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Exercise to improve walking: fix a heavy leg

Do you have a heavy feeling leg after a stroke or a brain injury? This is a very common problem and in this video you will learn a very simple exercise progression to improve your walking and improve your ability to lift the leg despite this “heavy feeling”. If you have suffered a stroke, traumatic brain injury, multiple sclerosis, parkinsons disease, Guillain barre syndrome, or polyneuropathy this video is for you.

Hi guys i’m dr. tar tobias i want to welcome you all back to my channel as promised this is part 2 in a two-part series going over how to help a heavy leg so hopefully you found the video the last video helpful if you haven’t watched it yet that is definitely a prerequisite for this video because we are going to the opposite extreme we’re gonna be adding on a lot

Of difficulty in this video so you really want to focus on the stuff in the first video before you progress onto these exercises in this video so what are we gonna be doing today as i threw out that little teaser in the last video we are gonna take those same movements and learn how to do those in standing now i told you in the last video that these movements are

A lot of times harder and standing and sometimes people just can’t do them in standing so that is confusing for a lot of people you can do it laying down and then you get up to standing and you can’t do it so there’s a few reasons for that standing is a lot more intense on the body so as i’ve mentioned in a lot of other videos when your body is tensed that can make

Spasticity worse and one of those abnormal movement patterns or patterns is extension so you stand up that spasticity that extends your leg is worse and so therefore lifting the leg means you have to bend the hip and bend the knee which is opposite to that pattern and you just can’t do it because it’s stuck in that a pattern so that’s one reason that might cause

Your leg to feel heavy the other reason is is this thing called dissociation i’ve also talked about this before that’s why i love half kneeling so i talked about it in the half kneeling position dissociation is when you can separate the left side of your body from the rest the right side of your body and a lot of times after a stroke you lose that so whatever the

Left side of the body or whatever one side of the body does the other side of the body wants to do it as well so you can see how this would be challenging so when you’re standing on one leg that leg needs to be straight and therefore the the involved leg that you’re trying to bring through is also gonna straighten out and vice-versa so if any of you feel like you

Can’t lift up your involved leg the same thing happens so your left you’re involved leg is now needs to stay straight because you’re standing on it and when you go to try and bend your uninvolved leg it just won’t bend and that really confuses people because they’re like this is my strong leg how come i cannot lift it up how come i cannot bend it so you could be

Dealing with that as well and that is the purpose of the progression that we’re gonna go through today in standing and let’s go ahead and just dive right in the first step in this progression is going to be with everything i just said and all that explanation i hope it made sense the objective of this first exercise is to learn how to disassociate so learn how to

Keep one leg straight while at the same time bending the other leg in standing the reason this is more challenging than standing is because your brain knows that when you go to lift your involve leg or try and bend your involve leg even if it’s someone else even if your therapist goes to bend it which i do a lot of times in therapy it’s near impossible because your

Brain knows that when you bend that involved leg and try and lift it up your other leg is gonna bend that’s gonna buckle and you are going to fall so it makes that extension even a little bit stronger with your brain kind of putting the brakes on saying i don’t want to fall our brains are extremely an extremely valuable safety mechanism built-in safety mechanism

That we have that is why i have taken this stool and you can use your involved arm and you can use your strong arm to lift foot up on the stool while you are still sitting and then with your strong arm you’re going to try and stand up on your uninvolved leg and really you’re just gonna hold it so right now what your brain is learning is it’s learning how to stay

Extended on your strong leg while letting the other leg bend and once you get in this position you really really really want to focus hard i’m trying to relax that involve side of your body as much as possible while also really fighting to keep that strong leg straight because remember when you bend that when you bend you’re involved leg your other leg might want

To bend so those are the two things you need to think about is stand up real strong on your strong leg and on your weak leg try and keep it relaxed so it can stay bend once you feel like you can do this you can work on trying to move the foot forward and backwards just little tiny movements while it’s in this flexed position that accomplishes a few things you’re

Already starting in a flexed position which is a little bit easier than having to start with a leg in an extended position because you’re usually having to overcome that spasticity so by putting the foot on the stool first before you even stand up you’re decreasing the chances that you’re gonna go into that extensor spasm the next thing i was like to do in this

Progression is work eccentric lee or start with the leg up and work on bringing it down which is just the reverse of what you’re trying to do but it’s usually an easier way of doing it so i just chose to go to a smaller block in this scenario the size of the step or the size of the block that your weak leg is on doesn’t really matter but you’re again gonna put

Your leg up on that block before you even stand up definitely hold on to something to do this remember it’s not just about balance but it’s also about just relaxing your brain a little bit giving your brain that additional support so the chances of that spasticity occurring are a little bit less and then you’re gonna work on taking the foot off the front of the

