TV can sometimes be your tutor, especially if you follow reruns of FOX TV’s popular medical drama, “House.” Dr. Gregory House, the title character played by Hugh Laurie, uses a cane, but the wrong way. Instead of putting it in the hand on his good side, he uses it on his bad side. Sometimes there’s a reason for that. “We may have to break the traditional rules and do what’s best to mobilize the patient,” says Sharon Funk, PT, DPT, University of Colorado Denver Hemophilia and Thrombosis Center. “If you have a bad elbow or shoulder, you may not be able to use a cane on that side.”
Although life sometimes imitates art, when it comes to using a walking aid, such as crutches, a walker or a cane, your best bet to is seek the expert staff at your hemophilia treatment center (HTC). They can literally walk you through the proper procedure. It’s good to know when a walking aid is called for and how to use it.
Walking aids 101
Walking aids serve a variety of purposes, helping you get around after surgery and when dealing with a joint bleed. They provide stability and balance when your endurance and coordination are compromised. Further, they decrease the stress on a painful joint or limb. They also help you safely navigate your home, school or workplace.
Follow a few rules of thumb when using a walking aid. Wear shoes with rubber or nonskid soles, and avoid heels. Look straight ahead of you, not at your feet. Eliminate potential tripping or slipping hazards in your home or workplace, such as throw rugs, dangling cords and spilled food or drinks. Don’t use your staircases to stow boxes, laundry or other items that could get in your way.
If you’re ambulating with crutches or a walker, don’t wedge items in your hands or under your armpits. Instead, try using a small backpack or fanny pack. Lastly, replace worn or cracked rubber tips on the bottom of your cane, crutches or walker legs. If you live in a cold climate, winterize your walking aid with ice tips, which you can purchase at your local drugstore.
Crutches are called for after some types of limb and joint surgeries, and if you can’t bear weight on your foot or leg. But watching a teenager whip around the mall on crutches may give you a false sense of security. Any adult who has tried crutches knows just how exhausting they can be. Not to mention how awkward and clumsy they make you feel. “They require good balance,” says Funk. They also require upper limb strength. “People get very sore in their upper bodies because they’re not used to bearing their whole body weight on their arms.” If you already have decreased range of motion in your joints, using crutches can be tough. That’s why it’s important to use them the right way and take breaks as needed.
If you borrow a set of crutches from a friend or rent them from your pharmacy, adjust them for your body size. While standing on level ground, the top of the crutches should hit about 1-2 inches below your armpit. You should be able to place two finger widths in the space. With your arms at your sides, the hand grips should be even with the crease in your wrists. Here’s the clincher: rest your weight on your hands, not your armpits, when crutching. Otherwise, you could damage nerves and blood vessels in your armpits.
Your elbows should be slightly bent when you hold them. “You want to have a little bit of flexion in the elbow, 5 to 10 degrees max,” says Funk. That way when you push down on the crutch hand grips, you can extend your elbow, she adds. If you have limited elbow extension, your PT can modify your crutches or walker to provide a platform to rest your forearm, Funk says. “This takes some of the stress off the elbow.”
Getting a move on with crutches take a little forethought. Lean slightly forward and place the tips of the crutches about 1 foot in front of you, forming a tripod. Stand on your good foot and swing your injured leg forward. Then bring your body forward slowly between the crutches, with your good leg following through. The rubber tips should be flat on the ground as you move through the motion.
When you need to rest, find a chair with arms. Back up to it, until you feel the edge of the chair against the back of your legs. Extend your injured leg out in front of you and place both crutches in the hand on that side. Use the other hand to feel behind you for the chair’s arm rest. Then lower your body slowly into the chair, keeping your good leg bent. Place the crutches on the floor, leaning them on the handles, not the tips, so they don’t slide or fall down.
To stand up, scooch to the front of the chair. Put both crutches in the hand on your good side. Then push up and stand on your good leg. Coordinating crutches on stairs can be tricky, so ask your physical therapist if you should even attempt them.
Although less common and more expensive, Canadian crutches, which come up to the forearms, may be preferable at times. “If you’re going to have to be on crutches for a really long time, Canadian crutches are easier to get in and out of places,” Funk says.
Walkers offer more stability than do canes or crutches. “Depending on the person’s age or how bad their balance might be, the walker is more stable,” says Funk. A walker might be needed after total ankle, knee or hip replacement surgery. By propelling yourself with your arms, the walker keeps some or all of the weight off your lower body as you walk.
