Part 2 of 5 in Your First Year with a Prosthesis, a series with Bethany Nelson, PT.
Pain, frustration, and what’s normal versus what’s not.
Adjusting to a prosthesis is not a straight path. Even when therapy is going well, many patients encounter periods of frustration as they adapt to the physical and practical realities of daily life with a prosthesis.
According to Bethany Nelson, these challenges are a normal part of the process. Understanding what to expect — and why these issues happen — can make them easier to manage.
Socket frustration
One of the most common frustrations for new prosthetic users is the socket. Many patients initially feel that the socket is too tight, but Bethany emphasises that a snug fit is actually necessary. “You want it as snug as a glove,” she explains. “The tighter it is, the more connected to your skeletal frame it is, and the more it feels like it’s a part of you.”
During the early months after amputation, the residual limb gradually shrinks as swelling decreases. This means the socket that once fit well may begin to feel loose. Patients then need to add prosthetic socks to maintain the correct fit, and over time the prosthetist may adjust the socket or create a new one.
While this process can feel repetitive and frustrating, it is part of reaching the definitive socket — the stage where limb volume stabilises and the prosthesis becomes more comfortable and predictable.
Low back pain
Low back pain is another common issue during early rehabilitation. This often happens because many amputees spend weeks using a wheelchair before receiving their prosthesis.
During that time, hip flexors tighten from prolonged sitting, while gluteal and core muscles weaken. When standing and walking begin again, the lower back may overcompensate for this weakness, leading to fatigue or pain.
This is why therapy programmes frequently include exercises that strengthen the core and glutes while stretching the hip flexors and lower back. These exercises help restore posture and improve walking endurance over time.
The gap between home and community mobility
Another challenge many amputees face is the difference between walking at home and walking in the community. Inside the home, distances are short and the environment is familiar. Public spaces such as grocery stores or shopping centres require longer walking distances and expose individuals to uneven surfaces and distractions.
Because of this, patients may feel confident at home but struggle when they begin walking outside. According to Bethany, this is a normal stage in the recovery process. Building endurance gradually and practising in different environments helps bridge this gap over time.
Socket-related pain: the 20-minute rule
After removing the prosthesis, it is normal to see some redness on the skin where the socket applied pressure. Bethany recommends a simple guideline: set a timer for twenty minutes after removing the prosthesis. If the redness disappears within that time, it is usually not a problem.
If the redness lasts longer than twenty minutes, it suggests that there may be too much pressure in that area and that the prosthetist should be contacted.
Redness on bony areas, such as the bottom of the tibia for below-knee amputees, should be addressed immediately, because these areas should not be receiving pressure from the socket.
Phantom pain
Phantom pain is the sensation of pain in a limb that is no longer present. It occurs because the brain continues sending signals to the missing limb and expecting feedback. For many amputees, phantom pain gradually decreases over time and may eventually become infrequent or disappear completely.
For those who continue to experience phantom pain, therapists may recommend techniques such as mirror therapy, massage, heat or ice, or transcutaneous electrical nerve stimulation.