"The Good Go To Heaven, The Bad Go To Hell"

When working with a client status post hip, knee or ankle surgery, we must ensure that they will be safe when they are moving around in their home.  Many people have stairs that they will need to navigate to enter or exit their home or to move from one floor to the next.  Initially, they may have too much pain when fully weight-bearing on the surgical leg.  So we use the saying "The Good Go To Heaven, and The Bad Go To Hell" in order to explain that the "good" or stronger leg goes up first upon ascending the stairs, while the "Bad" or weaker leg goes down first, upon descending the stairs.  Basically, the stronger leg is in control of the body weight completely when ascending as well as descending the stairs.  It does the work of controlling the body safely up and down while the weaker, surgical leg goes along for the ride.  Many patients/clients receive home care treatments immediately following their surgery and may receive therapy for up to 2 months.  I have seen these patients many times towards the end of their 2 months, and when I ask them to show me how they climb stairs, they continue to perform the task with "The Good Go To Heaven, and The Bad Go To Hell" strategy.  I think many times, as therapists, we get so caught up in educating a patient to perform this task the safest way possible, that we never progress them to the next step.  As therapists, it should be our goal to get our patient/client as close to their prior activity level as safely possible.  There is nothing wrong with being safe, and advising our patients to perform stair-climbing this way.  However, when they no longer have us by their side, what happens if they accidentally forget and try to go up or down the stairs using the weaker leg to control their body weight?  They never practiced the technique this way while we were with them because we were so intent on doing it the "safest way."  We actually limited their functional improvment by 'protecting' them so much.  In general, the #1 most important thing is to be safe.  But we also want to challenge, progress and move forward.  If your patient/client independently climbs stairs using the "Good go, Bad go" rule, begin strengthening the surgical leg in the same manner so that they are symmetrical, safe and confident if they ever need to use it (Do this as long as their doctor allows full weight bearing on the surgical leg, of course).  Remember, if they didn't have to think about it before, you do not want them to have to think about it now.  Do not fall into the routine of doing the same treatment day in and day out.  Challenge your patient/client and take them to the next level.