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View Full Version : T4-S1 with pelvic fixation - I'd like to be able to tie my own shoes!



mkatz
11-25-2014, 03:47 PM
I'm 67, 4+ months out of surgery, progressing fairly nicely in terms of energy, reduced pain, improved muscle strength... able to walk miles comfortably at a reasonable pace (5+ miles at 3.2mph on relatively flat grade, to be precise). My "major goals" include being able to tie my own shoes and clip my own toenails . (Having my wife clip my toenails makes me fear that she will amputate one of my toes in the process :) ) Given the extant of my fusion are my goals realistic? (when? ever?)

Before someone suggests relying upon slip-on shoes, I should remark that I find tie-on hiking shoes/boots to provide greater stability and security.

ksmom0611
11-25-2014, 04:14 PM
That's the surgery they are proposing for me. I know it's been a few months for you. How is your range of motion?

JenniferG
11-25-2014, 05:21 PM
Hi mkatz, I am fused T4 to S1 with pelvic fixation and am now 5.5 years out from surgery. I can assure you it gets easier. But tying shoelaces and cutting toenails is still difficult for me, but doable. It really takes a stretch. I buy shoes without shoelaces, in fact I buy shoes without backs in them because putting shoes on is still hard. I can do it but it's an effort. I can pick a pin off the floor, I swoop down and swoop it up, but holding myself in that position is difficult.

I know what you mean about having your partner clip your toenails. YEECCCHHHTTTTT! Haha!

I always think though, that in the scheme of things, this surgery has been amazing.

jackieg412
11-25-2014, 06:32 PM
As you continue on in the healing process it gets easier(but not easy) to tie shoes. I put my foot on my knee to tie the shoe but the bows are on the side not the top of the shoe. You have to be careful to not allow the strings to be too long, as you will step on them and untie them. Then you have to find a place to sit and tie them again. I still can't cut the toe nails straight. Sometimes I find laying on my back makes it easier to reach the feet. We just adapt to what is needed.

titaniumed
11-25-2014, 07:15 PM
Mark

It seems like you are doing well! It took me a year to get up to a mile.....

Wasn’t that fun? Back when we were kids we were all afraid of the Dentist.....Now its no problemo.....(smile face)

I started my gentle stretching at around the 7 or 8 month mark. I would simply lift one leg onto a stool about 28 inches high, and lean over and reach. It’s a slow process and should be done slowly since soft tissue injuries hurt like the dickens. I used a long 18”shoe horn for around 2 years.....

For toenails, I set my foot up on my desk and do the reach. It gets easier as the years pass....

For socks, I like the arm of a chair to set my heel onto to get the sock started. It’s not necessary, just easier.

I do tie shoelaces without any trouble at all now and have for around 5 years. It’s the ski boots that take patience!

Congratulations....

Ed

LindaRacine
11-25-2014, 09:01 PM
Like Jackie, I can only tie my shoes on the side. Even then, it's difficult. I'm pretty lost without my long handled shoehorn. I use it as both a shoehorn and as a dressing stick.

--Linda

mkatz
11-25-2014, 10:36 PM
KSMOM611: Mobility or, rather, flexibility is slowly and fairly steadily increasing. It is of course less than it was pre-surgically. With respect to mobility I can only remark that at this time I cannot envision scrambling up a rock formation :)

JenniferG: I never thought I would be afraid of my wife, but when she volunteers to cut my nailsI start to sweat :eek:

jackieg412: Bows on the side! My first thought at that image is the teasing I would get: "gee, dad, are you regressing now to your age 3 year old skills?"... yet, that is a compromise I could accept. Double knotting, something I used to do before surgery to eliminate the loose shoe-lace risk, would alleviate the excess length issue.

titaniumed: Thanks for all of your suggestions. I found the detailed descriptions helpful. (I also found our phone conversation of a few months back helpful.) I do most of my stretching in a warm water pool (e.g. "bicycling" my legs forward and backward...), starting (with my surgeon's "clearance") at about the beginning of month 4. I've recently started swimming (breast stroke) with the aid of a snorkel in an effort to start "restoring" some of the musculature in my back. (I wish you had not written "5 years" :( .)

LindaRacine: For "around town" I'm content to use "slip-on" shoes, for which I fortunately do not need a shoehorn. For hiking, I think the more stable tied hikers are desirable.

