Does using a cane really mean you are "crutched"?

"Oh no! I'm crippled now! I should have listened to the doctor and used a cane!" 65-year-old Grandma Wang was lying in bed, regretting. Since her student days, Grandma Wang has been an active participant in culture and sports, and her beautiful figure is indispensable in various occasions. But in recent years, she began to suffer from knee pain frequently. After visiting the hospital, she was diagnosed with bilateral knee joint degeneration. We suggested that she use a cane to assist walking as much as possible. "I'm not too old to walk. It's so troublesome to ask me to use a cane whenever I need something! If acquaintances see it, that would be crippled!" Grandma Wang, who has a strong character, refused without thinking. A week ago, an old friend who she hadn't seen for many years came to Chengdu from another place. She happily acted as a tour guide and accompanied him to visit all the scenic spots in the east, west, south and north, such as "Wuhou Temple", "Jinli", and "Panda Base". A week later, the old friend went home satisfied, but Grandma Wang, who had taken a break, "was crippled" because she couldn't even stand up because of the pain in her knees.

Cases like Grandma Wang's are common around us. The cause of the disease is knee degeneration. What is knee degeneration? In fact, it is the most common chronic, progressive joint disease among middle-aged and elderly people. It is also known as osteoarthritis, osteoarthritis, degenerative joint disease, proliferative arthritis, hypertrophic arthritis, senile arthritis, etc. The most common symptoms are joint pain and swelling, difficulty in movement, joint deformity, and noise when moving. Epidemiological surveys show that the incidence of knee osteoarthritis is 4%-13% worldwide, and the incidence rate in the elderly population over 60 years old can reach 28% [1]. The cause of the disease is that the articular surface cartilage of the knee joint degenerates and wears, resulting in uneven articular surface and changes in the load-bearing line, which causes irreversible degenerative changes in the joint and cartilage tissue. Since the wear and degeneration of the knee joint are irreversible, we can only find ways to reduce the wear of the knee joint and effectively alleviate the occurrence of degeneration. Studies [2-3] have found that controlling weight can reduce the load on the knee joint and relieve wear and tear, while the use of crutches can effectively transfer the load from the lower limbs to the upper limbs. Other studies [4] have shown that walking with crutches can be used as a means of exercise rehabilitation for degenerative knee joint disease. It can improve the abnormal gait of degenerative knee joint disease and delay further degeneration and wear of the joints. Its mechanism of action is likely related to the fact that the crutches share part of the limb weight, enhance the stability of the knee joint, and relieve the compensatory effect of the rectus femoris. Therefore, walking with crutches can be used as a muscle compensation method to maintain joint stability in patients with degenerative knee joint disease. Therefore, in order to effectively prevent and treat knee osteoarthritis caused by degenerative knee joint disease in the elderly, a small crutch (stick) can play a big role.

So how should we choose among the various crutches on the market?

For Grandma Wang in the case, we chose an ordinary T-shaped crutch for her. The ordinary T-shaped crutch is the most commonly used single-point crutch for patients with mild knee degeneration. In terms of appearance, it has a straight rod crutch and a curved rod crutch, as well as a telescopic crutch and a folding crutch for easy carrying. It is suitable for elderly people who have difficulty walking but are in good physical condition and have a good sense of balance.

For elderly people who are unsteady when walking and have poor grip, it is recommended to use a multi-point cane (such as a three-legged cane or a four-legged cane) with a larger support area and is safer. At the same time, multi-point canes are not easy to fall because of their strong bottom stability, and can also reduce the risk of elderly people falling when bending over to pick up things. However, it should be noted that four-legged canes are only suitable for flat surfaces. If you walk on uneven surfaces, someone must be there to guard you. If you are an elderly person with severe knee lesions or impaired balance, it is recommended to use safer elbow crutches, axillary crutches or four-legged walkers.

After choosing the type of crutch, let's look at how to choose the length of the crutch: keep the body upright, shoulders level, elbow flexed 30 degrees, wrist dorsiflexed 30 degrees, and measure the distance between the wrist skin line and the ground as the length of the crutch; or keep the body upright, shoulders level, and the height from the greater trochanter of the femur (the protrusion of the thigh joint) to the ground is the length of the crutch. If the elderly have a hunchback, the height of the crutch needs to be appropriately lowered to the height of the normal walking posture.

In addition, you need to pay attention to the following details when choosing a crutch: the crutch head should be comfortable to touch the ground and have an anti-slip pad; the handle should be made of cork or latex for easy grip; the weight of the crutch is recommended to be controlled within 250-350 grams.

Now that we have chosen the crutch, let’s talk about how to use it correctly.

01Crutch support point

It needs to be 15cm in front of the toes and 15cm on the outside.

02 Steps for walking with a cane (single knee lesion) (1) Before using a cane, you should prepare well, maintain a good attitude, and adjust the cane to an appropriate height;

(2) Hold the stick on the healthy side and put all your weight on the healthy leg.

(3) Move the crutch and the affected side forward an appropriate distance;

(4) Use crutches and the affected side to support the body and step out with the healthy leg;

(5) Before taking a step, place the crutches firmly on the ground and do not move them too far forward to prevent them from slipping.

03 Going up and down stairs with a cane When going up the stairs, the cane should be placed on the previous step, with the healthy side going up first, the center of gravity moving forward, and the affected side following; when going down the stairs, the cane should be placed on the next step, with the affected side going down first, and then the healthy side.

With our help, Granny Wang was soon able to travel again, but unlike before, she now remembered to bring her crutches every time she went out. In addition to using it to keep steady during daily walking, she also discovered many new uses for the crutches: she could use it to explore the surrounding environment when it rains and the road is slippery, and it could act as a "guard" when going up and down stairs or up and down slopes... She no longer felt that she was "crutched" with the crutches.