What the H. E. DOUBLE HOCKEY STICKS is “weightbearing,” why is it important, and how do I do it?

Well, weightbearing is exactly what it sounds like. Put weight through your limbs, but after a CVA (cerebral vascular accident) or neurological insult, it can feel impossible, especially if you have hemipelegia. Here is the thing though, many things after a neurological insult FEEL impossible, but they aren’t impossible they are just HARD. Like really hard.

Why do we need it? Besides helping us balance, the weight we put into our hands and feet act like a feedback loop for our brains. There are these little cells on the palmar side or bottoms of our hand feet and some on our tongue and lips that send out position sense signals. I imagine these cells to be like little clear sponges and every time we step or press through our hand or foot they contort and report back to our brains. This is how we know where that foot/hand is in space and it is also thought to help us wake up our hands and feet after injury or a surgery.

Whether you have flaccidity, your arm or leg has very low tone and usually limited  movement, or spasticity, where your arm and leg have very high tone and limited movement, weightbearing techniques will help you. Seriously, they work. Here are some super simple steps to begin your practice.

Step one: Stand up on TWO feet. Often, I meet people in the outpatient clinic who are “walking,” but when they move from sit to stand they look like a world class one leg skier. This is an incredible phenomenon. Your doctors might refer to it as neglect, basically your brain stops recognizing your leg as a base of support that means that every time you move you have to consciously think about using your more affected side of your body. I loved when one of my clients called his leg or arm “Lefty.” He would preface all of his movements with “c’mon Lefty.”  It made us both chuckle every time and it was a good reminder. Every single time you get up think about lefty or righty and make sure you are using that leg.

Step two: Use it. Stretch it. Put weight into it OR lose it. The upper extremity is harder in many ways when it comes to weightbearing. I took a class once that asked me to write down all of the times I weightbeared (a word?..tis now) through my hands. As a new mom, it was incredible! I put weight through my hand countless times in one hour. Reaching for my diaper bag, I used my non-dominant hand to steady myself on the wall. Reaching for a cup in my cabinet, I pressed trough my dominant hand on a counter top. Sitting and holding my coffee mug, I steadied myself with my elbows on a table. It was ALL the time.

Step three: Erase the perfectionism from your practice. It doesn’t have to be perfect. So, what, if you are not weightbearing 50/50 on each foot? It is better than not standing on that foot at all.  So, what if, your hand is fisted while your weight bear through your wrist? It is so much better than not using that hand at all. Let your occupational and physical therapists be a perfectionist during your session, but at home don’t sweat it just do it.

Step four: This is high level, people. Incorporate weightbearing into everything When brushing your teeth, use that more affected hand to steady yourself on the counter.  When you are shaving your legs use that hand on your shower chair to balance yourself. Every single time you move from sitting to standing use that affected hand to help you.

These steps are easy, stand on two feet, use your more affected hand, don’t be a perfectionist, and incorporate weightbearing into your daily activities.

As my clients leave our clinic, I watch them like the little OT sadist I am. I make sure that they are using their more affected arm to lean on the wall as they gather their items. I watch to see if they are walking mindfully using both sides of the body. I look to see if they attempt to open the door with their more affected hand. If they miss any of these steps, I call them out and you will often hear me ending a session with a shrill “don’t forget to weight bear.” Do it. It works.