I think what all of you are advising me is to "have patience". I do, sort of. My response to people who ask me when I will know if my surgery has resulted in a successful fusion has been to respond: "at the autopsy". (Hopefully not soon.) Until then, I will enjoy (generally) pain free walking and a complete resolution of my GERD, "heartburn" and early satiety problems. (Now, I can eat like the proverbial pig without repercussions. Somehow, my weight has stabilized at 130 lbs.)

To avoid misleading, I do still experience post-surgical pain of varying severity. However, I now have no pain induced limits with respect to standing/walking.


Thanks, all for your responses. I realize that not all bides are alike, but the "trend" I read in your suggestions is encouraging.

mark

Irina
11-25-2014, 10:36 PM
Mark, have you tried elastic shoelaces? You can buy them on Amazon and they stay put, so no need to tie and retie. Cutting toenails is still difficult. I thought I would never be able to do it... it took me a year and a half to be able to cut it. Still prefer pedicures though.

susancook
11-25-2014, 11:13 PM
Mark, first of all, don't piss off your wife. Serve her with kindness and gentleness because....guess who will be trimming your toenails next week? ( Pedicures run about $25.00 and include a warm water soak, leg massage, and a woman who is a complete stranger who cuts your toenails.....and at least in my salon, mostly speaks Vietnamese. She is always kind to my toenails (which I like short) because she knows that I tip well. Just a thought.

I tie shoes like Ed described, putting my foot up on a chair and bending at the hips.

Patience....when you find it, tell me how to get some.

Susan

mkatz
11-25-2014, 11:31 PM
Irina,


Mark, have you tried elastic shoelaces? You can buy them on Amazon and they stay put, so no need to tie and retie. Cutting toenails is still difficult. I thought I would never be able to do it... it took me a year and a half to be able to cut it. Still prefer pedicures though.

The problem I have with the use of elastic laces is that as I place my foot into the shoe (low trail shoes in this case) I wind up pushing the "tongue" down. If I could reach and hold the tongue I wouldn't need the elastic laces! I read one suggestion (somewhere) that I use pliers to hold onto the "tongue": didn't work for me. :(

With respect to a "pedicure", i thought of that... and still think of that... but, I can's (yet) get past the image thing! ;)

LindaRacine
11-25-2014, 11:32 PM
Mark, have you tried elastic shoelaces? You can buy them on Amazon and they stay put, so no need to tie and retie. Cutting toenails is still difficult. I thought I would never be able to do it... it took me a year and a half to be able to cut it. Still prefer pedicures though.

Unfortunately, athletic shoes have tongues. Between the tongue and the laces, I find them to be a lot more work than they're worth.

mkatz
11-25-2014, 11:35 PM
Mark, first of all, don't piss off your wife. Serve her with kindness and gentleness because....guess who will be trimming your toenails next week? ( Pedicures run about $25.00 and include a warm water soak, leg massage, and a woman who is a complete stranger who cuts your toenails.....and at least in my salon, mostly speaks Vietnamese. She is always kind to my toenails (which I like short) because she knows that I tip well. Just a thought.

I tie shoes like Ed described, putting my foot up on a chair and bending at the hips.

Patience....when you find it, tell me how to get some.

Susan

Susan,

you wrote: "Pedicures run about $25.00 and include a warm water soak, leg massage, and a woman who is a complete stranger ..." Sounds kind of sexy to me! What background video is played during this introduction?

Irina
11-25-2014, 11:58 PM
Hey Mark, get past that image thing and get a pedicure. It's so relaxing! You don't have to color your toes unless you want it, hehe. I've seen men getting pedicures in my salon. Not often, but occasionally I see them and trust me, nobody cares!

Speaking of athletic shoes tongs and elastic shoelaces - it depends on a shoe. I have one pair of scetchers and the tong stays in place when I slide my foot in. Another pair (can not remember the brand) not so much - tong moves and elastic shoelaces are not helpful. I wore that first pair of scatchers with elastic laces all the time after the surgery.

susancook
11-26-2014, 12:01 AM
Susan,

you wrote: "Pedicures run about $25.00 and include a warm water soak, leg massage, and a woman who is a complete stranger ..." Sounds kind of sexy to me! What background video is played during this introduction?

Mark,

1) I promise not to show the delightful-wife-mother-of-your-children-cutter-of-your-toenails your comment....for a price.

