Missing Leg and Stretching

Question:

I have a client who is missing his lower limb. He has a knee but only two centimeters of leg below; therefore, he finds a traditional quad stretch impossible without his prosthetic popping off! Can you give me any ideas? We have tried having him lie on floor face down with me helping him bend at the knee, but this does not work.

Answer:

Great question! There are a number of ways to stretch the quadriceps without much knee involvement. You tried the traditional stretch in a standing position and the lying prone position, both of which involve more knee flexion to get a quadriceps stretch. When working with a client who is missing an extremity at the knee or just below, you will have to use a method of hip extension in place of extreme knee flexion to stretch that group.

Only one of the four quadriceps muscles will get a good stretch in this manner, but it’s better than none at all. With two centimeters of leg below the knee, there really isn’t much to work with to provide the adequate knee flexion to get a great stretch from the quadriceps femoris tendon. The vastus medialis and vastus intermedius both originate on the femoral shaft and the vastus lateralis originates at the greater trochanter and upper half of the femur. Thankfully, to solve your problem, the rectus femoris originates at the hip bone. It actually has two origins: one is the straight head at the anterior inferior iliac spine and the other is the reflected head at the upper surface of the acetabulum. The tendons from both heads come together to form the muscle. Essentially, a hip flexor stretch is also a stretch for the rectus femoris.

A great rectus femoris stretch for a client with a prosthetic limb is to have him lie on his side on the floor or stretch table. Have him rest his head on his arm and bend his lower leg. Your client should hold his bottom leg with his other arm at the knee. You will rest your knee against the client’s low back to prevent lumbar extension. With abdominals braced, cue him to flex his glute max to create hip extension. If your client has the capability, once maximum hip extension is attained, cue him to flex his hamstrings through whatever knee flexion he can manage to create an active-isolated quadriceps stretch. Help your client keep the prosthetic leg in alignment, if necessary. Good luck!