Video summary

Stairs and Ramps For Amputees - Prosthetic Training: Episode 13

Main summary

Key takeaways

Wellness and Self-Improvement

Key Strategies for Stair and Ramp Navigation With a Prosthetic

Core principles (apply across tasks)

  • Stairs: move one step at a time
  • Ramps:
    • Going up = power
    • Going down = control (prevent the prosthetic knee from “getting away” from you)
  • Body positioning:
    • Lean into the incline (keep weight forward over the prosthetic-side support)
    • Keep weight “on top of” the prosthetic/control point rather than behind it

Stair Training (Step-by-Step Technique)

Going up stairs (general)

  • Start with stance control on the prosthetic side.
  • “Up with the sound foot, then prosthetic” (one-at-a-time):
    • Step up with the sound foot
    • Bring the prosthetic up only after clearance and alignment are ensured
  • Avoid a common mistake:
    • Don’t drag the prosthetic up—it can catch on a step lip and pitch you forward
  • Muscle activation cues:
    • Tighten glute/butt muscles to clear the prosthetic and stabilize
    • When moving forward, clear by going slightly backward (helps avoid kicking someone if walking near others)

Coming down stairs

  • One step at a time
  • Prosthetic limb goes first
  • Stabilize at the knee before fully transferring:
    • Step down with the prosthetic
    • Tighten quad/thigh (and engage the knee) to keep it stable
    • Step down again to the next step

If the knee feels unstable (angled approach)

  • Turn about 45 degrees sideways before stepping down
  • This shifts pressure so the knee is guided into more natural stability
  • Then place the other foot down

Faster rhythm when you can’t do “leg-over-leg”

If matching others’ pace:

  • Step up, bring prosthetic to it
  • Skip one step rather than trying to alternate rapidly (Many prosthetics limit higher-speed leg-over-leg.)

Microprocessor / controlled descent emphasis

  • Use both hands on rails.
  • At the top:
    • Hang the prosthetic slightly off the step to clear the toe
  • Descend:
    • Tighten glutes to stabilize
    • Step off with the other foot and “ride” the hydraulic down
  • Instructor preference for training method:
    • Instead of immediately controlling a bent knee:
      • Stabilize first
      • Then shift center-of-weight forward and let the knee lower under control

Technique Adjustments for Descent Safety (Heel/Toe Loading)

When coming down:

  • Avoid leaving the whole foot on the step (toe/lever push can kick you back)
  • Instead:
    • Move the foot out by ~3 inches
    • Clear the edge so the knee can bend more easily as weight transfers

Goal visual/feel:

  • Toes slightly hanging
  • Weight on the heel
  • Roll over the toe as you bring weight forward

Below-Knee vs. Above-Knee and Toe Clearance Going Up

Leg-over-leg stepping may be possible, but the main going-up risk is:

  • Not clearing the toe

Fix:

  • Exaggerate knee bend slightly to ensure clearance, then return to normal once confident

Ramp Training (ADA ramps and steeper declines)

Going up a ramp

  • Focus on:
    • Power
    • Leaning into the hill
    • Keep body weight forward over/above the prosthetic
  • Mechanism cue:
    • The prosthetic foot/surface pushes the knee into extension, which can feel stabilizing
  • Shorter strides can improve control and stability

Coming down a ramp

  • Focus on:
    • Control (the prosthetic tends to want to “get away,” and the knee may bend)
  • Technique cues:
    • Step forward slightly
    • Tighten butt muscles/glutes to stabilize the knee
    • Step weight forward on top and “ride over it”
  • Don’t try to “walk it off” with big movements—let knee control do the work.

Steeper ramps / embankments (when walking straight is unsafe)

  • Safer strategy: turn and sidestep rather than going straight down
  • Setup:
    • Prosthetic limb on the low side
    • Sound limb on the high side
  • Key sidestep cues:
    • When stepping out with the prosthetic, put weight on the instep
    • Keep weight leaning into the hill as you move downslope
  • Error to avoid:
    • Don’t lean too far “high sided” over the prosthetic (risk of coming over the top/fall)

Bilateral Prosthetic Ramps (Both Legs Prosthetic)

  • Same fundamentals:
    • Lean in
    • Keep weight forward (don’t let it fall behind the feet)
  • Control speed on descent:
    • Use heel/toe mechanics and quad tightening
    • Control via prosthetic alignment as a lever/brake, rather than allowing weight to shift too quickly

Presenters / Sources

  • David Lawrence (presenter)
  • Keith (participant/model in demonstrations)
  • Dan (participant/model in demonstrations)
  • ADA ramp (referenced standard)

Original video