2) What video would you like in the background?....remember that this forum has children that read our threads from the adolescent section, so keep it clean.

3) I will gladly share my container of "fire engine red" nail polish with you if you decide to go the pedicure route.

Susan, just a Rollin' along

Like Irina says, "get over it"

susancook
11-26-2014, 12:08 AM
Your previous comment: With respect to a "pedicure", i thought of that... and still think of that... but, I can's (yet) get past the image thing! ;)[/QUOTE]

Mark, Can't get past the image thing? Have it done in Hillsboro where nobody knows you. Or you can come with me and I promise not to point and laugh at you too often. ;@ ) hahahahahahahahaha

JenniferG
11-26-2014, 03:51 AM
"At my autopsy" I love it!

LindaRacine
11-26-2014, 11:14 AM
When I go for pedicures, I regularly see men getting one of their own. Many of these guys are young and fit, so one assumes that they're doing it because it's convenient and fun.

--Linda

Lizardacres
11-26-2014, 11:39 AM
Congratulations on your so far successful recovery! I haven't had surgery yet, upcoming in January, but I thought that bending and twisting was not allowed until you had achieved a solid fusion. What instructions did your surgeon give you as far as attempting things like tying shoelaces and clipping toenails? Are you allowed to work on doing these things now? I'm so worried I will be inadvertently doing more bending during recovery than is good for me.

susancook
11-26-2014, 12:20 PM
Liz, you are right: no bending at the waist. Bending at the hips is OK. You are totally right about thinking that you might do some bending and twisting that is inappropriate. I have tried to twist to see oncoming traffic at a ramp which comes in at an awkward angle in Portland. Immediate pain stops that activity quickly. Susan

mkatz
11-26-2014, 01:29 PM
Your previous comment: With respect to a "pedicure", i thought of that... and still think of that... but, I can's (yet) get past the image thing! ;)

Mark, Can't get past the image thing? Have it done in Hillsboro where nobody knows you. Or you can come with me and I promise not to point and laugh at you too often. ;@ ) hahahahahahahahaha[/QUOTE]

Actually, if the leg massage includes a foot massage, that part I know I would enjoy. I'm actually not that shy. Now, when it comes to the part of selecting the type of acrylic/polish I would have to say "none">

LindaRacine
11-26-2014, 04:03 PM
Congratulations on your so far successful recovery! I haven't had surgery yet, upcoming in January, but I thought that bending and twisting was not allowed until you had achieved a solid fusion. What instructions did your surgeon give you as far as attempting things like tying shoelaces and clipping toenails? Are you allowed to work on doing these things now? I'm so worried I will be inadvertently doing more bending during recovery than is good for me.

Hi...

You need to check with your surgeon for specific instructions. I think we generally tell patients to observe the No BLT (bending/lifting/twisting) restriction for 3 months. Fusion is not complete at that time, but it's usually got a decent start. When I had my original surgeries 20+ years ago, I was told no BLT for 5-6 months. The truth is that, as far as I know, no one has actually studied how long we're vulnerable.

Humans don't actually bend very much at the waist, so it's not as much of a problem as it might seem. When you're in a seated position, your torso and upper legs form a 90 degree angle. We tell patients not to break that 90 degrees. That means, when you're seated, you're not supposed to bend forward (which can be especially difficult when you're eating). I taught myself to bring food up to my mouth on plates or in bowls. And, I can tell you that those of us who didn't have to wear a postop brace probably broke that 90 degree rule at least some of the time.

Example of bending at hips (http://www.brigiddineen.com/wp-content/uploads/2011/02/Ardha_Uttanasana.jpg)

--Linda

Irina
11-26-2014, 05:46 PM
I didn't bend at all - not from the hips, not from the waste, etc for 6 months. I thought this is what UCSF told me, but may be I was too drugged up. Anyway, I decided better safe than sorry and no BLT for 6 months. I am an accountant and follow the rules to the t not just in my professional life, but eveywhere haha.

I brushed my teeth standing straight up with two cups or in the shower. Didn't attempt to tie any shoes or clip toenails for 6 months. Only used grabbers to pick things of the floor, no oven use (slow cooker instead). Might be an overkill, but it served me well, knock on the wood.

I would recommend people facing the surgery to start practicing things like log rolling ahead of time so that you get into a habbit of proper getting in and out of the bed without twisting.

