
residual limb, and would also make the exercise more difficult . In order to concentrate on
the hamstring muscles, the best attachment point is at the middle of the socket . If the
residual limb is long, the cuff strap may be worn on the lower part of the leg.

SKILL LEVEL
Intermediate.

NOTE
Most people with below-knee amputation will
be able to flex to a maximum of 90 degrees.
Trim lines of the socket, length of residual
limb, and suspension will be limiting factors . In
certain cases, your prosthetist can make ac-
commodations . If balancing on the prosthetic
leg presents a problem, exercise the sound leg
on the leg curl bench as shown in Exercise 45.

Albert Rappoport demonstrates the correct form for Leg

Curls for a person with aohort residual limb wearing a BK
prosthesis .
 111

Conditioning Exercises : Legs

EXERCISE 47 . STANDING PULLEY HIP EXTENSION

PURPOSE
Works the hamstrings and gluteus maximus.

PROCEDURE
n Attach the ankle cuff in a comfortable position to the exercising leg . Face the weights
and hold the handrail for balance and support . Keep the trunk stationary and the back
straight.
▪ Start with the legs together and then extend the weighted leg backward as far as
possible . The other leg remains planted on the floor for support.
▪ When the back leg is fully extended, hold for a few seconds and then slowly bring the
leg forward until it is even with the other leg and in a standing position.

MODIFICATION
For those with a short residual limb, exercise is often more comfortable when the cuff
strap is placed higher on the leg.

SKILL LEVEL
Intermediate to Advanced .

John Everett demonstrates the use of the standing pulley

weights to exercise the hamstrings and gluteus muscles of
the thigh . Everett places the cuff strap at ankle height
because his residual limb is long .
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 48 . NAUTILUS HIP ABDUCTION/ADDUCTION MACHINE

PURPOSE
Strengthens the abductor and adductor muscles of the hip . Improves endurance for
walking and other ambulatory activities.

PROCEDURE 1 : ABDUCTOR EXERCISE

IS Before sitting down, adjust the thigh pads so they are on the outside of the leg rest as
shown.
n Adjust the lever on the side of the machine to bring the leg rest portions together.
▪ When seated, secure the waist strap and place the legs inside of the thigh pads . Push
against the thigh pads until your legs are as wide apart as they will go (see photo).
n Slowly bring the legs back together.

PROCEDURE 2 : ADDUCTOR EXERCISE

® Adjust the thigh pads so they are on the inside of the leg rest.
n Adjust the lever on the machine to spread the leg pieces outward for a range of motion
that is challenging but still comfortable, as shown in the photo.
n When seated, secure the waist strap and place the legs on the outside of the thigh pads.
n Press against the pads until they touch each other and the legs are at mid-line . Slowly
let the legs retract out until they are at full spread position.

MODIFICATIONS
Weight resistance should be minimal for beginners . If you have never used this machine
before, ask an instructor to show you how to change positions for abduction and
adduction.

SKILL LEVEL
Intermediate .
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Conditioning Exercises : Legs

A
PROCEDURE 1 . ABDUCTOR EXERCISE

PROCEDURE 2 . ADDUCTOR EXERCISE

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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 49 . LOW PULLEY SINGLE HIP ABDUCTION

PURPOSE
Exercises the abductors of the hips.

PROCEDURE
n Secure the cuff strap to the prosthesis of the leg furthest from the weights.
n Stand with the feet close together and pull the cable away from the stack of weights by
extending the working leg out from the mid-line of the body, as shown.
Hold for a count of two.
n Bring the leg back slowly (with a count of four) to the standing position before
repeating the exercise.

MODIFICATIONS
For maximum workout benefits, place the cuff strap higher on the prosthesis for short
residual limbs and lower for long residual limbs . Many people find it most comfortable to
place the cuff strap around the prosthesis where the middle section of the residual limb is
located. If standing is too difficult, try working the abductors from a seated position
(shown in Exercise 49).

SKILL LEVEL
Intermediate to Advanced.

John Everett demonstrates the exercise, maintaining his

balance by holding on to the handrail .
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Conditioning Exercises : Legs

EXERCISE 50 . LOW PULLEY SINGLE HIP ADDUCTION

PURPOSE
Exercises the adductors of the hip.

PROCEDURE
n Secure the cuff strap to the prosthesis of the leg closest to the weights.
n Stand with feet slightly apart.
n Move the strapped inside leg forward, away from the leg used for balance, so adequate
clearance is available.
n Pull the cable away from the stack of weights toward the stationary outside leg until
they meet, or until the working leg slightly passes the standing leg.
n Return the working leg to the starting position before repeating the exercise.

MODIFICATIONS
For maximum workout benefits, place the cuff strap higher on the prosthesis for short
residual limbs and lower for long residual limbs . Many people find it most comfortable to
place the cuff strap around the prosthesis where the middle section of the residual limb is
located . If standing is too difficult, try working the adductors from a seated position
(shown in Exercise 49).

SKILL LEVEL
Intermediate to Advanced.

John Everett demonstrates the exercise, again maintaining

balance by holding on to the handrail .
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RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

EXERCISE 51 . WEIGHTED STANDING CALF RAISE

(NAUTILUS MULTIPURPOSE MACHINE)

PURPOSE
Develops the calf muscles, especially the two heads of the gastrocnemius . Strengthening
the calf will help prevent premature muscular fatigue when performing daily activities.

PROCEDURE
▪ Adjust the weight to the desired resistance and place the attached belt around your
waist.
NI Position the sound leg with the ball of the foot on the first step, allowing the heel to
hang over the edge of the step . Keep the prosthetic leg on the floor.
1I Keep your head up and your back and knee straight during the exercise.
• Hold the support bars and raise up on your toes . Raise as high as you can and hold the
position momentarily.
▪ Lower your foot as slowly as possible so that your heel drops well below the step.
▪ Raise back up to contract the calf muscle.

VARIATIONS
— Toes facing straight ahead works the
main calf muscles.
- Toes facing in and heels out works the
outer calf muscles.
— Toes facing out and heels in works the
inner calf muscles.
— All three positions are necessary to
achieve fully developed calf muscles.

MODIFICATION
The prosthetic leg is not placed on the step.

SKILL LEVEL
Advanced (primarily because only one leg is
being used at a time) .

Linda Pedersen works on the multipurpose machine to

develop strength in her sound leg .
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Conditioning Exercises : Legs

EXERCISE 52 . SEATED ONE-LEGGED TOE RAISE

PURPOSE
Develops gastrocnemius/soleus muscles . The seated toe raise is one of the best ways to
develop the underlying soleus muscle.

PROCEDURE
10 Sit on the calf machine and adjust the upper leg pad so that it touches the thigh and is
positioned just above the knee.
n Position the balls of the feet so they are directly below the leg pad.
II Push up thigh pad with calf muscle contraction and release the safety stop.
$ Let go of the safety stop and lower your heel as far as is comfortable, trying to get a
good stretch . Lower your heel to well below the foot rest.
▪ Raise up on your toes, bringing your heel up as high as you can.
N When you reach the highest position, hold that contraction momentarily before
lowering the heel back down to the starting position.
▪ Try to get a complete range of motion on each repetition.
n Use only the calf . Do not pull with the hands or flex the thigh except on the last
repetitions which you could not normally complete otherwise.

MODIFICATION
Keep prosthetic leg out to the side because it is not exercised.

SKILL LEVEL
Advanced.

Mike Nitz demonstrates the exercise with the toes pointed Albert Rappoport demonstrates the exercise with the toes
outward, thereby working the inner calf . pointed inward, thereby working the outer calf .