I think it’s fair to say that given the chance, most fit and active lower-limb amputees would like the opportunity to have a go at running. Unfortunately for amputees this is not as simple as just ‘going for a run’ for various reasons. This is the story of my first foray into the world of amputee running.
When offered the chance to take part in a beginners running clinic for amputees organised by the charity ‘Limbpower‘ I was initially enthusiastic. After giving the prospect some further thought I remembered that I had been advised prior to my ITAP surgery that I would be unable to take part in activities that produced high levels of impact on the implant. I would need to approach this with a certain level of caution. At the first opportunity I asked the ITAP team whether I could go running and initially they were not enthusiastic. Prior to the ITAP study commencing the developers had decided that a certain level of post-implant caution would be advisable to protect the expected fragility of the bone / implant interface and understandably they didn’t want me to put my implant at risk. I could have simply abandoned the idea of running at that point but I thought I had reasonable grounds to challenge the assumption that an implant attached prosthetic system cannot be subjected to the loads experienced during running.
It is well known that subjecting bone to loading forces causes it to get stronger. The remaining femur in an above-knee amputee’s stump grows weak with the lack of force borne over the years of using a conventional socketed-prosthetic. To overcome this acquired weakness and allow my bone to gain sufficient strength to support the implant bearing my weight, my post-surgical rehab had required a gradual increase in force through the implant building up to full walking. After being given the green-light at the end of rehab I took up hill-walking, mountain-climbing and cycling. All of these activities have an associated bone loading and impact. It is my assumption that my active lifestyle would have continued to cause my bone to strengthen to the point where running would not be a folly. This does seem to have been evidenced by bone thickness increases seen on subsequent x-rays compared with the image obtained immediately post-op. If I was correct then my implant would be embedded with sufficient strength to withstand the load generated by some gentle running. If I was wrong then I would be somewhat protected from catastrophe by the impact-limiting failsafe mechanism that connects my implant to the external prosthetic.
The running clinic itself started with excellent talks by an ‘amateur’ amputee runner and a former paralympian sprinter. We then went through some preparatory exercises guided by, in my case, a somewhat reluctant physiotherapist. No-one was sure that me having a go at running was a great idea but someone with an implant-attached prosthetic is going to run one day, it may as well be me. I was then instructed to put the various exercises together in sequence and that lead to a sort-of jog/run! After getting over the surprise, I decided to carry on as it felt okay. After proceeding up and down the track a few times I got one of the other participants to take a movie of my efforts:
Although I’m clearly not going to break any speed records I was quite pleased at how everything went and felt. My jog/run was certainly a different gait to fast walking and I must have gone up and down the track many times over the next hour or so with no ill effects. I had forgotten how tiring ‘running’ was but it felt good. I was using standard prosthetic components which were not optimised for running and had managed to do okay. I like to think that with a running leg prosthetic I would have the ability to improve my running gait by gradually building up the distance I could manage. This would obviously improve my running fitness and strength, improving my technique and continuing to strengthen my implant bone interface. I also like to think that the springiness of a running blade would cushion my implant from some of the impact generated with the floor, leading to an even greater tolerance for running.
Many people have said to me that running couldn’t or shouldn’t be attempted by an amputee with an implant attached prosthetic. I’m not suggesting that this group of people should all now go for a run but at least we know a run of sorts is possible. It may be that the design of ITAP makes it particularly able to cope with these high impact loads, meaning recipients of other implant systems should refrain from attempting this, I just don’t know. I do know that I enjoyed my little bit of exercise and would like to do more!