Karen Ocker
12-01-2014, 10:46 AM
I'm 67, 4+ months out of surgery, progressing fairly nicely in terms of energy, reduced pain, improved muscle strength... able to walk miles comfortably at a reasonable pace (5+ miles at 3.2mph on relatively flat grade, to be precise). My "major goals" include being able to tie my own shoes and clip my own toenails . (Having my wife clip my toenails makes me fear that she will amputate one of my toes in the process :) ) Given the extant of my fusion are my goals realistic? (when? ever?)

Before someone suggests relying upon slip-on shoes, I should remark that I find tie-on hiking shoes/boots to provide greater stability and security.

In the earlier part of my long recovery my husband cut my toenails-along with the surrounding skin.
I now do everything myself. I just bring feet up to my chair or a slightly lower table in front of me. The only thing I might need help with are high-laced hiking boots-the side hooks.

mkatz
12-01-2014, 12:27 PM
In the earlier part of my long recovery my husband cut my toenails-along with the surrounding skin.
I now do everything myself. I just bring feet up to my chair or a slightly lower table in front of me. The only thing I might need helpI with are high-laced hiking boots-the side hooks.

Interesting: You are able to reach your toenails using a clipper but are not able to reach the lower part of your ankle? I was thinking that tying higher ("mid" hikers, for example) would be easier than tying low hikers.

Karen Ocker
12-01-2014, 03:50 PM
Interesting: You are able to reach your toenails using a clipper but are not able to reach the lower part of your ankle? I was thinking that tying higher ("mid" hikers, for example) would be easier than tying low hikers.

The reason for that is, once the foot is in the boot, there is less flexibility in the ankle and then I need to twist a little- not a good idea-to work the lace around the 3 or 4 terminal hooks.

mkatz
12-01-2014, 09:52 PM
The reason for that is, once the foot is in the boot, there is less flexibility in the ankle and then I need to twist a little- not a good idea-to work the lace around the 3 or 4 terminal hooks.

Good explanation! I wonder if I could locate hiking boots that are designed to be tightened/adjusted with laces and the opened/closed with a side zipper? Gotta do an online search. One of my friends told me that the military (Vietnam war era) retrofitted jungle boots in that fashion to allow rapid donning of boots.


______ Just did a Google search and found several medial-side zippered boots that might be suitable: with laces and zipper (for easy entry/exit)!

titaniumed
12-01-2014, 09:55 PM
Mark, be patient it will come.....I waited till I was around 7-8 months before even attempting any stretching or pulling down.

Here are some photos of me bending so you can see the positions....also tying shoes with chair and without.

Ed

titaniumed
12-01-2014, 10:00 PM
And some more.....Of all these photos, I started perfecting Squat 1 first at the kitchen counter unloading dishes from my dishwasher right after surgery. Always keep spine erect.....The penny is there because with rising medical insurance rates, older males being in the most expensive group and have to learn to pick up pennies.....(That's no joke)

mkatz
12-01-2014, 10:31 PM
Mark, be patient it will come.....I waited till I was around 7-8 months before even attempting any stretching or pulling down.

Here are some photos of me bending so you can see the positions....also tying shoes with chair and without.

Ed

Ed, Thank you!! pictures were very helpful. Note that I am jealous of your flexibility :).

With respect to having patience, that is great advice but is difficult for me to implement. The key problem with me being patient is that I believe there is, realistically, no way of determining if a firm fusion has been effected, short of the onset of critical (obvious) failure or autopsy. Radiographic evaluation will reveal the presence of bony deficiencies but does not clearly distinguish between formed bone and un-resorbed graft material. (I'm a retire periodontist with lots of experience doing bone grafts.) Thus, until I am able to test function aggressively (in 6-12 months additional time post-op?) I worry about the possibility that when that test occurs it will reveal failure.

No, I do not spend all of my time worrying, but periodically it does break through.

Meanwhile, I've progressed to working on my flexibility (waist down) in a warm water pool, working aggressively (wall-sitting, treadmill on incline,...)on lower body, cardiac and core strength, and (recently) starting light weight arm exercises.

