How To Get Your Right Leg Moving Post-Stroke

A stroke can leave survivors with a range of secondary effects, including muscle weakness and loss of control of an arm or leg. This can make walking difficult, and in some cases, survivors are unable to walk at all. However, there is hope for improvement, and rehabilitation is key to recovery. Doctors and rehab teams will help create a rehabilitation plan, which may include physical therapy, occupational therapy, and speech therapy. Physical therapy often involves a combination of passive stretches, active exercises, and therapeutic modalities, with the best exercises being those that are challenging yet not overly difficult to perform. This can help stroke survivors regain the ability to walk and improve their gait (manner of walking).

Passive exercises, such as gentle stretches, can be performed by a therapist or caregiver to improve flexibility and blood flow

Passive stretching involves using external forces, such as a partner, towel, or fitness strap, to stretch the muscles rather than relying on one's own flexibility. This can be particularly beneficial for stroke patients who may have limited mobility or range of motion. By using passive stretches, they can gently stretch beyond what they could normally do on their own.

For example, a standing quad stretch can be performed to target the quadriceps. The patient stands next to a steady object like a table or wall for balance. A rolled-up towel or fitness strap is looped around the ankle, and the patient slowly pulls their foot towards their buttocks. This can be repeated on the other leg.

Another example is the towel hamstring stretch. The patient lies on their back with their legs straight and relaxed. They slowly raise one leg towards the ceiling without bending their knee. A towel or strap is hooked behind the hamstring, calf, or under the arch of the foot, and the leg is gently pulled towards the body until a stretch is felt.

These are just a couple of examples of passive stretches that can be performed to help improve leg movement after a stroke. It is important to consult with a licensed physical therapist or medical professional to determine the most appropriate exercises for the patient's specific needs and abilities.

Active exercises, like seated marches and toe taps, can help regain movement by using one's own strength

Regaining movement after a stroke can be challenging, but there are exercises that can help improve mobility and strength in the right leg. Active exercises, such as seated marches and toe taps, can be beneficial in regaining movement and strength by engaging different muscle groups.

Seated marches, as the name suggests, are performed from a seated position. Start by lifting the affected leg up towards your chest, and then slowly lower it back down to the floor. Keep your back straight and maintain controlled movement throughout. Repeat this process, alternating between your right and left legs. If needed, use your unaffected arm to assist with lifting the affected leg and controlling its descent. As your strength improves, gradually reduce the assistance from your arm. To increase the challenge, you can add resistance by gently pushing down on your quads (thighs) with your arms when your leg is lifted.

Seated marches help improve stability and balance, activate the glutes and hip flexors, and enhance core stability. This exercise is a great way to work on stability for both sides of the body and can be beneficial for stroke survivors experiencing weakness on one side.

Toe taps are another effective exercise to regain movement and improve coordination. Start in a comfortable seated position with your feet below your knees. First, bring your right foot out to the 3 o'clock position and tap your foot. Return it to the centre, and then move it up to the 12 o'clock position and tap again before returning to the centre. This will form an "L" shape. Repeat the same process with your left leg, tapping at the 9 o'clock and 12 o'clock positions.

Toe taps involve complex coordinated movements, providing stimulation to help rewire the brain and improve overall movement. This exercise can be performed slowly at first and gradually increased in speed as you become more comfortable with the pattern.

In addition to seated marches and toe taps, there are other exercises that can be beneficial for stroke recovery, such as single-leg knee extensions, inner thigh squeezes, and hamstring stretches. It is important to consult with a healthcare professional before starting any new exercise routine, and to stop if any pain or discomfort is experienced.

Gait training focuses on improving walking patterns and safety, such as walking on different surfaces

Gait training is a set of exercises that are specifically implemented by a physical therapist to help you walk better. It focuses on improving walking patterns and safety on different surfaces. Here are some gait training exercises that can help:

Seated Leg Lift

This basic gait training exercise can be done from any seated position. Start by lifting your affected leg up into your chest, and then place it back down onto the floor. Then repeat on the other leg, alternating back and forth. Do a total of 20 to 30 repetitions. Be mindful of keeping your back straight and maintaining controlled movement. To add some challenge, pause at the top for a second or two. You can even add arm swings (opposite arm, opposite leg) like you’re walking in place on the chair.

One-Leg Standing

For this simple gait training exercise, stand like a flamingo. Practice standing on one leg for about 30 seconds and then switch to the other foot. A little bit of shaking is normal! The best way to improve your balance is by challenging it, but make sure you are in a safe area with a chair, bed, or wall directly behind you in case you lose your balance. Hold onto a chair, counter top, or table for safety and stability. When you’re ready for a challenge, progress yourself from using two-hand support to one hand, then to fingertips until eventually you can hold your balance without holding onto anything.

Knee Extensions

Knee extensions are an important gait training exercise because they help to strengthen quadriceps muscles and improve leg mobility. To perform this exercise, start from a seated position. Extend your leg out in front of you parallel to the floor, making sure to contract your thigh muscles at the top. Then, slowly bring your foot back down to the floor. Alternate back and forth between your right and left leg while maintaining your posture (this takes core stability). Repeat for 10 repetitions.

