Exercise guide
Exercise is part of recovery from the day after an amputation, and it stays important for life. It keeps your hips and legs strong for walking with a prosthesis or getting around in a wheelchair, improves your balance, and helps protect your heart, which matters because heart problems are more common after an amputation.
This guide is mainly about leg amputations, with a short section on arm amputation, for people with limb loss or limb difference. It follows NHS information and the UK guidelines for amputee physiotherapists. Your physiotherapist and limb centre know your situation best, so use it alongside their programme.
You'll find the exercises you're likely to be given early on, how much to do once you're home, preventing falls, looking after your stump (residual limb) and your other leg, what the evidence says about phantom limb pain, and a follow-along routine.
Exercises start the day after surgery. The UK guideline for physiotherapists who work with amputees recommends a personalised programme of strengthening, stretching and joint movement for everyone using a leg prosthesis, plus sport, hobbies and ongoing activity.
About 12% more for a below-knee amputation that wasn't caused by circulation problems, and about 102% more for an above-knee amputation after circulation problems, and more again at slow speeds. Fitness and strong hips make it easier.
Programmes that mix walking, balance and strength improve walking speed, how far you can walk, balance and transfers. With moderate confidence, 1 to 3 sessions a week of 20 to 60 minutes did this.
In different studies, 20% to 53% of people with a leg amputation fell within a year. Strength and balance training, and learning how to get up from the floor, are recommended.
Heart attacks and heart failure are more common after an amputation, and after an amputation for diabetes the risk of dying was more than doubled. Look after your other foot with well-fitting shoes, a podiatrist and regular checks.
About 6 in 10 people have it, and it usually eases over time. Mirror therapy may help some people, but there's no good evidence yet that general exercise treats it.
An amputation is the surgical removal of part of the body, such as an arm or a leg. Leg amputations range from toes and part of the foot, through below the knee and above the knee, to the hip. Some people are born with a limb difference instead, and the charities in this guide support both.
Severe infection, gangrene (often from peripheral arterial disease, where narrowed arteries reduce the blood supply to the legs), complications of diabetes, a serious injury, or a deformed limb that doesn't move well. In older UK figures, 26% to 53% of people who lost a leg to circulation problems needed a second amputation within 1 to 5 years, which is why the other foot needs care.
Exercises in bed and in a chair start the day after surgery, and with a leg amputation you get around in a wheelchair first and learn to transfer. Don't stand or walk until your therapists say so, "to protect your stump, prevent damaging your remaining limb and to prevent you falling", as one NHS trust puts it. A limb-fitting centre assesses you for a prosthesis; not everyone is suitable, because using one takes a lot of physiotherapy and "a considerable amount of energy".
People who lose a leg to circulation problems are often weak and unfit beforehand, and even very active people with a below-knee amputation took only 49% to 68% of the steps of people without one. Prosthesis users rely on their hip extensors, the muscles at the back of the hip, to make up for the lost ankle and knee.
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You favour your other leg, which may put more load on its knee and hip, and the thigh bone and hip on the amputated side can thin from less loading. Phantom limb pain, stump pain and low back pain are each reported by about 6 in 10 people, and pain in the other leg by about 4 in 10.
The NHS lists heart problems such as heart attacks among the complications of an amputation, and the UK physiotherapy guideline notes a higher risk of obesity after a leg amputation.
In a Norwegian study of 224 people with an arm amputation, pain in the neck and upper back (57%), the shoulders (59%) and the remaining arm was more common than in people without one, whether or not they wore a prosthesis. Overuse problems were found in 6% to 24% of those examined.
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The cause and level of the amputation matter most: the energy cost of walking rises with a higher amputation and with circulation problems, and people who lose a leg to circulation problems are often less fit to begin with. An older falls guide lists being a woman among many risk factors, but no source gives different exercise advice for women and men.
A review of 23 studies (408 adults living at home) found the best evidence for programmes that mix aerobic exercise with strength or balance work. With moderate confidence, 1 to 3 sessions a week of 20 to 60 minutes improved balance, walking speed, how far people could walk, and transfers. Evidence on fitness, strength and flexibility on their own was weak, because there were few studies.