LindaRacine
12-01-2014, 10:32 PM
And some more.....Of all these photos, I started perfecting Squat 1 first at the kitchen counter unloading dishes from my dishwasher right after surgery. Always keep spine erect.....The penny is there because with rising medical insurance rates, older males being in the most expensive group and have to learn to pick up pennies.....(That's no joke)

Ed... You're able to hook a sock over your foot with one hand? That's definitely a feat (or feet, haha).

titaniumed
12-02-2014, 12:03 AM
Ed, Thank you!! pictures were very helpful. Note that I am jealous of your flexibility :)

Me? I never ever thought I would hear these words......Wow, I’m blown away! LOL

Ahhh, the test of all tests.....

My surgeries were extremely painful and had a lot of bone ground out in ALIF partial corpectomy procedures on all my lumbar levels. All the end plates were shot from DDD. Anyway, after all that, I walked on eggshells for a really long time and was also worried. My surgeon told me that I was fused at 6 months but I was still worried. At 10 months in the Redwoods National Park of Northern California, I tripped over a 3 ft rock in the campground at 10PM in the dark and did a hard face plant. I thought that was it. What a slam! My shins were bleeding, but I got up and things were fine with the spine.....That’s when I knew, that’s how I found out I was good to go. The test of all tests. I have also had a few low speed ski crashes that scared the heck out of me, and now I have permission to lift 100#. I have lifted around 80#......yes, I would say I’m fused. I resumed snow skiing at 14 months....

I also had a broken shoulder at that time from a ski crash 10 days before my scoliosis surgeries, and my gall bladder was acting up so that had a tendency to slow things down. I eventually had to have it yanked since they found these 30mm golf balls in there.....It is a rare scoliosis surgery complication per Dr Moe’s handbook, I believe written by Dr Hu around 30 years ago.

Another thing to consider is that IF something were to happen, these surgeons don’t like going back in until a year is up. I thought I had an incisional hernia and was sent over to my vascular surgeon and he told me that there was no way he was going back in so soon...

My surgeon did have to order me to go skiing after a year. Doctors orders you know? LOL No velocity, of course....and well....no more jumps.

But I’m glad that I took it easy, especially for the first 6 months.....

I have to add that when I did my shoulder surgery PT at 8 months, the arm bike was very helpful in “toughening” up the paraspinal’s that run over the screw heads and rods in the thoracic spine. This 4” wide area is a delicate area in all of us that have full fusions, we get this gripping feeling which I call the “bear traps” that happens mostly upon approaching storms. I think it’s a low pressure thing, nerve cell expansion theory.....Usually during winter storms so cold affects it. The strange feelings of muscle imbalance in this area we do have to get used to and the arm bike helps.

Ed

mkatz
12-02-2014, 03:09 PM
Me? I never ever thought I would hear these words......Wow, I’m blown away! LOL

Ahhh, the test of all tests.....

My surgeries were extremely painful and had a lot of bone ground out in ALIF partial corpectomy procedures on all my lumbar levels. All the end plates were shot from DDD. Anyway, after all that, I walked on eggshells for a really long time and was also worried. My surgeon told me that I was fused at 6 months but I was still worried. At 10 months in the Redwoods National Park of Northern California, I tripped over a 3 ft rock in the campground at 10PM in the dark and did a hard face plant. I thought that was it. What a slam! My shins were bleeding, but I got up and things were fine with the spine.....That’s when I knew, that’s how I found out I was good to go. a we do have to get used to and the arm bike helps.

Ed

So, you're advising me to wait another 3 1/2 months and then deliberately fall? :) Sounds like a good idea (?) that would measurably Improve my confidence... if I were able to get up and hike home after the event.

Seriously, your comment/posts I appreciate. Surprisingly, to me, (as I do not participate in many forums) I've found reassurance in reading threads in the forum. Actually I have pretty high expectations for a successful outcome, but must still heed Susan's advice that "something always goes wrong". I must also keep in mind the fact that as we age we tend to grow less flexible (mentally as well as physically).

Thanks, again, Ed et al

Lizardacres
12-02-2014, 07:38 PM
Ed, I too have found your pics inspiring, but what I really want to know is how you put on underwear post surgery without bending or breaking any rules. I was thinking about that when getting dressed today. Pictures for this are optional.

titaniumed
12-02-2014, 09:54 PM
I've found reassurance in reading threads in the forum. Actually I have pretty high expectations for a successful outcome, but must still heed Susan's advice that "something always goes wrong".
I was guaranteed 100% that something would go wrong.....which was the way my surgeon conveyed the complexity of my situation. He told me that “it would help”, which in the end helped with my decision.....anything was better than the agony I was going through. I was also told I could go blind. Anyway, most of us do well, we just have to have that positive attitude and if things get a little rough, we cant quit.

