As May gave way to June, I knew I had to ramp up my leg workouts. We were almost to the midpoint of the year, heading into summer at the end of the month; now was the time for me to strengthen my leg and make it more flexible. The window to developing outdoor independence from the cane wouldn’t be open that long. I began doing a minimum of three leg exercises four times per week.
When I began walking on the treadmill that spring, my left leg had been so weak that I felt very uneasy about climbing on and off the treadmill. The first time I tried to step up onto it with my left foot, it had been impossible. I tried to lift my foot three times before having to give up and step up with my right foot. During the past three months I had done so much to strengthen my left leg that I was able to start stepping up with it. The first few weeks, I had a hard time pulling myself up after leading with my affected leg. But gradually, this became easier too. Ultimately I found that I could lift my left foot about four inches above the treadmill.
Once I was on the treadmill, walking was the easy part. Where my toes had once dragged every time I tried to lift my left foot, it now caught fewer and fewer times. When I had first begun using the treadmill, I had tried to step forward using my quadriceps. While I had become more adept at walking, the progress had not been fast enough. After a few weeks, it occurred to me that I needed to incorporate my glutes and hamstrings. At first I wasn’t sure how to access these muscles. It soon dawned on me to imagine that I was squeezing my inner thighs. This technique made it easier to lift and advance my foot.
At first I had to put the treadmill on the slowest setting. Each time I stepped, I had to squeeze my thighs to get my foot to rise off the treadmill. This wasn’t physically difficult, but it did require a lot of concentration. It was so mentally taxing that I longed for the day when this motion would become automatic. As I walked, I would gradually increase the speed of the machine. While I could keep up, I couldn’t relax because of my need to concentrate on my leg muscles. I had to step and squeeze every time over the next few months, and it resulted in an increase in my muscle strength. Through building strength, walking would soon begin to feel more automatic.
I was quite proud of how much stronger my left leg was getting. It was getting easier every week to advance it while walking. But while my glutes, quadriceps, and hamstrings were getting regular attention, if I really wanted to be able to walk normally without my cane, it would take reactivating the muscles of my lower leg. I had been doing leg curls to try to work my calves, but I was seeing minimal gains. I needed to try other exercises.
Lunges seemed to be the ideal exercise. Placing my legs at different angles would help me to isolate each and work on developing balance. Alternating which foot I placed forward and which one I kept beneath me would help me to work specific muscle groups. The only drawback was that lunges are usually done while holding dumbbells. I didn’t yet have the stability to attempt this. I would need something to hold onto. I decided to do it by using the Smith machine. If I started out in a squat stance, I could do lunges safely that way.
For my first set, I slid my hands into place and ducked under the bar. Since it was almost time for muscle relaxant injections, I expected my left shoulder to be tight (It often takes a set for my shoulder to loosen up), but I had no problem with constriction. The physical therapist had been doing such a great job that I didn’t need to stretch my shoulder prior to exercising. I stretched out my arms, put my left foot out in front, tucked my right foot behind, and went down into a squat.
The exercise felt really awkward at first, placing me on a narrower base than I was used to. But with my arms wrapped around the bar, I knew I couldn’t fall over. I ignored how strange it felt and concentrated on breathing and form. I inhaled as I sank down. Then I exhaled as I slowly pushed myself up to a standing position, trying to use only the muscles of my left leg. This was much more difficult than I had anticipated. I lifted correctly, but my strength gave out after five reps. I sat down to catch my breath. It might take me a while to become proficient, but I knew I had found my next exercise.
After resting for a couple of minutes, I stood back up to repeat the exercise on the opposite leg. As I stuck my left foot out behind me, it took a little maneuvering to get it just where I wanted it. When I went down, I felt slightly unpleasant. My toes hadn’t borne the weight of my body in years. It wasn’t painful. So I kept going and eventually was able to reach a set of ten. Each time I stood upward, I tried to push with my left leg. As I did, I felt my calf muscles working.
I performed two more sets of ten reps with each foot forward. The exercise worked different muscle groups, from toes to glutes, depending on which foot was in front. When I was done, I didn’t stand up for ten minutes. All I could do was mop the sweat repeatedly from my head and torso. I felt good knowing that I had achieved my goal of activating my lower left leg. I was on my way to walking without a brace.
Now I wanted some cardio I could do with the same muscle groups. This had been tricky since the stroke. Initially they had me use the Nu-step machine. When I first started, my left thigh was so weak that they had to strap it to my right leg to keep it from flopping to the side. They would also have to lift my foot to the pedal and strap it in place. During those early days, my left leg was just along for the ride. Over the last four years, I had built up my leg through strenuous work. Now not only could my left thigh work independently, but I could lift my left leg onto the pedal without assistance. Not only was Nu-step easy for me, but I had progressed to a point where I needed a new exercise.
I really wanted to be able to do the stationary bike. When I had lived in Minneapolis before, I had enjoyed biking on urban trails. After the stroke, I had tried using a stationary bike a few times, but my left foot couldn’t stay on a pedal – not even when strapped in. Now I had gained a lot more control in my foot. Since my ILS worker was with me, I had him to help me lift my foot into the pedal strap. Setting the machine to no resistance, I pedaled carefully. My feet made a few rotations! I bumped the inside of my foot against the bike, but it wasn’t enough to knock my foot off the pedal.
After a minute, I felt like I needed more of a challenge. I moved the resistance from 0 to level 4. I was actually working now. I concentrated on pedaling as much as I could with my left leg. I tried to angle my knee inward so my toes would turn outward. After a few seconds, my foot stopped hitting the machine. I now was able to pedal smoothly. It was so amazing that I wanted to cry. My lungs started breathing rhythmically on their own. I felt my body heat up and begin to sweat.
After five minutes, I stepped off the bike. I wanted to do more, but I restrained myself because it was just an introduction day. I didn’t want to overdo it on my first day working calves. As I walked, I made sure to keep my toes pointed upward. I didn’t feel as though it required the same amount of effort as it had before. It felt as though my lower was actively working on its own, taking the mental strain away from walking normally.
With my strength improving so much, I knew it was vital to work on my walking technique. If I developed bad habits while relearning how to walk, I might carry them permanently. For instance, when I walked with the cane, I always leaned more to my right side in order to help lift my left foot. This was a compensating mechanism due to my having a weakened leg. Now that I was able to lift my foot more easily, I really wanted to stop walking incorrectly.
The next time I went to physical therapy, I had my therapist check the height of my cane. She stood it beside me and verified that it was the correct height. So I began try to walk with my body as erect as possible, with and without the cane. When I walked Mary, I would watch my reflection in the glass. I would correct my posture as I walked towards the door. At the gym, I would practice walking after every different weight exercise, anticipating that it would feel easier for my body to lift my leg after it had finished lifting weights. I had my ILS worker record me one day, and sure enough, I wasn’t deviating nearly as much.
Walking in my workout clothes was always easier. They were lightweight and I was usually warmed up from my workout when I practiced my stride. My moment of real triumph came when I was wearing jeans and a polo shirt. The fabric was more rugged, which constricted my muscles. It was a little more difficult to lift my leg, and I did roll slightly to the side. But my posture was much better than it had been. With hard work in the gym, it wouldn’t be hard to keep correcting my stride. And hard work in the gym was the one thing that seemed to be coming easily to me now.