Swim 01

Peer Support Helps Amputees Take the Plunge

Web Development inMotion

Volume 17 · Issue 6 · October 2007 Special Edition | Download PDF

by Élan Young

“You probably wouldn’t worry about what people think of you if you knew how seldom they do.” ~ Olin Miller

Less than a year after her leg amputation, then 15-year-old Christina Skoski found herself sitting beside a resort pool where her parents had taken her for a family vacation. While other kids splashed and played, the young hemipelvectomy amputee sat watching, sweating in her prosthesis and aching to jump into the pool. Her mom, sensing her discomfort, said, “Don’t be stupid, you know you want to jump in.” She did, and in that act of courage she realized that the benefits of enjoying an activity she loved far outweighed her fears of what others thought of her amputation, and it has stuck with her ever since.

Swim 02While strangers’ stares may not be comforting, Skoski, who went on to become an MD and now sits on Amputee Coalition’s Medical Advisory Committee, has learned to brush them off.

“They stare at you because you’re different. But after 10 minutes, so what? You’re doing your thing, they’re doing their thing,” she says. Over time, her experience has proven that the two basic reactions from strangers at the pool are born from either curiosity or admiration.

Jeff Cain, MD, another of Amputee Coalition’s medical advisors and a board member, is a bilateral below-knee amputee and fitness swimmer. He explains, only half-joking, that he deals with people’s stares by taking off his glasses. Like Skoski, his experience has shown him that while people may be curious, they don’t mean any harm, and most are supportive.

Cain and Skoski agree that body image poses the biggest barrier for amputees getting in the water. Aside from the mechanical challenges of getting into a pool or adjusting to new strokes, swimming in public pools can be intimidating. It’s one place where amputees can’t hide their limb loss from others if they feel self-conscious. The result is that many amputees don’t swim, and, sadly, don’t experience the benefits of a non-weight-bearing activity that can momentarily free them from a cumbersome prosthesis.


The 2007 Amputee Coalition National Conference offered its first-ever swim session to provide a safe environment for amputees to learn from each other about the joys and challenges of swimming. Cain and Skoski, along with Kellye Campbell, a former Medical Advisory Committee member, led the session with Fred Lamback, a representative of the U.S. Disabled Swimming team. The session showed that peer support was as much an outcome as practical fitness demonstration.

The general willingness of experienced swimmers to help other amputees impressed Skoski. “Every amputee who was comfortable with being in the water was going up to strangers and asking ‘Would you like some help?’” she notes. Campbell noticed that at least 10 amputees who were fitness swimmers came on their own accord to help with the packed session, but some amputees came just to watch. “I think that was a good sign. They were at least thinking about it,” she says. “They saw how other people managed and maybe talked to some of the coaches.”

Amputee Coalition members Jim and Deb Ramage attended the swim session and were excited to participate in their favorite form of exercise and encourage other amputees to go to their local pool. The couple met when they were scuba students, before Jim became a bilateral above-knee and belowknee amputee. Even though he had spent his life swimming and was previously a lifeguard in the Army, Deb recalls how difficult it was for him to get back in the water. “It took Jim two years to feel comfortable swimming in a public pool, but now we swim year-round,” she says. “Eventually, we felt that if others weren’t comfortable with seeing an amputee, it was their problem, not ours.”

Swim 04Non-amputee physical therapists also helped participants by lowering them into the water or pulling them out. Because not all pools have a graduated slope in the shallow end, upper-body strength is important when exiting the pool, especially for bilateral lower-extremity amputees. In fact, Campbell remembers that some people who came to watch had this concern. “They knew they could get in but they weren’t sure they could get out,” she says.

People who need one-on-one help of this kind might find it through physical therapy sessions that build upper-body strength. Many physical therapy centers have pools or people might find one-on-one training at a health club. For others, assistive devices like flotation belts and noodles may be all that are needed. Skoski’s advice is to be open and ask about resources. “People are happy to help,” she says.

Cain believes that amputees need to get out there and be as active in the world as they can be. “It’s helpful to have peers who understand the challenges, but in my experience, most amputees don’t have a large peer support group,” he says. However, if people are willing to look beyond support from other amputees, he thinks they will find it. “Many will find that their support group extends to the fitness community,” he says. “People who value fitness value it for its own sake, and they will be supportive of others who share that and are working beyond their physical challenges.”

Lamback stresses that swimming is an ideal fitness activity for everyone. “It uses all the major muscle groups, whereas most other activities use specific groups,” he says. To get the most benefit out of the activity, he advises that amputees always use the residual limb, if possible, whether it’s an arm or a leg. “The thought there is that some propulsion is better than no propulsion,” he says.

By scoping out facilities in advance and asking questions, amputees will be able to assess what will work best for them. For example, while Cain takes his prostheses off at the poolside, Skoski uses crutches to get to the pool. Some pools may offer a chair lift that a lifeguard can operate, making entering and exiting the pool much easier. Family locker rooms are also becoming more common for spouses or caretakers to help with changing or showering. In addition, there are creative ways to get better fits for bathing suits. Some hemi/ hip amputees may simply cover the leg hole of the suit with a piece of fabric, while other high above-knee amputees may opt for shorts over their suits. Each amputee may find his or her own strategy for comfort and convenience, but safety is always the most important consideration.

Amputees can minimize injury by using common sense and the following safety tips:

  • Never swim alone.
  • One-legged amputees should not hop. Hopping can not only lead to falls, but also can damage remaining knee and hip joints.
  • Protect a remaining foot with an aqua shoe to prevent scrapes and fungal infections. Sock liners can protect residual limbs from hard surfaces.
  • Use sunscreen, especially on residual limbs when swimming outdoors.
  • When using crutches near a pool, make sure tips won’t slide on slick surfaces. Consider wooden crutches when at the beach since sand and salt can corrode metal crutches.
  • Use assistive flotation devices as needed to create stability, balance and comfort in different depths of water.

“Swimming for Fun and Fitness” was one of the most popular sessions at the 2007 Amputee Coalition National Conference, showing a strong demand among amputees to learn swimming techniques, no matter how many years it has been since they entered a pool. The Ramages were thrilled to be able to help a participant swim for the first time in 30 years. “She had a huge grin on her face as I helped her hold onto a kick-board and move about,” says Deb. The Amputee Coalition hopes to help more people rediscover the joy of swimming by offering the swim session at future conferences, while using feedback from participants to make it better every year