Confidence is built up slowly in time. My second year of my recovery was a hard year for me with skiing. My skiing muscles were extremely weak, and couldn’t handle the G forces....If it wasn’t for my skiing buddies not accepting any excuses for not skiing, I might have quit. They would come over here and bang on my door in the morning. All half my age, I guess I was their skiing mentor.... It was really something when they actually waited for me at the bottom at the lift line and helped put my ski boots on. I cant ski like I used to and I have accepted it......I guess you have to slowdown at some point.

Its great to have a Doctor posting here, I am glad that you appreciate my testimonials, they are an accurate account of my scoliosis recovery and experience. Its something that is of value for the scoliosis community....

Don’t be a stranger....

Liz
To answer your question about underwear, here is my video response for the evening. We all remember Bill Clinton answer the “Boxer or brief’s” question in 92. He he
http://www.mtv.com/videos/misc/133280/vintage-mtv-bill-clintons-briefs.jhtml

Select loose fitting clothing, larger sizes, elastic waistbands and you wont have to bend at all.

Ed

mkatz
12-02-2014, 10:45 PM
Ed, I too have found your pics inspiring, but what I really want to know is how you put on underwear post surgery without bending or breaking any rules. I was thinking about that when getting dressed today. Pictures for this are optional.

also, for underwear (for your lower half)... use a "grabber". I found, and still find, this one to be very helpful: Ettore 49016 Grip 'n Grab Reach Tool, 16-Inch, purchased through amazon.com. Also helpful, at least initially, is the longer version of this grabber.

Irina
12-02-2014, 11:39 PM
Liz,

They will teach you in a hospital how to put underwear, pants and socks on. You will be using a grabber and a sock aid. They will give you these tools in the hospital, but you can look up sock aid on Amazon if you are curious what it is.

LindaRacine
12-02-2014, 11:50 PM
Hi Irina...

Unfortunately, insurance companies are no longer paying for the grabbers and dressing aids, so I think most hospitals have stopped providing them.

--Linda

susancook
12-03-2014, 02:26 PM
also, for underwear (for your lower half)... use a "grabber". I found, and still find, this one to be very helpful: Ettore 49016 Grip 'n Grab Reach Tool, 16-Inch, purchased through amazon.com. Also helpful, at least initially, is the longer version of this grabber.

Mark, so kindly brought one of these grabbers to me as a gift in the rehab hospital. I really like it and recommend it. Thanks Mark! Susan

mkatz
12-03-2014, 02:32 PM
Mark, so kindly brought one of these grabbers to me as a gift in the rehab hospital. I really like it and recommend it. Thanks Mark! Susan

I just wish you did not need it.

susancook
12-03-2014, 02:52 PM
I just wish you did not need it.

Having to use a grabber is so-so-so minor compared to the rest of problems that I face. I hope to recycle it to someone else in the future. Your visit at rehab was so awesome for me. You are such an inspiration for me and keep up the great work on getting back to enjoying your retirement.
Susan.....enjoying margaritas south of the border

Lizardacres
12-03-2014, 05:32 PM
Susan, I am so glad you are taking a much needed vacation and enjoying yourself; you sound so relaxed!

Those grabbers look nice - I'm going to order one, thanks for the recommendation. Also, a Gerontology acquaintance told me to go to the Active Forever website to pick up any dressing tools I needed. They have a 7-piece Hip Kit which includes all the gadgets mentioned above plus four pairs of elastic shoelaces for only $32.99. The grabber they include probably isn't as nice as the one listed above but I figure I'll need more than one. They look they can also double as a cat torture device so I will need to keep them away from my husband.

Lizardacres
12-03-2014, 05:45 PM
Also, I wanted to mention my favorite stretching exercise for the back of the legs. Find a long belt, a karate belt is perfect. Lie on your back on your yoga mat and with one knee bent, lift it toward your chest so you can grab your foot with the looped belt. Hold one end of the belt in each hand. Now slowly straighten out your leg, while pulling your leg into as vertical a position as you can manage. The height is not important, everybody is different. Push your straight leg on the ground into the mat while using the belt to pull your other leg into a more vertical position. Since you are lying down, you don't need to be worried about bending your back.