Leg Lift to the Side

For this gait training exercise, start in a standing position. Then, lift your leg out to your side about 45 degrees (or as far as you can). Hold it there for a few seconds and then bring your foot back down. The key is to keep your core stable and not lean your trunk. The only thing that should be moving is your leg. Do 15 repetitions, then switch sides.

Core Exercises

Gait training involves more than just your legs. Walking is a full-body activity, which means that your gait training exercise program should target the full body as well. One such exercise targets all the muscles in your core. Lay on your back with both legs bent up at a 90-degree angle. Try flattening your lower back against the ground by engaging your abdominals. Make sure you’re still able to breathe! Your shins should be parallel to the floor and your core should be fully engaged. From there, slowly lower to tap your left foot on the floor and bring it back up to the starting position. Repeat on the other leg and alternate between each leg for a total of 20 repetitions, focusing on keeping your spine flat and neutral on the ground throughout the exercise.

Balance and Proprioception Exercises

Walking requires that you spend about 40% of the time standing on one foot. Thus, single-leg standing is an important component of safe walking. Balance and proprioception training should be a component of your gait training exercise program. Exercises that can help improve balance and proprioception may include single-leg stance on an unsteady surface, single-leg stance with eyes closed, tandem standing and walking, and single-leg stance on a BOSU or BAPS board. To improve your balance, you have to challenge your balance by creating situations where you may be a little unsteady. Your body then has to correct for this unsteadiness. As you practice, your balance should improve along with your gait. But be sure to remain safe while balance training.

Mobility aids, like walkers and canes, can provide support and stability when walking

Mobility aids are an important part of stroke recovery, helping to improve independence and safety. After a stroke, survivors often experience muscle weakness and reduced control of their limbs, which can make walking difficult. Mobility aids, such as walkers and canes, can provide support and stability when walking, reducing the risk of falls and improving balance.

Walkers are a common type of mobility aid used after a stroke. They provide support and stability when walking, helping to improve balance and reduce the risk of falling. There are several types of walkers available, including those with no wheels, two wheels, or four wheels. A physiotherapist will help determine which type of walker is most suitable for an individual and will ensure they are using the correct posture when walking with it.

Canes are another option for those seeking support and stability after a stroke. Canes come in a variety of styles, including those with a single prong or three prongs for balance. Some canes also have a rubber tip with an attachable claw for added stability during winter walks. A physiotherapist can help individuals choose the most suitable cane and provide instructions on how to use it safely.

In addition to walkers and canes, there are other mobility aids that can be used to improve walking after a stroke. These include orthotics and braces, which can support and stabilize weakened muscles or those that have developed spasticity. Electric scooters and wheelchairs may also be recommended by a healthcare professional if an individual is unable to walk safely, even with the assistance of a walker or cane.

It is important to note that the use of mobility aids should be recommended and fitted by a healthcare professional, such as a physiotherapist or occupational therapist. These aids should be tailored to the individual's needs and abilities, and instructions on safe usage should always be provided.

Orthotics and braces can help stabilise muscles affected by spasticity or weakness after a stroke

Following a stroke, survivors often experience secondary effects such as muscle weakness and spasticity. This can make daily activities difficult and frustrating, impacting a person's independence. However, orthotics and braces can help stabilise muscles and promote recovery.

Orthotic devices are worn externally to help build stability while increasing strength, comfort, and independence. They can be used to correct physical issues and maintain a person's level of mobility. Orthotics consist of a series of inserts and braces that are fitted to address an individual's specific needs. They can be prefabricated or manufactured in specific sizes, and they may need to be modified or replaced over time as the body changes and heals.

Braces are a type of orthotic device that can be worn inside shoes or boots, on the wrist, or over the knee to maintain proper joint alignment and prevent unwanted movements. They can also help with foot lift, swing, and plant, as in the case of foot drop. Braces provide stability and support, helping to reduce inflammation and the risk of injury.

Ankle-Foot Orthotics (AFOs) are semi-rigid L-shaped braces that stabilise the foot and ankle, bringing muscles and joints into alignment. These braces extend up the calf and typically feature straps to hold them in place. AFOs are often used to correct foot drop and account for 26% of all orthotics used in the United States.

Orthotic devices can provide a stable base for movement, establish an efficient gait, minimise spasticity, and aid in transitioning between sitting and standing. They can also reduce excessive energy expenditure during movement, lower the potential for accidents, and increase a person's physical and mental functioning.

In addition to AFOs, there are several other types of orthotics, including:

• Hip-Knee-Ankle-Foot Orthotics (HKAFOs)
• Knee-Ankle Orthotics (KAFOs)
• Knee Orthotics
• Spinal Orthotics
• Trunk-Hip-Knee-Ankle-Foot Orthotics (THKAFOs)
• Prophylactic Braces

Orthotics and braces, in conjunction with physical therapy and other rehabilitation methods, can play a crucial role in helping stroke survivors regain muscle strength, improve balance, and enhance their overall quality of life.

Frequently asked questions