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.      

Get A Jump Start On Your Recovery

Get A Jump Start On Your Recovery

The above is something that has become very common regarding health care coverage.  Many times, your medical insurance will not cover enough Physical Therapy treatment, or not enough local providers will accept your insurance.  Either way, you are left wondering if you will be able to return to your prior athletic or functional level.  That is where www.strengthondemand.com comes in.  

Exercises for common therapy diagnoses are offered in the Protocol section of our website, including protocols for the ankle, knee, hip, shoulder, elbow, neck and lower back.  There is also a protocol for people who are Homebound & Deconditioned, recently released from the hospital, and those who are having difficulty with balance, transfers, bed mobility and fall recovery.  All protocols are in video format based on time frames following your injury or surgery.  You are not only educated on what exercises to do, but you are also advised on when to perform the exercises in order to maximize your rehabilitation.  

KB Fitness Home Exercise Physical Therapy Protocols can be used alongside your present therapy treatment.  If you do not feel that you are receiving an adequate amount of Physical Therapy from your current provider due to insurance issues, or if you can not afford to attend therapy at all, KB Fitness Protocols can help! You are provided with printouts of each protocol's exercises so that you can consult with your doctor or therapist for further guidance. A Consultation Service is also offered to ensure that your questions are answered, further guiding your recovery.  

Let KB Fitness be your Knowledge Base!!

Benefits Of The Single Leg Deadlift

Benefits Of The Single Leg Deadlift

 

When performing the Single Leg Deadlift, in order to maximize the benefits you must perform the technique with proper form, especially upon fatigue.  I have used this exercise to train ankle and knee stability, hip stability and strength, balance, trunk rotational stability, grip and scapula control (to name a few). 

To begin the technique, place the kettlebell on the inside of the stance leg so that as you flex forward you can reach the handle with the opposite side's arm

While lowering your trunk down towards the kettlebell, you do not want to allow your trunk to rotate.  Keep your shoulders and hips 'square' with the floor.  The image directly above is incorrect, while the image below is correct

You want to maintain a straight line from your shoulder to your hip, knee and ankle.  This will help you with the hip hinge technique which protects your lower back

Lower your trunk while maintaining scapula retraction.  Keep your ears in line with your shoulders.  You lower your trunk until your hand reaches the kettlebell handle. 

 

Do Not allow your scapulae to protract or your trunk to rotate towards the kettlebell in order to "lengthen your arm" for you to more easily reach the handle.  You will need to work hard at this especially upon fatigue

Grip the handle, contract your glutes and scap retractors and return to stance

 

Finish the repetition in tall standing with glutes squeezed. Do not rush into the next repetition by not locking out in tall standing first

Rehab Devices That Make Life Easier

Rehab Devices That Make Life Easier:

Canes

During Physical Therapy assessments, patients and their family members ask me for advice on which type of device they should use to walk safely.  In regards to canes, the most common are the straight cane and the quad cane.

STRAIGHT CANE

QUAD CANE

The main differences between these two types of canes are that the Straight Cane is used mainly for people with balance deficits, while the Quad Cane assists with balance deficits and lower extremity weakness and instability.  The straight cane should only be prescribed to a patient who has slight balance deficit and needs just a little extra support (wider base of support) when walking.  The straight cane is not a weight bearing device, so if your patient or family member seems to be pressing heavily down on the cane when walking in order to safely navigate their environment, the straight cane is not the appropriate device.  

The Quad Cane is a weight bearing device.  Many people recovering from stroke present with one-sided weakness and benefit from this type of cane in order to prevent buckling of their knee.  The only con is that all four legs of the quad cane must be placed on the floor/ground at the same time in order to be safe.  You should not walk and place the back two legs on the ground, followed by the front two legs of the Quad Cane.  It is sometimes more difficult to coordinate this action, and many times patients will trip over the Quad Cane.  

Take home message: A straight cane is only for people with slight balance issues while a Quad Cane assists with balance and weight bearing (supports the weak leg).  

Allow Self-Corrections

Many times I will be performing balance training with a patient and he will lose his balance slightly, frequently falling backward.  As I am by his side, I am able to prevent him from falling.  But instead of preventing the fall and completely bringing him to his upright posture, I tell him to "fix it."  As I physically support him, I ask him to maneuver himself back to his stable upright position.  This forces him to use the ankle, hip, core musculature to regain his center of gravity over his base of support.  This is used as an exercise as well as a motor development skill.  If we can get him to regain his balance by synchronizing all the necessary muscles, we are hoping he will incorporate this same technique the next time he feels himself falling backward, thereby correcting it.  So my advice is: Let them make mistakes, be there to protect them and prevent injury, but allow them to attempt corrections on their own.   Let them figure out the solutions and this will enhance their motor planning abilities.

Small Adjustments Produce Big Changes

As a Physical Therapist, I treat many deconditioned patients in their home.  Most of these patients suffer from generalized weakness, balance deficits and difficulty walking.  Initially, depending on the extent of their weakness, I may start them with seated or supine (lying down on their back) exercises.  They then progress to standing exercises, usually holding onto their kitchen sink.  These exercises include heel raises, marching, squats, etc.  We use the sink because it is a stable surface that will not move while the patient holds onto it for balance.  Most of these patients have a fear of falling due to poor balance.  As time goes on, they begin to have less trouble with these standing sink exercises.  However, what is the true functional value of these exercises?  If your patient's goal is to walk without a cane or walker, they are definitiely not going to be walking while holding onto a sink, right?  So how do we get them ready to be independent with their daily activities?

One small adjustment to their position during your sessions will make a big change in their confidence, strength, balance and walking ability.  Have them step back away from the sink, into the middle of their kitchen, with nothing else at arm's reach except for you.  Make sure you remain close to them, but only place your hands on them to prevent a fall.  Now have them perform the same standing exercises that they did when they held onto the sink.  They will seem very cautious, almost fearful.  Progress slowly with this.  Perform only a few reps of each exercise.  This is a confidence building exercise as well as balance and strength building.  They will feel a much greater challenge due to the mental aspect.  The difference here is the risk or fear factor.  They no longer have their security blanket, the kitchen sink.  They must rely on their own abilities (as well as your ability not to let them get injured).  Once they accomplish these tasks over numerous sessions, you will see improvement in confidence, strength, balance and walking ability.  You will see that one minor change can have a very beneficial effect on your patient's progress.  Remember, you are not just training their body, you are also working on their mind.  Take away their "crutch" to get them to the next level.

Multi-Angle Deadlift

Simple exercise to set up, all you need is 4 cones and possibly a kettlebell (challenging with no weight also). 
Click below for the video
 
Tips to remember:
-HIP HINGE!!! Do not bend through the lower back segments
-Maintain body weight on the posterior aspect of your foot (heel)
-Keep your hip bones facing forward (minimal rotation)

Functional Values:
-Glute Recruitment for lower back stability
-Core engagement
-Single leg balance
-Ankle and knee stability
-Acceleration/Deceleration pattern for sports
-Kinesthesia for the lower body

http://www.youtube.com/watch?v=-ZO1ZUjyntU

Enjoy,

Nick