Effect of Free Swing Gait Training on Back Pain with Bilateral Amputation: A Case Report

Cassie Duff, University of St. Augustine for Health Sciences
Megan Flores, University of St. Augustine for Health Sciences

Poster presented at the American Physical Therapy Association (APTA) Combined Sections Meeting, February, 2017, San Antonio, TX


Background & Purpose: Back pain is a common occurrence in persons with a lower extremity amputation, and can cause a chronic disability. Early prosthetic gait training can prevent patients with amputations from becoming disabled by chronic back pain. One technique for patients learning to walk with a prosthesis is free swing gait training. This method of gait training includes unlocking the knee component of the prosthesis and leaving it unlocked throughout the gait cycle. Ambulation with an unlocked prosthesis requires the patient to exhibit confidence in his or her balance capabilities and ability to control where his or her weight is being placed throughout the gait cycle. Free swing gait training has the potential to reduce the number of gait deviations these patients would normally adopt during ambulation. However, there is a lack of evidence for the benefits of free swing gait training on decreasing back pain. The purpose of this case study is to describe the effect of free swing gait training on low back pain in a patient with bilateral lower extremity amputation.

Case Description: The patient was a 57 year old Caucasian male with a history of left transtibial amputation and recent right transfemoral amputation. He was referred to physical therapy for education on using his new transfemoral prosthetic and to improve functional independence. One of his chief complaints was debilitating low back pain that had increased since his latest amputation. It was hypothesized that the normalization of the patient’s gait pattern through free swing gait training would decrease his complaint of back pain.

Outcomes: Upon initial evaluation, the patient reported pain of 6/10 in both shoulders and low back, as measured by the Numerical Rating Scale. The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) was administered to assess the patient’s self-confidence when performing different functional activities. He scored a 34/60 on the initial OPTIMAL, indicating he felt approximately 60% impaired with his ability to perform daily activities in his home and in the community. After 8 weeks of physical therapy, including 3 weeks of free swing gait training, the patient’s OPTIMAL score decreased to 20/60, indicating he felt more confident being able to perform functional activities out in the community. Additionally, he reported a decrease in bilateral shoulder and low back pain to 0/10. The patient also improved with ambulation from an initial distance of 50 feet with a rolling walker and physical assistance, to 300 feet with a rolling walker independently utilizing a free swing gait pattern.

Discussion: After an intervention of free swing gait training, the patient demonstrated decreased low back pain, increased strength, and improved gait quality and distance. The results of this case report demonstrate that the use of free swing gait training can be beneficial to decrease back pain in a patient with bilateral amputation.