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How to Manage Persistent Lower Back Pain

Posted by Bryan Potok, CPO on

Your body undergoes many complex changes after lower limb amputation, in part because it now has to reconfigure and reprogram itself to perform once subconscious movements, like walking. Numerous muscles are reutilized post-surgery, and this change is what ultimately creates an astonishing statistic reported by the Archives of Physical Medicine and Rehabilitation: 52% to 89.6% of lower limb amputees experience lower back pain.

Persistent lower back pain can be managed with a maintained prosthesis and physical therapy.

This is not to say that an amputation guarantees low back pain. It's possible that it existed before amputation surgery and now made worse as a prosthetic user. Or laying in bed for too long post-surgery led to muscle weakness and subsequent low back pain. Regardless, more than half of amputees encounter lower back pain during their initial rehabilitation phase, as they begin to weight bear on their temporary prostheses.

It can be said that lower back pain is more impairing for many than the amputation itself.

This article delves into lower back pain to better understand its causes and possible preventative measures you can start today.

Causes of lower back pain

As mentioned earlier, prosthetic users may be at a higher risk for lower back pain for reasons that the general population isn’t exposed to.

Poor socket fit and poor prosthetic alignment 

Since childhood, your mind and body has been performing the same specific sequence of movements necessary to walk. Learning how-to walk with a prosthetic leg alters years worth of "programming." 

When beginning to walk with a prosthetic leg, socket fit and alignment are critical. If either is incorrect, many will over compensate and develop poor habits and secondary unnatural movements. These poor habits or compensatory movements can lead to lower back pain. Maintaining a prosthetic maintenance schedule, especially during early rehabilitation is really important. Early misalignments, fitting issues and poor sock management issues can be resolved when a schedule is kept.

Too often prosthetic users will rely too heavily on their sound side, by either limiting how much weight they drive through their prosthesis or using their prosthesis as a pseudo crutch. Walking in a "protected" fashion for reasons of distrust or skin irritation forces the body to utilize muscles in an unnatural way, adding stress to one's joints.

There is evidence from a 2005 study mentioned in the Archives of physical medicine and rehabilitation that not being able to wear your prosthesis can lead to a reduced quality of life. Thereby, potentially increasing the risk of depression and further affecting lower back pain.

Wearing a prosthesis that is well maintained from an alignment and fitting perspective, in contrast, can reduce chances of lower back pain. However, further studies are necessary that look directly at the effect of prosthetic alignment and its influence on chronic lower back pain.

Postural and muscle imbalances

Muscles imbalances, including muscle strength and length, have been documented in amputees by Physical Therapists and Prosthetists. Amputees experiencing prosthetic side weakness or tight muscles create compensatory movements with each step. This is very common in above-knee amputees who walk using a prosthesis with an improper degree of socket flexion, causing an exaggerated arching of the lower back.

Leg-length discrepancy

A leg length discrepancy from either a prosthesis that is too short, poor suspension, or improper sock ply count, directly affects the lower back. All it takes is a quarter inch difference in height for you begin feeling lower back pain after walking an hour.

Chronic Pain

Pain that lasts at least three months is considered chronic and is typically associated with surgeries that involve transecting nerves. Today a long-term multidisciplinary approach to chronic pain is suggested to lessen its influence on how you walk and any associated compensatory movements.

Lower Back Pain Management

There's little evidence or studies comparing the following treatments for lower back pain. However, it is clear that a lot of the issues that lead to lower back pain can be overcome with these treatments.

Exercise and Stretching

Leading a sedentary lifestyle causes muscle weakness and is linked to lower back pain. When your abdominal muscles are weak, this can cause weak hip flexors and lower back pain by encouraging a forward-leaning posture. We can't stress enough strengthening your core muscles.

Tight hamstrings, the large muscle group along the back of your leg, can restrict motion of your pelvis and cause chronic lower back pain for those wearing a below-knee prosthetic leg.

Tight hip flexors make it really difficult to control a flexed prosthetic knee for above-knee prosthetic users. Restricted hip extension related to tight hip flexors reduces the available range of motion to extend your hip and subsequently cause the prosthetic knee to extend.


Acupuncture has been found to effectively treat lower back pain when compared to using no treatment. The ideal treatment would involve both acupuncture as well as another intervention such as adjusting your prosthetic alignment or correcting a leg length discrepancy.

In Summary

A multi-prong approach that includes education, physical activity and specific exercises and stretches in conjunction with acupuncture may be the most appropriate treatment for lower back pain. Directly addressing weak abdominals and deconditioning from a sedentary lifestyle, along with swimming will lead to improved lower back health. 

Do you experience lower back pain? Please leave a comment below.

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  • I started having knee and back pain a few months after I started using my prosthesis (12/2019) on a regular basis. The pain goes away immediately after I take my "foot’ off! I have appointment with prosthetist to see if I am walking correctly or something else.

    Isabel Ruiz on

  • I am in year 3 of right prosthetic below knee.
    6 months after my surgery in 2016 I developed 2 cysts in the original incision. Since those were removed , one being almost to the bone on top.
    I am with no 3 prosthetic office.
    I have had one leg shorter than the other leg all my life. Now along with my scoliosis I am into some debilitating lower bck pain that is also working on other body parts. and still not driving. No independent. Female at 69 with husband & family.

    Please let me know if shoes or chiropractor or anything can help.
    Recently have had pin system ordered to work on improving my walking better.
    Please help?? Too many different answers.
    I have had X-rays in my bck and the curvature is worse in my bck with hopefully none to get worse with new prosthetic. My life is at a dead stop.
    I hopefully will have changes in walking ASAP. I never sat down until losing my mid calf amputation.
    In wheel chair again during the day to relieve pain in my bck.
    I can’t take pain pills because of acid reflux.
    Waiting to hear. Thank you , Pam

    Pam DeLine on

  • I;m Amputeestic and I suffer from lower back every 2 or 3 month.

    Rosie MGarnett on

  • I do experience chronic lower back pain. I suspect a compressed L 12 many years ago contributes to the routine lbka, and the right pfa. I guess I better get the Kings prosthetist and hurry off to the gymnasium while I’m at it . . . . .

    Darrel Smith on

  • Have worn nice knee for 50 years and always have lower back pain

    Marty on

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