Proper Use of a Cane by Alan Ray
A single, normal human step doesn’t seem like it would be much of a load on feet and joints (ankles, knees, hips). In truth, every step brings a load of three times body weight. In my case, at 200 pounds, every step was a load of 600 pounds on a failed hip. I learned this from a fellow Belgian hippy (Deborah Page) who did body work and had access to medical texts. The information on loading comes on one orthopedic textbook chapter she sent before we had surgery.
Proper use of a cane will reduce the step-load by 60 per cent. In my case, that amounted to reducing the load by almost 400 pounds…per step. And this is the difference it can make. Before I started using a cane (two months before surgery), I was taking 300 mg a day of Celebrex. (The maximum recommended dose is 200 mg a day. The day I picked up the cane was the last day before surgery I ever took any medication for pain…not even an aspirin. But the critical issue is “proper” use of the cane. If you hold the cane in the hand on the side of the bad hip, you’ll only reduce the load by about 15%. That’s not usually enough to help. (Ignore what you may have seen on the TV show “House”, though I quite like the show.)
To get real benefit, you must hold the cane in the hand opposite the bad hip. (In my case, left hip/right hand).
These are the basics, as explained in the orthopedic textbook: Proper use of a cane transfers about 60 percent of the body weight through the horizontal midline of the pelvis...through the arm and lat muscle (the lat is sometimes called “the crutch muscle) on the other side. Indeed, in the weight room in the weeks before surgery, as I walked with the cane, the mirrors showed the muscle taking the load.) But achieving that weight transfer involves the right cane used with the proper technique.
Length is important. The text instructed that the cane should fit such that the handle falls comfortably into the palm of your right hand (if the left hip is the bad one), with the right arm comfortably relaxed at your side.
Step technique with a cane: Remember, a limp with a bad hip is the body’s intuitive way of reducing ground contact on the bad hip. The step becomes shorter, in part because a limp plants the foot flat minimizing loaded contact. Before long, we forget how to walk. As much as possible, try to maintain a natural length of step. Begin with your feet together and the cane at your side. As you step out with the damaged hip, swing the cane forward, matching foot fall (the heel should touch the ground first) on the bad side with the cane’s ground contact on the good side. (It may actually sound much more complex than it is.) With just a few steps of practice, you’ll develop a stepping rhythm. When that happens, you will quite likely notice the pain of walking significantly diminishes, if it doesn’t disappear entirely.
Because there’s a tendency to walk faster with a limp, there also can be a tendency to walk faster than normal with a cane. Before surgery, try to remember and use a natural walking pace.
There is another reason (if pain reduction weren’t enough) to use a cane to reduce the load on a damaged hip in the last few months before surgery. There’s a limited window within which resurfacing can be done with expectation of a high degree of success. It you are bone-on-bone, or nearly so, it’s possible to damage the hip by overloading it repetitively to a point at which the joint will be beyond resurfacing.
Additionally, retraining yourself to proper gait motion (as long a step as you normally would take, and planting the heel on the group first) before surgery…will make it easier and quicker to learn to walk again after surgery.
I will mention from time to time, as I do now, that what I say here is what I pass along. It’s what I think I’ve learned from people who were smart enough to make it clear to me.
Walkin’ in Straight Lines
LBHR 15Dec04 Dr. De Smet