Using a Cane: What Dr. House Needs to Learn

... using a cane correctly is not as straightforward as it appears. Just check out Hugh Laurie on the popular show "House" -- he plays a doctor and even he can't get it right!
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What's to know? Seems like a no-brainer, right? Well, from what I see on TV, in many films and on the sidewalks around me, using a cane correctly is not as straightforward as it appears. Just check out Hugh Laurie on the popular show "House" -- he plays a doctor and even he can't get it right! This one's for you Dr. House ...

1. To Cane or Not to Cane, That is the Question?
If pain prohibits you from walking normally, you should use a cane or crutches to offset some weight and ease the pressure on whatever ails in your lower extremities. That means, if pain causes you to limp, consider assistance to help you walk with a more normal gait pattern. This will promote healing and prevent stresses to other areas, like your back or otherwise uninvolved areas of your lower body.

2. Cane or Crutches -- Which Should It Be?
If you are unable to put any weight on your foot, or were advised to avoid weight bearing through one ankle, knee or hip, crutches it is -- there is no other option. Advance the crutches and follow by swinging your legs through, putting weight only on your non-injured limb. As you progress to partial weight bearing, gradually increase the weight you put on your involved side as you continue to use two crutches. Though you are still putting less weight on your injured side, try to walk with a normal heel-toe gait as soon as you are able. Ditch one crutch when you can walk with the aid of just the other, or, you may opt to skip this step and go right to a cane if it provides sufficient relief.

2. Right or Left? It Makes a Difference!
This is where the entertainment industry almost always goes wrong. Whether you are using one crutch or a cane, hold it with the hand opposite the side of your injury. If that seems counter-intuitive, I will explain the rationale.

When we walk, we naturally swing our arms, swinging the right arm forward as we step with the left foot. It is this natural opposite arm-leg motion that you want to preserve when using a cane or one crutch. If you are stepping forward with your injured right foot, you will want to advance the cane in the left hand to allow your left hand and upper body to absorb some of your weight.

If a cane is held on the same side as your injury, you will walk robotically. Try it and you'll see what I mean! If you don't have an injury, walk without a cane and try swinging your right arm forward at the same time as you step with the right. Keep the pattern going as you step with the left. Feels strange, doesn't it? It is equally awkward and ineffective when using a cane or crutch.

3. Sizing It Up
One size does not fit all. Size your cane so that when your hand rests by your side, the very top of it rests approximately at your hip. Not sure where your hip is? Put your hand where you think it is and simply rotate your leg in and out; you will feel the prominence of the greater trochanter moving. Line the cane up with this spot. This is well below your waist, and about level with the top of the pubic area. If the cane is sized correctly, your elbow should be bent about 20 degrees when holding it. If the cane is too tall, it will force you to hike your shoulder up or lean the other way -- onto your injured side. Too short and you will have to bend your side toward the cane.

To size crutches, stand upright with the base of each crutch about two inches to the side of your feet and six inches in front of your feet. Most important is to allow a couple of fingers to fit comfortably between your armpit and the top of your crutches (1.5-3 inches). Provided you also avoid leaning on them, this will prevent excess pressure on the axillary nerve. As with a cane, when sized correctly, your hand should rest at your hip, with your elbow bent about 20 degrees.

For some reason, when hospitals and physicians dispense assistive devices, they sometimes do so without providing enough instruction. I would recommend working with a physical therapist to learn how to walk with crutches or a cane, as well as how to negotiate stairs safely. It is important to re-learn proper gait pattern in order to focus on achieving a return to your pre-injury level of function -- and to keep from establishing bad habits that might be tough to break. This will also aid in your overall recovery.

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