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In 16 randomised trials, exercise improved walking a little in the first months after an amputation and moderately later on. Another review pooled 7 trials: the distance people walked in 2 minutes rose by about 9 metres, and a timed test of standing up, walking and sitting down got about 2 seconds quicker. The studies were small and varied.
In 8 low-quality studies, walking practice with resistance or everyday tasks improved walking speed more than supervised walking alone. Strength training combined with other exercise improved strength, balance and walking, though the trials can't separate the strength work from the rest.
In a very small trial (15 people), 12 weeks of strength, balance, flexibility and walking exercise was followed by fewer falls over the next year, and walking became about 0.2 metres a second faster. Falls guidance for amputees, mostly drawn from research in older people, recommends combining balance, strength and endurance exercise.
Pooling 3 studies, organised activity programmes didn't clearly improve quality of life, and their effect on phantom pain is unclear, because there wasn't enough data to pool.
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In 22,950 people in South Korea with an amputation after an injury, heart attacks (1.30 times as likely), heart failure (1.27 times) and an irregular heartbeat (1.17 times) were more common than in matched people without one. UK veterans with combat amputations had more insulin resistance, inflammation and fat around the organs than both injured veterans without an amputation and uninjured veterans. In Sweden, people with type 2 diabetes who had an amputation had 2.46 times the risk of dying of those without, and more than 3 times in the first year. These are observational studies, so they show links, not causes.
Studies disagree. In US veterans, knee pain in the other leg was 3.3 times as common after an above-knee amputation, but not clearly raised after a below-knee one. In 78 Dutch people with an amputation after an injury, 27% had knee and 14% hip osteoarthritis. Yet a database study of 1,569 people with an above-knee amputation found less osteoarthritis than in matched people without one.
Low back pain is common, about 62% across 51 studies, and more common after the amputation than before; frequent back pain goes with more disability. Only 2 studies have tested exercise for it.
Mirror therapy reduced phantom pain in the first month across 10 trials, but a review of only the trials with a placebo comparison found no clear benefit. Graded motor imagery may help, with very low certainty. In one trial of 51 people, 8 sessions of relaxation, mental imagery and phantom limb exercises reduced phantom pain a month later, compared with physiotherapy for the residual limb. High-quality trials are scarce.
Where there's time before surgery, the UK guideline asks for a structured exercise programme as early as possible, and a check of your strength and any joint tightness. Afterwards, your physiotherapist teaches you exercises in bed and in a chair to help prevent blood clots and improve your blood supply, and you learn transfers and wheelchair skills.
The core exercises below, chosen by your physiotherapist, which can start from the first day after surgery; lying and sitting positions that keep your hip and knee straight; a compression sock once the wound has healed, to control swelling and shape the stump; gently tapping and massaging the skin to make it less sensitive; and general fitness, for example on an arm bike.
Prosthetic rehabilitation should start as soon as possible and aim for an energy-efficient way of walking. You wear the prosthesis for short periods at first, building up as your skin allows, and practise walking in parallel bars, then at home. Your physiotherapist then works through harder tasks: sit-to-stand, getting up from the floor, stairs, kerbs, slopes, uneven ground, carrying things and picking things up.
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The guideline recommends a personalised programme of strengthening, stretching and joint movement, advice about the benefits of being active and help finding local activities, encouragement to take up sport and hobbies, and a review within 12 months, with the option to refer yourself back.
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Do only the ones your physiotherapist has chosen: 5 of each to start, building to 10, 2 to 3 times a day (NHS hospital leaflets), holding squeezes for 5 seconds and the hip stretch for 30 to 60 seconds (the exercise sheets UK amputee physiotherapists agreed on). The thigh squeeze, straight-leg raise and knee straightening are for a below-knee amputation; put pillows under your thighs for the bridge.
