This question is asking about ascending and descending stairs.
Sometimes, looking at the search terms that were used of how people ended up on my blog is a great way to give me an idea for a new post. This exact wording was put into Google(or maybe a lesser-known search engine)….”why do you go up with the good and down with the bad?” Somehow my blog came up in the results, my site was clicked on and the rest is history.
So, back to the question. Why indeed? Hey I know why!!!! Here’s why……(in case the first time around your question was not answered)…..
I’ll explain this using the example of a sprained ankle, think of an orthopedic injury that requires you to put less weight through one foot when walking or it will hurt like a m-f’er. When it comes to the weird gait patterns after a stroke, sometimes honestly this won’t apply. It did not apply to me for the first couple of years after my stroke. It didn’t work for me. Because of the tremor and ataxia in my right leg, I had to do the opposite of this gait pattern for quite some time when negotiating stairs. Going down with the bad didn’t work for me because my “bad” leg had a mind of its own for a while and I had zero control over it. I wasn’t able to direct it and tell it where to go.
Ok, back to the question. Pretend your right ankle is messed up. So the right leg is the “bad” leg. When going up stairs, the entire weight of whole body must be lifted up to the next stair. You wouldn’t want to put all that weight through your messed up ankle. So, when you go up stairs, you “lead” with your left leg, using that leg to do all of the work lifting your body, and bring your right leg up to same step to meet it. That way, when climbing a step, all the weight being lifted is on the “good” leg, you wouldn’t want all that weight put on your messed up ankle.
Going down a flight of stairs is the exact opposite. Again, you don’t want all that weight on your “bad” leg, so you would put your “bad” leg down onto the next, lower step first, which will transfer all the body weight to the left “good” leg and it can then do the job of lowering your body down without using your right leg at all.
Try it, go down a step, put your right leg first on the step below, you should feel your left side tense up a little as it prepares to perform the act of lowering the body to the next step down.
I told a couple of people that I would research trunk ataxia and see if I could make any specific suggestions other than just strengthening the trunk. I never had trunk ataxia. I had ataxia BAD, still do but it’s not so bad anymore, and it did not affect my trunk. It affected my right arm and leg. I have a friend who has significant ataxia in the trunk and told me that for a while, she felt her trunk shaking even when she was just sitting down.
Here’s what I think………………balance exercises would be extremely important because balancing engages the postural muscles. But balance exercises require standing….and balancing….and that’s too much to ask of some people. Soooo here’s an exercise that I used to give to people right after back surgery to help engage, be aware of, and strengthen those muscles. It’s fun and it’s a mental game too. Ok maybe I’m stretching the truth by calling it fun. Lie on your back and put a blood pressure cuff under your low back. Then inflate the cuff to about 80 mmHg. Then you contract both the muscles in your belly and in your low back. They work together. Once these muscles are contracted, you do leg lifts and different things with your limbs while trying to keep the blood pressure cuff at 80. Ataxia is a problem with control and this exercise is all about controlling those muscles.
When I was 24 I decided to go to school for physical therapy. I was bored and thought well I’ll go do this…. A few years after I finished that up I thought, just to mix it up a little, I’ll have a stroke at the age of 30 and completely F up my life. In school I learned this phrase…”up with the good, down with the bad.” This is how I was taught to teach people with a bum leg to go up and down steps. Up with the good – lead with the “good” leg going up stairs, then bring up the “bad” leg to the SAME step. Down with the bad – go down steps leading with the “bad” leg, then the “good” leg follows to the SAME step. This works perfectly for a sprained ankle or broken leg, not so much with a hemiparetic leg with severe ataxia and an intention tremor.
It’s the down with the bad that was my problem. That first year I had pretty much zero control over my right leg(bad leg). Going down is harder anyway and combine that with severe ataxia and uhhh(insert profanity here). Well, now I have complete control over my right leg. But I didn’t then and I couldn’t “lead” with it if someone offered me a zillion dollars to do so. So for the first year the whole “up with the good, down with the bad” thing didn’t work for me.
So what did I do? I led with my left leg(good leg – opposite of what I was taught) going down steps for about a year until I had the strength and control to do it the “right” way. I also held on to railings for dear life.
But that’s totally the PT in me talking, not the stroke survivor. I don’t think there is a “right” way to do things after a stroke. There are things that you should know to make it easier to get around but there is no “right” way. Do what you can, when you can.
The first time I wrote about ataxia it was so bad I would sit on my hand. Maybe I had to sit on my hand because of the intention tremor. It was a combination of both I think. Remember that the 1st time that I wrote about this I didn’t know that I didn’t know anything. I thought I knew something. I was wrong. I don’t admit that I’m wrong a lot so mark this date. Ataxia is a problem with coordination of movements. I don’t really have a big problem with it anymore but right after the stroke Oh. My. God. It was bad. This was the main thing I think that made me look so freakishly bad to the outside world. I had ZERO control over my movements. Walking was ridiculously bad. Because of the ataxia, my right leg would just do its own thing before landing in the correct spot. I had to concentrate like hell in order to make my arm and leg on the right side of my body do what I wanted them to do and everything I tried to do took like 5 hours. It’s not that my muscles DIDN’T work, they didn’t work CORRECTLY. A lot of stroke survivors have a limb that doesn’t really work, doesn’t function at all. That wasn’t my problem. My problem was that those muscles worked TOO much. They were just crazy. Those muscles were insane. Now they’re sane. Kind of.
When there is a problem with the cerebellum, along with an intention tremor you also may have ataxia. I have very ataxic movement. Ataxia means a problem with coordination. Every time I was evaluated by a doctor, one thing they would have me do is touch my index finger to my nose then to their finger and repeat that a few times. This is called – cleverly – the finger to nose test. This is to test for ataxia and can also test for a tremor. I had problems doing that, still do. I can do it, but it’s a lot slower and less steady on my right side. When I go to push a button on the microwave I have problems coordinating that movement. I’m all over the place, my hand can’t go directly there. This is ataxia. Then when I get to where I want to be with my hand, like a button on the microwave, I start shaking because my intention tremor kicks in! It’s a double whammy. But it’s OK, it’s getting better. For more information on ataxia go here, good site.