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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.
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.
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.
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Figure 1 Figure 2
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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.