3D demoGlute bridgeBeginner · No equipment
3D demoSingle knee-to-chest stretchBeginner · No equipment
3D demoStraight-leg raiseBeginner · No equipment
3D demoQuad set (static quads)Beginner · No equipment
3D demoSide-lying leg raiseBeginner · No equipment
3D demoLying adductor ball squeezeBeginner · Other / check instructions
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weightChange position often and don't sit for long periods. Don't put a pillow under your stump, hips or knee, or between your thighs, unless you're told to, and don't let your stump hang over the edge of the bed. After a below-knee amputation, support your stump on a stump board or stool rather than sitting with your knee bent. The UK guideline says active exercise and splints or rigid dressings prevent joints from stiffening in a bent position (contractures).
The NHS leaflets suggest each exercise 5 times to start, building to 10, 2 to 3 times a day. The exercise sheets hold squeezes for 5 seconds and the hip flexor stretch for 30 to 60 seconds.
Trials that worked used 1 to 3 sessions a week of 20 to 60 minutes, mixing walking, balance and strength; later on, 15 to 60 minutes, 2 to 3 times a week, for 4 to 16 weeks. The best amount isn't known.
UK guidance says there is no reason to change the activity guidelines because of an impairment: build towards 150 minutes of moderate activity a week, with strength on at least 2 days and less sitting, as you're able. LimbPower runs daily online classes to help amputees get there.
Before a prosthesis: the exercises your physiotherapist chose, 2 to 3 times a day, plus short arm-bike or wheelchair sessions. Walking with a prosthesis: 2 to 3 sessions a week mixing hip, knee and core strength, balance at a counter, and walking or cycling. Every day: check your stump and your other foot.
Prosthesis users rely on the muscles at the back of the hip, and in one study hip strengthening with high-intensity intervals improved strength, balance confidence and how much people used their prosthesis.
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Once your physiotherapist agrees, stand holding a sturdy chair, table or counter and move the amputated leg out to the side and back from the hip, keeping your body upright; an NHS leaflet includes these among its early exercises, standing on your other leg. Then add sit-to-stands and stepping with your prosthesis.
5 of each, building to 10 (our editorial starting point, following the NHS leaflets), holding a counter for anything standing. Skip calf raises if your other foot has sores, numbness or poor circulation, unless your team agrees.
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoStanding band hip extensionBeginner · A band + An anchor point
3D demoSit to stand from a chairBeginner · A bench or box
3D demoLow step-upBeginner · A step
3D demoSlow calf raiseBeginner · A wall
3D demoDead bugBeginner · No equipment
3D demoBand rowBeginner · A band + An anchor point
3D demoWall push-upBeginner · A wallIn different studies, 20% to 53% of people with a leg amputation fell within a year, and in one 2-year study 52% fell, compared with 32% of older people without an amputation. Falls happen after surgery, during rehabilitation and at home, and people who feel more confident may take more risks.
Combined balance, strength, tai chi and endurance exercise; a comfortable, well-fitting prosthesis; a review of your medicines; walking aids; and advice on avoiding falls. Your physiotherapist should teach you how to get up from the floor and what to do if you can't.
The UK guideline says everyone should be told that phantom sensations raise the risk of falling. One example (ours): getting up at night and forgetting the leg isn't there.
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Hold a counter: 10 side steps each way, and 3 holds of 10 to 20 seconds in the semi-tandem stance (our editorial starting point). Learn to get up from the floor with your physiotherapist first, and practise with someone there.
Slow walking with a prosthesis costs much more energy. People with an above-knee amputation who could reach 30 watts on an arm-crank machine were more likely to manage a 6-minute walk with a prosthesis, and brisk walking with a prosthesis counts as moderate exercise.
Because heart problems are more common after an amputation, activity matters alongside blood pressure, cholesterol, blood sugar and stopping smoking: the Swedish researchers call for intensive heart risk care before and after an amputation. The UK physiotherapy guideline recommends advice on health and diet.
