Which Hand Should I Hold My Cane In?

Which Hand Should I Hold My Cane In?

If you are working with a client who is learning how to walk with a cane because of weakness/instability in one of their legs, it is adviseable to have them use the cane in the hand on the opposite side of their weaker or more "troublesome" leg.  

Although a cane is not to be used as a weight bearing device, as it is strictly for balance, holding the cane in the opposite hand will be more energy efficient for a client.  The reason is similar to the last post, which described the unilateral Farmer's Carry, a very useful exercise that strengthens the hip musculature particularly on the side opposite of the side carrying the weight.  

It all deals with Moment Arms, which are defined as the length between the axis of a joint (your hip in this example), and the line of force acting on that joint....kind of like a lever.  The line of force can be a weight, as in the Farmer's Carry, or a cane which provides a supportive force rather than a resistive force.   In terms of resistance, think about holding a weight with both hands at your chest.  Then hold that weight with your arms stretched out in front of you (lengthen the lever).  The longer the lever or moment arm, the more the resistance, and the harder the task feels.  On the other hand, when using an assistive device rather than a resistive device, the longer the lever (moment arm), the more assisted or easier the activity is.  

In regards to the Farmer's Carry, as described in the previous post, as a weight is carried in the left hand while walking, each time you stand on the right leg during gait, the right hip and trunk muscles have to work even harder to maintain stability due to the force applied by the weight on the opposite side.  If you carried the weight in the right hand instead, the right hip and trunk would not have to work as hard when in right single leg stance due to the shorter moment arm.  

In terms of a supportive device, holding the device (cane) in the hand further away from the weak joint will assist that joint in stability more than if the cane is held in the hand on the same side as the weaker leg.  This is because the Moment Arm is longer from the weak hip joint to the opposite hand than it is to the same side hand.  This is seen by the blue arrow on the picture below.  

Figure 1                                                          Figure 2

You can see that the Moment Arm is much shorter in figure 1 than it is in figure 2.  Holding the cane in the left hand provides more assistance to the right hip than it does to the left hip as a result.  Therefore, if you have trouble with your right hip and your balance is impaired because of it, try holding the cane in the left hand.  If the problem is your left hip, hold the cane in your right hand.  

This is also the reason why I progress my patients in the Single Leg Stance (SLS) activity described in the previous post from holding a support with 2 hands, to holding the support with the hand opposite the leg they are standing on, followed by SLS holding on with the same side hand, finally to SLS without holding onto a support.  When in SLS on the right leg, holding the kitchen counter with your left hand makes the task easier than holding the sink with the right hand.  

Keep these tips in  mind when training gait, balance, and hip stability.      

Single Leg Stance

Single Leg Stance

One common exercise prescribed by Physical Therapists as part of balance and gait training is the Single Leg Stance.  Upon performing this activity, patients usually ask why they are doing it. They can not make the connection between this exercise and its usefulness in daily function.  

If you want them to remember to perform this exercise consistently as part of their Home Exercise Program (HEP), you will have a better chance if you explain the functional value of it.  I usually explain to patients that in order for them to walk properly, they need to be able to maintain Single Leg Stance (SLS) on one side (Stance Phase) in order to swing the other leg forward (Swing Phase).  If you are not comfortable in Single Leg Stance, you will take shorter strides and may even shuffle. Although the patient may feel safer by minimizing time spent on one leg, the resultant shuffling poses a trip/fall risk.  This is why we focus on Single Leg Stance during our treatments.  

We break the task of walking down into its specific components, focusing on the parts that are most difficult for the patient.  Once they demonstrate improvement in each part, we bring it all together and have them perform the entire task...in this case, walking.  

When evaluating patients, a Physical Therapist may perform the Single Leg Stance (SLS) Test to assess the patient's risk of falling.  Click here for testing details.  

During training, due to patient apprehension to perform SLS, I will have them first practice by holding onto their kitchen sink with two hands.  I will then progress them as follows:

1)SLS on level surface, 2 hands holding sink

2)SLS on level surface, holding sink with the hand that is opposite the stance leg

3)SLS on level surface, holding sink with the hand on the same side as the stance leg

4)SLS on level surface without holding sink

You can also modify the SLS by having the patient turn their head left, right, up, down to challenge the inner ear and visual systems, which will further challenge their balance.  You can begin with the patient's eyes open, then try it with the eyes closed.  You can even modify the surface they are standing on by having them stand on a pillow or Balance Pad. 

If your patient is unable to perform the SLS without holding onto the sink, then have them continue to hold the sink, and place the focus on maintaining proper upright posture while in SLS.  Cue them to avoid sidebending, performing a Trendelenburg stance, or allowing one side of the pelvis to drop while in SLS. With this, they will still be training the hip muscles of the stance leg for strength and endurance, even though the are holding onto the sink for balance.  

Another activity that will train your patient's hip while in SLS is walking while holding a weight in the hand on the side opposite the hip you are trying to strengthen.  Check out one of the older posts here.....

Farmer's Walk: By holding the weight in the right hand, whenever you are in single leg stance on the left leg, you are challenging the left hip and trunk muscles.  The weight in the right hand is applying a downward force toward the right.  Your trunk is fighting the right sidebending force that holding the weight in the right hand is introducing to your body.  The right side of your pelvis wants to drop when you are swinging your right leg forward because the "column of support" (your right leg) is no longer planted on the ground.  Since the right side of your pelvis does not have support of your right leg, the only way to prevent the pelvis from dropping and to keep your pelvis level is to contract your left hip muscles while in left SLS.  Holding additional weight on your right side makes this even more difficult, as more force is directed down to the right.  This activity will strengthen your SLS hip muscles and should be performed alternately.  Walk while holding a weight in your right hand....then walk while holding the weight in your left hand.  The weight should not be too light...start with 10-15 pounds.