Step so you’re working in reverse so instead of bringing a leg up you’re working on starting high and bringing it down then if your leg is really heavy i don’t think you’re gonna be able to put the leg back up on the block standing so you’ll sit back down reposition the leg on the block and then do it again try and bring it off the front of the block another

Exercise that i really like is again starting with the leg bent before you even stand up again so you don’t have to overcome that extensor spasticity and put it on something that’s role shaped so putting it on something that only rolls in one direction so that’s why i like these foam rollers and with your foot on there you’re just gonna try and do a little roll

Forward and a little roll back if your leg is extending and going off of the roll try it and sitting first and then try and standing it still may do that and if it is doing that and you can’t control it go back to having it on a block or a step it just means that you’re just not ready for this exercise and then this last and final one is really advanced i am only

Showing this for those of you that are extremely high level and you maybe just have a little tiny what i call hitch and you’re walking you can try and do this so now we’re gonna set it on a ball a little bit of a heavier ball is going to be easier to control so for instance a volleyball in my mind is extremely lightweight that might not be as good as let’s say a

Basketball which is a little bit heavier and again you’re gonna set your foot on it before you stand up and you’re gonna do exactly what you did with the previous exercise of the log roll of the foam roll only now the ball moves in multiple directions so you have more planes of movement that you have to control and you’re still gonna work on just trying to roll

It forward and backward if your knee goes out to the side which is extremely common after a stroke this would be a great opportunity to not let it because the ball is almost going to make it easier for that knee to go out to the sign for that leg to go out to the side if you can’t control that remember connection we are connecting so whatever you are practicing

Your brain is learning i know i say that a lot but i feel like it’s worth repeating if you are not using good quality movement it’s not helping you as much as it could if you went to an easier activity that you could perform with good quality movement so if your knees flopping out to the side or you can’t keep your foot on the ball go back to the previous exercise

If you have an afo definitely wear your afo for these now some therapists might disagree with me on that some patients even disagree with me on that how’s my ankle supposed to get stronger if i have my afo on work on that separate work on an ankle strengthening separate if there’s too much going on and your brain has to think about too many things at the same time

Nothing gets accomplished so control what you can so you can focus on specific movements and the end goal is always gonna be to bring it all back together and then there’s just one more exercise that i’m gonna add to this you can do this with one arm but i love also having patients use a wall so you’re gonna face the wall with either one hand you should be able to

Support yourself in this position even if you can only extend one arm and have one hand up on the wall but this is another great position to work on learning how to lift that leg the benefit of this position over the other positions i’m not gonna say where this one falls in the progression i think they’re both equally valuable you do need to be able to stand so

I would say if you can’t stand then you can’t do this exercise but between this and having your foot up on the block they’re addressing really two different issues or two different problems that cause the leg to feel heavy so this would just be another exercise that you can do but you’re gonna start with your hands on the wall and in this position your ankle is

Dorsi flex so your ankle is flexed so it can’t point because your body weight is keeping it flexed and what that does a lot of times is it’s what we call it breaks up that extensor pattern so just by flexing the ankle like that a lot of times you’ll break up that whole extensor patterns if you have a very strong extensor movement pattern abnormal movement pattern

This would be a great position because that ankle is flexed and then you’re just gonna work on bending the knee and sliding the foot forward so you can see you’re still getting that hip in that knee flexion but it might be a little bit easier because your ankle starts in a flexed position so you’re not gonna be as likely to go into that extensor pattern if you

Feel like you can’t unlock your knee don’t go to full extension keep the knee bent the entire time and just slide it forward and then bring it back and you can do that as many times as you need to and then you can progress this to where you’re actually lifting the leg up and bringing it forward and then bringing it back just another variation different position

For some it’s gonna work for others it’s not gonna work but i just like to give a variety so you have a lot of options and a lot of different positions in case one position doesn’t work you can try another position so that is it so i hope you all found this helpful if you have a heavy leg go ahead and just comment below and let me know if you did these exercises

If they were helpful keep leaving comments this video was created because i had more than one person tell me what they’re that they were struggling with this problem i’m listening to you i hear you but if you don’t comment i don’t know what you guys want to see so definitely leave those comments below so i hope you all found this video helpful and valuable if

You did go ahead and hit that subscribe button click that notification bell and give it a i can’t stress this enough there’s a few videos that have over a hundred likes and those are definitely the videos the content that i focus on when i’m planning the next several months of videos to do is that those seem to be where people have the greatest problems so leave

A comment below when i know what you what you need it’s easier for me to help you and that is it that’s all i have for today i thank you all so much for watching i look forward to seeing you all in the next video and until next time you all have a great day

Transcribed from video
Exercise to improve walking: fix a "heavy leg" By Rehab HQ