20 to 30 minutes, 2 to 3 times a week, at a talk-but-not-sing effort (our editorial starting point, within the trials' 20 to 60 minutes). On a treadmill, start with short bouts holding the rails and build time before speed. The arm crank has no 3D demo yet.
Look after it, especially with diabetes: well-fitting shoes, a podiatrist and regular foot checks. The UK guideline says people with circulation problems or diabetes, and their carers, should be told the risks to the remaining foot and how to reduce them. Hopping and pivot transfers may overload a foot at risk, though this hasn't been studied.
Whether they wear faster is uncertain. A well-fitting prosthesis and balanced strength between your legs are the sensible protections.
Low back pain is common after a leg amputation. The UK guideline warns that problems like this can develop, and says you should be able to get reassessed when things change; our back pain guide has general back exercises.
Wash your stump at least once a day (more in hot weather) with warm water and a mild, unscented soap, and dry it carefully. Moisturise at bedtime or when you're not wearing your prosthesis, clean the socket, change your socks daily and avoid long soaks. Massage the scar once it has healed.
Check morning and night, before and after wearing your prosthesis, using a hand mirror. Look for redness that doesn't fade within 10 to 15 minutes of taking the limb off, blisters, broken skin, cracks or rashes. Don't treat broken skin yourself: get an urgent review from your GP, practice nurse or district nurse.
Stay off your prosthesis, using crutches or your wheelchair, until a prosthetist or doctor has seen it, and don't pad a pressure area. If you have less feeling in the skin, check more often and keep it away from hot water and the sun.
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A compression sock or garment, worn once the wound has healed, controls swelling and shapes the stump. The NHS says to take it off at bedtime, and one NHS leaflet builds it up to 24 hours a day apart from washing, so follow your team's advice. Gently tapping, massaging and touching your stump early helps it get used to a prosthesis, and massage can help reduce phantom sensations.
Pain that seems to come from the missing limb. The NHS says the term "phantom" doesn't mean the sensations are imaginary. About 6 in 10 people have it; in one group of patients it fell from 90% early on to about 45% at 6 months. Pain before the amputation, a higher amputation and stump pain make it more likely.
Medicines, including some for nerve pain; adjusting the prosthesis; massage; transcutaneous electrical nerve stimulation (TENS), a small device that sends gentle electrical pulses through the skin; acupuncture; mental imagery; and mirror therapy. The UK guideline says physiotherapists should teach you ways to manage it yourself, and that there isn't enough evidence to say which method works best.
No good trials show that exercise programmes treat phantom pain. Mirror therapy and graded motor imagery, done with a physiotherapist, may help some people. Being active is good for you whether or not it eases the pain.
Neck, shoulder and arm pain are more common after an arm amputation, because the other arm does more, and wearing a prosthesis doesn't prevent it.
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No exercise trials were found. Our suggestion: keep your remaining arm and both shoulders strong and mobile with rows, turning the arm outwards and shoulder-blade work; add neck and upper-back movement; vary and pace repetitive tasks; and follow the general guidelines for your legs and heart.
2 to 3 sets of 8 to 12 for the strength moves, and 30-second holds for the stretches (our editorial starting point). For the row, brace on the bench in whatever way is stable for you, or use a band.
Start with the stump exercises your physiotherapist chose. Once you're walking with a prosthesis, the strength and balance and leg workouts work with a counter to hold; leave out heel walks, toe lifts, backward walking and floor work until your physiotherapist agrees. The seated workout is for days without your prosthesis.
The hip, thigh and trunk exercises physiotherapists give after an above- or below-knee amputation: lying and sitting, then standing at a support when ready.
20 minBeginner11 movesOther / check instructions, A bench or boxA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.
20 minBeginner7 movesA bench or box, A stepBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 25-minute workout done sitting, in a chair or wheelchair: seated cardio intervals, light strength work, posture and stretches, with pacing and cooling built in.
25 minBeginner14 movesA bench or box, A dumbbellGrief, low mood, anxiety and, after an injury, post-traumatic stress are common: talk to your care team, especially if you feel depressed or suicidal. The UK guideline recommends checking for depression and putting you in touch with other amputees. The Limbless Association runs a helpline (0800 644 0185) and volunteer visitors.
