Beyond exercise. Can application of manual therapy before exercise benefit a low functioning person with limb loss? A case study

ABSTRACT

Background

Most people with lower-limb loss (PLL) have musculoskeletal conditions and range-of-motion and muscle performance impairments. Such impairments limit potential for functional movement but can be reduced with manual therapy. Manual therapy, however, is rarely used for PLL. This case demonstrated how integrating manual therapy, exercise, and functional training led to lasting benefits for one low functioning PLL.

Case Description

A 54-year-old woman more than 1 year after transtibial amputation due to peripheral artery disease presented with multiple comorbidities and yellow flags. Her function remained limited to the Medicare K-1 household walking level with slow gait speed <0.25 m/s. Treatment included four weekly sessions each beginning with manual therapy, followed by exercise and functional training.

Outcomes

After 1 month, performance-based strength, balance, walking speed, and physical activity increased. She advanced to the K-2 limited community walking level and maintained her functional level without further treatment after 3 months.

Discussion

Improvements maintained without treatment expanded upon research that lacked follow-up and excluded K-1 level walkers. Marked improvement after only four sessions was noteworthy since exercise protocols require ≥4 sessions.

Conclusion

Manual therapy followed by exercise and functional training may optimize movement potential and contribute to improving strength, balance, gait, and physical activity among PLL.

KEYWORDS:

• Amputation
• balance
• manual therapies
• walking speed
• prostheses
• physical activity

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This paper was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1TR001873.

Notes on contributors

Christopher K. Wong

Dr. Christopher Kevin Wong is Professor of Rehabilitation Medicine and Curriculum Director for the Clinical Residency in Orthopedic Physical Therapy at Columbia University Irving Medical Center. He has practiced as a board certified orthopedic clinical specialist for over 20 years and published his research in over two dozen journals.

Gregory A. Youdan

Gregory Youdan is an adjunct Assistant Professor at Lehman College, City University of New York and the Dance Anatomy Teaching Fellow at the Julliard School, New York. He holds a MS in applied statistics and MA in motor learning and control both from Columbia University.

Stanford T. Chihuri

Stan Chihuri is an epidemiologist at the Columbia University Vagelos College of Physicians and Surgeons. He holds an MS in epidemiology from Columbia University’s Mailman School of Public Health.