Running with a Prosthetic Limb - Prosthetic Training: Episode 17

Key strategies & tips for learning to run with a lower-extremity prosthetic

Core teaching goals (for patients who are new to running)

• Focus on starting someone who has never run before (straight-ahead running only in this video).
• Use the framework “who, when, and why” to decide how to teach running and when to progress.

The “who / when / why” decision-making framework

Who to teach

• Most patients can be taught to run, including older patients, especially if they can already walk reliably (e.g., community ambulation with a cane).
• If someone is primarily on a walker/rollator, that may not be the right target for running instruction.

When to teach

• Don’t start running right away.
• Ensure the person walks well for 2–3 months before introducing running so their brain retains a stable walking pattern before learning a different running mechanism.
• After running practice, finish with a couple of laps of walking to “re-gear” the motor pattern back to walking and avoid inefficient energy use.
• Running requires more energy; teach progression carefully.

Why choose one mechanism over another

• Hop-skip is typically the safest and simplest entry point (best for beginners).
• Fixed knee (leg-over-leg with locked knee) is often favored for distance-style goals because it provides stability across many repeated steps, but requires clearance strategies (e.g., circumduction) since the knee can’t bend.
• Free/swing knee (leg-over-leg with knee motion) may be preferred for more straight-ahead/sports-like movement where more normal knee motion feels beneficial.

Three prosthetic running mechanisms (main methodology)

1) Hop-skip running

• Teach the patient to hop and skip so they can manage the airborne transition safely.
• Progression:
  • Lift the prosthetic leg and hop.
  • Hop forward a little.
  • Combine into hop-and-skip with prosthetic landing/step-through.
• Key concept: running has airborne time; with hop-skip, the “air” phase is controlled so they’re not loading the prosthetic during swing the same high-risk way as other patterns.

2) Leg-over-leg running with a FIXED knee (locked prosthetic knee)

• Teach a forward airborne transfer while the prosthetic knee stays locked.
• Clearance requires compensations since normal knee bend can’t happen:
  • Circumducting the leg and/or hip hiking, lifting, or swinging to step through.
• Emphasis: build speed gradually because it’s more efficient than hop-skip, but requires confidence in weight transfer sound side → prosthetic side mid-air.

3) Leg-over-leg running with a FREE / swinging knee

• Introduce using the same skill-building steps:
  • Kick the leg/prosthetic out in front
  • Pull back to load it
  • Drive the opposite knee forward to trigger the run/airborne step (sprinter-like knee drive).
• For below-knee vs above-knee amputees, the video notes:
  • Below-knee: may also be taught as a march-into-a-run.
  • Above-knee: focus on timing and avoiding instability from knee swing (often need knee resistance/stiffening capability).

Spotting & safety technique for instructors/caregivers

Position yourself

• Stand on the prosthetic side where the patient is most likely to fall.

Use a gait belt

• Grip at/near the patient’s center of mass to control speed and balance.

If they start to fail

• Elevate/pull them up toward you rather than letting them drop and topple.
• Avoid being positioned where you could get pulled into them or end up landing on/over them.

Why spotting works

• Most early mistakes come from:
  • scuffing the foot / not clearing through,
  • prosthetic knee instability on landing,
  • resulting imbalance toward the prosthetic side.

The “three-step” progression to actually produce running (behavioral drills)

1. Step 1: Long step / prosthetic placement out in front

   • Priority: get the prosthetic out in front consistently.
   • Avoid short steps (a common cause of tripping).
   • Cue: kick forward “low and out,” like scooting it down the track—don’t high-knee (high-knee tends to worsen knee timing and stability).

2. Step 2: Pull-back with residual limb activation

   • After the prosthetic is kicked out, teach them to pull back at the right moment (using “butt muscles” / residual limb side concept).
   • This makes walking faster without “running” yet.

3. Step 3: Run trigger—kick out + pull back + drive knee through

   • While pulling back, drive the opposite knee forward (sprinter style).
   • This knee drive helps create the airborne step that transitions them into running.

Stopping, transitions, and avoiding the “end-of-run trip”

• Common failure: people run well, then fall when stopping.
• Fix:
  • When transitioning from running → walking/stop, the patient must use a more aggressive clearance on the prosthetic side (stronger prosthetic kick-through / step) so they don’t drag/scuff the foot on the last step.
• Practice drill:
  • Walk a few steps → run → walk, alternating patterns.
  • Example progression: walk 5 / run 10, then increase jogging/speed gradually.

Confidence-building principles (mental + physical cues)

• Running can feel scary due to the first airborne moment.
  • Instructors should keep the patient feeling stable/secure while they experience it.
• Start with a “bouncy,” higher-clearance run:
  • It’s safer early on and easier to progress from bouncy to relaxed once confidence grows.
• If a patient is apprehensive, instructors can use spotting cues:
  • lift/elevate slightly and/or provide a small forward push to help them get moving into the run pattern.

Technology and setup considerations (practical guidance)

• Technology doesn’t have to be “fancy,” but alignment and stability matter.
• Key points:
  • For below-knee: often no special running tech is required if suspension/alignment are stable.
  • For above-knee: you generally need a knee that can stiffen/resist flexion appropriately for running timing (free-swinging knees can kick up too much).
  • Alignment checks are emphasized more than brand:
    • midfoot/heel contact and rolling mechanics,
    • toe-loading consistency,
    • stable suspension and alignment.

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Presenters or sources

• David Lawrence (presenter/instructor)
• Mission Gait (referenced organization; source for the video series)