The NHS lists the Limbless Association, the Douglas Bader Foundation, Steel Bones, the Amputation Foundation and Blesma (for veterans). In the US, the Amputee Coalition runs the National Limb Loss Resource Center.
LimbPower helps amputees and people with limb difference into sport, with daily online classes, and the UK guideline asks physiotherapists to encourage sport and hobbies.
If you feel any pain, stop and tell your physiotherapist or doctor, as the exercise sheets say. Stop too for chest pain, unusual breathlessness or dizziness.
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Exercises in bed and in a chair start the day after surgery, to help prevent blood clots and improve your blood supply, and rehabilitation starts as early as possible. What you shouldn't do early on is stand or walk until your therapists say so.
The NHS says the term "phantom" doesn't mean the sensations are imaginary, and about 6 in 10 people have phantom pain.
The UK guideline recommends a personalised strengthening, stretching and mobility programme for prosthesis users, and ongoing activity. Walking with a prosthesis takes 12% to 102% more energy, so fitness and strength matter more, not less.
Mirror therapy reduced pain in the first month in one pooled analysis, but trials with a placebo comparison didn't show it works, and the evidence for graded motor imagery is very low certainty. It's worth trying with a physiotherapist; it isn't a proven cure.
Studies disagree: one found more knee pain in the other leg after an above-knee amputation, another found less osteoarthritis than in people without an amputation. A well-fitting prosthesis and balanced strength are the sensible protections.
The UK guideline asks physiotherapists to encourage sport and hobbies, and LimbPower runs sport and online classes for amputees and people with limb difference.
Usually the day after surgery, with exercises in bed and in a chair that your physiotherapist teaches you. Don't stand or walk until your therapists say so.
The usual core exercises are buttock squeezes, a lying hip flexor stretch, hip hitching, bridging, side-lying hip movements, lifting the leg while lying face down, and an inner-thigh squeeze, chosen by your physiotherapist. They keep your hip strong and straight, which matters for walking with a prosthesis.
The same hip exercises, plus thigh exercises that keep your knee strong and straight: thigh squeezes, straight-leg raises and straightening your knee while sitting. Don't sit for long with your knee bent; support your stump on a board or stool.
Early on, the NHS leaflets suggest 5 of each exercise, building to 10, 2 to 3 times a day. Later, 2 to 3 sessions a week of 20 to 60 minutes that mix strength, balance and walking or cycling improved walking and balance in trials. The long-term aim is the usual 150 minutes of activity a week, as you're able.
It takes more energy: about 12% more for a below-knee amputation not caused by circulation problems, and about 102% more for an above-knee amputation after circulation problems, and more again when you walk slowly. Building fitness and hip strength helps.
Falls are common after a leg amputation. Strength and balance training, advice on avoiding falls, a comfortable, well-fitting prosthesis and learning how to get up from the floor all help, so ask your physiotherapist.
There's no good evidence yet that general exercise treats it. Mirror therapy, graded motor imagery, and relaxation with phantom limb exercises may help some people, but the trials are small or mixed. Other treatments include medicines, TENS and adjusting your prosthesis.
Wash and dry it carefully every day, and check it morning and night and after exercise for redness that doesn't fade within 10 to 15 minutes, blisters or broken skin. If the skin breaks down, stop wearing your prosthesis and get it checked.
Yes: the UK physiotherapy guideline asks physiotherapists to encourage sport and hobbies, and LimbPower helps amputees find a sport and runs online classes. Talk to your limb centre and physiotherapist about what suits you.
It's uncertain: some studies found more knee pain or osteoarthritis in the other leg, and a large database study found less. Look after your remaining foot carefully, especially if you have diabetes.
Neck, shoulder and arm pain are more common after an arm amputation, whether or not you wear a prosthesis. Keeping your remaining arm, shoulders and upper back strong and mobile is a sensible approach, though it hasn't been tested in trials.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
