Single Leg Stance

Single Leg Stance

One common exercise prescribed by Physical Therapists as part of balance and gait training is the Single Leg Stance.  Upon performing this activity, patients usually ask why they are doing it. They can not make the connection between this exercise and its usefulness in daily function.  

If you want them to remember to perform this exercise consistently as part of their Home Exercise Program (HEP), you will have a better chance if you explain the functional value of it.  I usually explain to patients that in order for them to walk properly, they need to be able to maintain Single Leg Stance (SLS) on one side (Stance Phase) in order to swing the other leg forward (Swing Phase).  If you are not comfortable in Single Leg Stance, you will take shorter strides and may even shuffle. Although the patient may feel safer by minimizing time spent on one leg, the resultant shuffling poses a trip/fall risk.  This is why we focus on Single Leg Stance during our treatments.  

We break the task of walking down into its specific components, focusing on the parts that are most difficult for the patient.  Once they demonstrate improvement in each part, we bring it all together and have them perform the entire task...in this case, walking.  

When evaluating patients, a Physical Therapist may perform the Single Leg Stance (SLS) Test to assess the patient's risk of falling.  Click here for testing details.  

During training, due to patient apprehension to perform SLS, I will have them first practice by holding onto their kitchen sink with two hands.  I will then progress them as follows:

1)SLS on level surface, 2 hands holding sink

2)SLS on level surface, holding sink with the hand that is opposite the stance leg

3)SLS on level surface, holding sink with the hand on the same side as the stance leg

4)SLS on level surface without holding sink

You can also modify the SLS by having the patient turn their head left, right, up, down to challenge the inner ear and visual systems, which will further challenge their balance.  You can begin with the patient's eyes open, then try it with the eyes closed.  You can even modify the surface they are standing on by having them stand on a pillow or Balance Pad. 

If your patient is unable to perform the SLS without holding onto the sink, then have them continue to hold the sink, and place the focus on maintaining proper upright posture while in SLS.  Cue them to avoid sidebending, performing a Trendelenburg stance, or allowing one side of the pelvis to drop while in SLS. With this, they will still be training the hip muscles of the stance leg for strength and endurance, even though the are holding onto the sink for balance.  

Another activity that will train your patient's hip while in SLS is walking while holding a weight in the hand on the side opposite the hip you are trying to strengthen.  Check out one of the older posts here.....

Farmer's Walk: By holding the weight in the right hand, whenever you are in single leg stance on the left leg, you are challenging the left hip and trunk muscles.  The weight in the right hand is applying a downward force toward the right.  Your trunk is fighting the right sidebending force that holding the weight in the right hand is introducing to your body.  The right side of your pelvis wants to drop when you are swinging your right leg forward because the "column of support" (your right leg) is no longer planted on the ground.  Since the right side of your pelvis does not have support of your right leg, the only way to prevent the pelvis from dropping and to keep your pelvis level is to contract your left hip muscles while in left SLS.  Holding additional weight on your right side makes this even more difficult, as more force is directed down to the right.  This activity will strengthen your SLS hip muscles and should be performed alternately.  Walk while holding a weight in your right hand....then walk while holding the weight in your left hand.  The weight should not be too light...start with 10-15 pounds.

Rehab Devices That Make Life Easier

Rehab Devices That Make Life Easier:

Canes

During Physical Therapy assessments, patients and their family members ask me for advice on which type of device they should use to walk safely.  In regards to canes, the most common are the straight cane and the quad cane.

STRAIGHT CANE

QUAD CANE

The main differences between these two types of canes are that the Straight Cane is used mainly for people with balance deficits, while the Quad Cane assists with balance deficits and lower extremity weakness and instability.  The straight cane should only be prescribed to a patient who has slight balance deficit and needs just a little extra support (wider base of support) when walking.  The straight cane is not a weight bearing device, so if your patient or family member seems to be pressing heavily down on the cane when walking in order to safely navigate their environment, the straight cane is not the appropriate device.  

The Quad Cane is a weight bearing device.  Many people recovering from stroke present with one-sided weakness and benefit from this type of cane in order to prevent buckling of their knee.  The only con is that all four legs of the quad cane must be placed on the floor/ground at the same time in order to be safe.  You should not walk and place the back two legs on the ground, followed by the front two legs of the Quad Cane.  It is sometimes more difficult to coordinate this action, and many times patients will trip over the Quad Cane.  

Take home message: A straight cane is only for people with slight balance issues while a Quad Cane assists with balance and weight bearing (supports the weak leg).