Recently, I received a request to coach a 21-year-old gentleman who contracted polio as a child, resulting in severe muscle weakness and atrophy in his right leg. He wears a brace that begins at his foot and extends to the bottom of his glute. This allows him to walk without assistance, albeit with a limp. On the first day (yesterday), I taught him how to Deadlift (he struggled to lift 33lbs) and then we used the leg press to specifically train the weak leg.
Questions:
Would you suggest that we train the deadlift using one or both legs?
How about squats? What variations would you use for a trainee with this condition?
Overall, any advice in general for me?
Lastly, how much success do you think we will have in strengthening the weak leg?
Is your client from a developing country? Young people with polio I have run into are usually from India/Pakistan nowadays. The brace you are describing sounds like a knee-ankle-foot orthosis, sounds like he probably has weakness in his dorsiflexors/plantarflexors and knee extensors/flexors. Can you describe what part of the leg is atrophied? A picture will do as well.
Not to bore anyone with medical mumbo jumbo but what happens in polio is a constant denervation-renervation process. You get peripheral reinnervation by terminal axons, so what ends up happening is that the number of muscle fibers per motor unit can be up to 4x larger than normal. The good thing is that even if you loose about 3/4s of your motor units from polio damage you have enough reinnervation eventually that you might not notice any discernable side to side strength under normal circumstances. So what does that mean for someone who is having to use an orthosis for ambulation? Probably has lost lots of motor units - probably somewhere between 10-15% are left.
With that in mind your goal is to train what is trainable, those 15% still have lots of potential for training and since he is young he can be pushed and set up for a good life going forward.
I think you will have success strengthening the weak leg. I have not followed many young polio patients because we don’t have many thanks to vaccinations but patient’s with Post-polio syndrome do very well with intensive rehabiliation. There was a case study from 94 where a patient who had polio 40 years ago had new weakness in her leg and elbow, I forget the exact protocol but they ended up doing 3-4x resistance training and by the end of the year had improved her strength in the affected muscles by more than 50%. That can make a huge difference in function and quality of life.
In terms of unilateral versus bilateral movements I think at this point it can go both ways. Things like leg press might be comfortable to do bilaterally and you can get away with trying that. In general what I have seen PTs use for post polio patients is closed chain exercises on machines and bands. The worry I have is without knowing how truly weak the affected side is the asymmetric stress of a back squat/deadlift might put him at risk for injury, especially if truly a novice. I would probably use the leg press at first bilaterally or unilaterally, some closed chain isolation exercises on a machine/some band contraptions that would target the weak muscles - probably the DF/PF and KF/KE. If those progress and you notice some good strength returning to the point where he has anti-gravity strength to the affected muscles maybe something like a box squat would be next step.
I hope this is useful, let me know if you have any other questions.
