Muscles, Bones and Joints
An above-the-knee amputation significantly alters the anatomy of the lower limb. The primary bone affected is the femur, the thigh’s major bone, which is severed above the knee, reducing the lever arm for movement. The knee joint, a complex hinge involving the femur, tibia, fibula, and patella, is entirely removed, eliminating its role in flexion, extension, and weight-bearing. Major muscles impacted include the quadriceps (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius), which lose their distal attachment at the knee, reducing their ability to extend the leg. The hamstrings (biceps femoris, semitendinosus, semimembranosus) are similarly affected, losing their ability to flex the knee. The hip muscles, such as the iliopsoas, gluteals, and adductors, remain intact but must compensate for the loss of distal leverage, often leading to increased strain. The amputation also affects ligaments like the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), which are no longer functional, impacting stability.
Biomechanical Principals Impacted
1. Force Production
Definition: Force production refers to the ability of muscles to generate force to initiate or resist movement, governed by Newton’s Second Law (Force = Mass × Acceleration). In sports, it determines the power behind actions like pushing or accelerating.
Impact of Amputation: Lehoux’s above-the-knee amputation reduces the muscle mass available for force production, particularly in the quadriceps and hamstrings, which are critical for generating propulsive force in skating. The loss of the knee joint eliminates the ability to extend or flex the leg, forcing reliance on hip muscles (e.g., gluteus maximus, iliopsoas) and the intact leg. In Para ice hockey, players use short sticks (picks) to propel themselves on the ice, requiring upper body and core muscles (e.g., latissimus dorsi, pectoralis major, abdominals) to generate force. The prosthesis, typically a passive device for sitting in the sledge, does not contribute to force production, placing greater demand on the upper body and core to compensate for the loss of lower limb contribution.
2. Balance and Stability
Definition: Balance and stability involve maintaining the body’s center of mass over its base of support, critical for coordinated movement and preventing falls. In sports, this principle ensures efficient positioning during dynamic actions.
Impact of Amputation: The amputation shifts Lehoux’s center of mass, as the right leg’s mass is significantly reduced. In a sledge, balance is maintained by the seated posture, but the asymmetrical loss of limb mass affects stability during dynamic movements like turning or checking. The intact leg and core muscles must compensate to stabilize the pelvis and trunk, increasing the risk of overuse injuries. The sledge’s design, with a low center of gravity, aids stability, but Lehoux must rely heavily on upper body strength and core engagement to maintain equilibrium during rapid maneuvers.
Workout 1 (Upper Body and Core)
Warm Up
Arm Ergometer: 5 minutes at moderate pace to increase heart rate and warm upper body muscles.
Dynamic Stretches: 5 minutes of arm circles, torso twists, and seated cat-cow stretches to mobilize shoulders, spine, and hips.
1. Medicine Ball Slams
Targets explosive upper body power (pectorals, deltoids, triceps). Slamming mimics pick propulsion.
2. Seated Cable Rows
Strengthens back muscles (latissimus dorsi, rhomboids) for pulling actions in sledging.
3. Russian Twists
Enhances core rotational strength (obliques, transverse abdominis) for stability during turns.
4. Push Ups with Bosu Ball
mproves chest and shoulder strength (pectorals, deltoids) while challenging balance.
5. Plank with Shoulder Taps
Builds core stability (rectus abdominis, erector spinae) to maintain sledge control.
Finisher (5 Minutes)
Battle ropes (double slams, 30 seconds on, 30 seconds off) to boost anaerobic power and endurance.
Cool Down (5 Minutes)
Static Stretching: Focus on shoulders, chest, and core (e.g., doorway chest stretch, seated forward fold).
Breathing Exercises: Diaphragmatic breathing to promote recovery.
Workout 2 (Anerobic and Sledge Training)
Warm Up (10 minutes)
Sledge Ergometer (if available): 5 minutes at moderate intensity to mimic skating motion.
Dynamic Mobility: 5 minutes of seated arm swings, hip circles, and lateral reaches to prepare for sledge movements.
1. Sledge Sprint Simulation
30 seconds max effort propulsion using picks, focusing on rapid arm movements to train anaerobic alactic system.
2. Resistance Band Pulls
45 seconds mimicking pick motion against resistance to build latissimus dorsi and biceps strength.
3. Sledge Turns
30 seconds of alternating left and right turns to improve core stability and coordination.
4. Dumbbell Bench Press
45 seconds to strengthen chest and triceps for checking and propulsion.
Core and Stability
Seated Pallof Press: 3 sets of 12 reps per side to enhance anti-rotational core strength.
Side Plank (intact leg side): 3 sets of 30 seconds to strengthen obliques and compensate for asymmetrical loading.
Cool-Down (5 Minutes)
Static Stretching: Focus on upper back, shoulders, and hip flexors (e.g., lat stretch, seated hamstring stretch).
Foam Rolling: Target upper back and chest to reduce muscle tightness.
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