Getting out of the wheelchair and relearning to walk.
I’ve been spending the last few months working with Joan, who has been in a wheelchair for a long time. The goal has been to help her stand and re-learn how to walk.
And that is the important bit…she needs to relearn how to walk. How do you teach someone how to walk? Is it just a case of “put one foot in front of the other?” At first, I thought it was as simple as that. But I now know, if you do that you will fall over. There is a hell of lot more to it than just that.
Just some of the things you need to do include:
- Transfer your bodyweight from one foot to another.
- Balance on one foot.
- Transfer your weight from one part of your foot to another.
- Control the hip in in such a way that it does not collapse under the weight of your entire body.
- Coordinate all these things through many different joints (hips, knees, ankles etc).
- Stabilise and control the moves from your upper body so they don’t cancel out the moves from the lower body.
Luckily, most of us do all the above without even thinking about, or even being conscious of it. We can even do it when we are asleep (sleepwalking)! But how do I take this massively complex task and simplify it to such an extent that I can teach it?
Well, the current strategy I am following is:
Going from bigger to smaller.
And by this I mean:
- Bigger to smaller joints (hips -> knees -> ankles -> toes).
- Bigger to smaller moves (moving the body -> moving the legs -> moving the feet).
- Bigger to smaller muscles (body/”core” muscles -> hips muscles -> leg muscles -> foot muscles).
So we are prioritising bigger things over smaller things. First we worked on “core” muscles to improve sitting position and strengthen the back half of the body. This is to compensate for the increased amount of work done by the front half when wheeling the chair (we used exercises that were adaptations of Scapular Retractions, Seated Rows & Back Extensions).
Next we worked on standing up. This involved waking up/strengthening bum and leg muscles and (very importantly) the nerves that control/work them. This involved adaptations of the Bodyweight Squat.
Now we have gotten this working well, we are moving on to the actual walking part. This is a much more complex move and I have a feeling that it will take a bit longer to progress through this part, but she has got off to a flying start! This week she walked about 20 meters, from one exercise station to the next Before this, I had not seen her walk more than 1 meter! So bloody well done!
The hip movements that were already being practiced in the standing up, need to be made much more delicate, precise and coordinated. This takes a lot more fine control over the joints. And this also means that smaller, “unsexy” muscles (i.e. the ones we don’t drool over looking at in the mirror) have to start working harder and playing their part.
Also, the smaller joints (eg knees) are going to become more important. So we are going to start work on them any day now. But I was asked yesterday about the ankles. They felt a bit weak, as though they may give way while walking. And this is totally understandable. When you have been sitting in a chair for months/years, the muscles controlling the ankles are going to weaken. And if that joint is unstable, it may give way.
But even with the strongest, most stable ankle in the world, you are not going to walk anywhere if you can’t move your leg from the hip. So while we are going to work on stabilising/strengthening the ankles, our focus is still going to be on the bigger issues (i.e. the hips).
So Joan is doing bloody well and making good progress. And the main reason for this is the amount of hard bloody work she is putting into the basics. And that is the bit that I love to see. She consistently comes in and works her socks off time and again. I don’t think she has had an “easy” training session yet.
So bloody well done!
So the moral of this story is, when it comes to joints, movements and muscles,
go from bigger to smaller.
Don’t spend your time worrying about the tiny details, if you don’t have the big things sorted out first.
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