Pilates for All Abilities: Working with a Prosthesis

Heidi was physically active as a dancer during high school. But by age 24 the rigors of graduate school and the loss of her left foot in a motorcycle accident propelled her into a sedentary lifestyle. Eventually Heidi became determined to embrace a more active lifestyle and began to attend various aerobics classes. The classes proved unsuccessful because her prosthesis would slip as she began to sweat.

Discouraged but undeterred, Heidi began studying yoga and engaging in some strength and cardiovascular training. Still unsatisfied, she decided to try a Pilates class taught by Laura Gideon, MS, owner of Bamboo Balance. Heidi enjoyed the classes, but yearned for a greater challenge, so she started working with Gideon privately.

A Unique Challenge. “I had never trained anyone with a prosthetic limb before, [so this was new] territory for me,” states Gideon. “This made me feel excited and concerned; however, I knew I was up for the challenge.”

At the outset, Gideon made every effort to approach Heidi’s training sessions as she would any other client. “The differences came out when I asked Heidi to do certain exercises on specific pieces of equipment, or perform moves that required certain types of balance.” Through this process, Gideon quickly learned which movement patterns required adjustments and which ones should be eliminated from the program. “Before selecting an exercise I had to consider to what extent ankles would be required for balance, and what adjustments could be made.”

Program Modification. A typical session with Heidi consists of Pilates mat exercises to increase warmth in the core and extremeties and then equipment-based exercises. “Our training is normally comprised of a full-body workout with an emphasis on core training, with secondary emphasis on the limbs,” Gideon says. Though Heidi is proficient with many of the exercises, some require adjustment to ensure safety and effectiveness.

“While training Heidi on the reformer, I find it best during the leg press series to have her perform it with a single leg on the footbar, rather than two legs simultaneously.” This helps avoid imbalances that may result from uneven leg length due to the prosthesis. “We also avoid any exercises [that require] standing on the equipment.” Without a left ankle, Heidi feels unstable as the carriage moves. When performing exercises that require footstraps, Gideon is careful to apply two straps: one around Heidi’s ankle and the other around the prosthesis. “I found that a rubbery material worked best since in addition to protection, it prevents the straps from slipping as much during the full range of motion.”

Mind Over Matter. Heidi has lived with her prosthesis so long that she often forgets she has one. She successfully triumphs over many of the movement patterns she faces during a typical training session. But there are moments when those successes are undermined by limitations, causing frustration. Those frustrations arise “at times when we forget about her being an ‘amputee’ during a session, and then something comes up to remind her of her limitations and that she cannot do a particular exercise,” says Gideon.

Each time is a learning experience, so Gideon works to ensure minimal future frustrations. “When an adjustment is necessary to work with her prosthetic foot to perform an exercise, it is done as if it is ‘no big deal.’ Heidi appreciates being trained as if ‘handicap’ is not an issue.”

Able-Bodied. “I’ve never felt better than with a strong core from Pilates training,” enthuses Heidi. “And instead of dragging myself along when I walk through the sand at the beach, I’ve started flying across it!”

“Heidi is a rockstar!” exclaims Gideon. “She has developed incredible strength and confidence in her ability to perform many of the very difficult Pilates exercises. I would say Heidi is my most impressive client regardless of her ‘dis’-ability. In fact, you would never know she had a disability unless she showed her leg to you.”

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