Make sure your walker fits you. While standing straight with your arms at your sides, the top of the walker should reach the crease of your wrists. Your elbows should be slightly bent when grasping the handgrips, and your back should be straight, not hunched. Inspect the legs’ rubber tips to make sure they’re in good working condition.
To ambulate with a walker, place it one step ahead of you, with all four legs firmly on the ground. Hold the handgrips and move your injured leg into the middle area, but don’t step all the way to the front. Push down on the handgrips and move your good leg. Try to take small steps and turn slowly. Never use a walker on a moving escalator or while climbing stairs, warns AAOS.
Placing tennis balls on the front legs of a standard walker turns it into a semi-rolling walker, says Funk. “This sometimes allows for easier control by an older person or someone with balance issues.” The modified walker slides more easily, but doesn’t get out of control as easily as a rolling walker, she adds.
For people with bleeding disorders, canes are transition walking aids. They’re for patients who are ready to graduate from crutches, a walker or wheelchair. “As they’re getting better and I want them to bear some weight, I’ll have them use a cane,” says Funk.
Canes have come a long way since Fred Astaire’s tap dancing days. Several shapes and styles meet different needs. The C, or crook, cane is the classic style. “It’s fine for someone who’s strictly using it for balance,” says Funk. The offset, or functional support, cane has a straight handle, which is easy to hold. “It is going to give you a better grip if you have a somewhat challenged elbow or wrist,” Funk says. The Arthritis Foundation recommends it for those with arthritis in their hands and wrists. The quad cane has four prongs on the bottom, providing stability and helping improve balance. “With hemophilia, it could be used by someone who is young who has a lot of joint disease,” says Funk.
Cane heights can be adjusted, so measure yours properly. With your arm hanging at your side, the top of the cane should reach the crease in your wrist. When walking with a cane, your elbow should be bent at a 15-20 degree angle. According to the American Academy of Othopaedic Surgeons (AAOS), place the cane on your good side one stride ahead of you. Then step off on your injured leg, followed by your good leg.
Curbs and stairs may look like a challenge, but with practice, you can manage them confidently. “Up with the good, down with the bad” is an easy way to remember which leg goes first. Step up on the curb or stair with your good leg, then bring your injured leg and the cane up next. When going down, move the cane down to the stair or street below you. Then step down with the injured leg and bring your good leg down last. Always grasp the banister or railing with your free hand when using a cane on stairs.
Turns out, scooters are not just for kids. Knee scooters, or knee walkers, are often recommended for patients after foot surgery or injury to the lower leg, ankle or foot. Typically, they have four wheels, a padded seat where you rest your injured leg and handles with grips. Some models have a basket for carrying things. With your good leg, you push off, while your bad leg glides along next to you. Scooters leave your hands free to do other things.
Getting a proper fit is important. While standing, your good leg should be straight and your injured leg should be bent, resting comfortably on the cushioned seat. “It has to be at the right height for that person’s femur and you want to keep the hips level,” Funk says. Make sure to adjust not only the seat height but also the handles. You should be able to grip the handles without leaning.
A knee scooter has several advantages. It won’t tax your shoulders, arms or hands. And it doesn’t require the kind of coordination you need to master crutches. Further, it helps prevent some of the muscle atrophy that occurs on crutches. “It’s going to keep your muscle strength up in your hip much better because you can shift your weight over the hip,” says Funk. Plus, the hip and trunk are in better alignment, she adds.
Outside, knee scooters work well on pavement and sidewalks; some also move smoothly on grass and gravel. They fold up, so you can pop them in the car. But they do have limitations. They’re not for people who with hip and/or knee problems, cautions Funk. They can be heavy to carry and should not be used on stairs. Further, they are more expensive to rent or buy.
Mobility stepping stones
How long you’ll need a walking aid depends on the cause. “For ankle fusion, patients will be non-weight bearing for up to several months,” Funk says. For an acute bleed, though, it could be only a day or two. “But if they wait until it’s a really bad bleed it could be a week or more,” says Funk.
Think of a walking aid as your stepping stone to mobility. “People should not hesitate to use them when they need them,” Funk says. But don’t go it alone, ask your HTC for help. “The more involved your joints or your balance, the more careful you’ll have to be about what you use and that it’s fitted properly.”