Body weight support through a walking cane in inexperienced users with knee osteoarthritis (2023)

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  • Cited by (3)
  • Recommended articles (6)

Volume 67,

January 2019

, Pages 50-56

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Abstract

Background

Walking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading.

Research question

1) How much body weight support do people with knee OA place through a cane? 2) Do measures of body weight support increase following a brief simple training session?

Methods

Seventeen individuals with knee pain who had not used a walking cane before were recruited. A standard-grip aluminum cane was then used for 1 week with limited manufacturer instructions. Following this, participants were evaluated using an instrumented force-measuring cane to assess body weight support (% total body weight) through the cane. Force data were recorded during a 430-metre walk undertaken twice; once before 10 min of cane training administered by a physiotherapist, and once immediately after training. Measures of BWS (peak force, average force, impulse equal to the average cane force times duration, and cane-ground contact duration) were extracted. Using bathroom scales, training aimed to take at least 10% body weight support through the cane.

Results

Before training, the average peak BWS was 7.2 ± 2.5% of total body weight. Following 10 min of training, there was a significant increase in average peak BWS by 28%, average BWS by 25%, and BWS impulse by 54% (p < 0.05). However, individual BWS responses to training were variable. Duration of cane placement increased by 22% after training (p = 0.02). Timing of peak BWS through the cane occurred at 51% of contact phase before training, and at 53% after training (p = 0.05).

(Video) Using a walking stick or cane for osteoarthritis in the knee or hip

Introduction

Knee osteoarthritis (OA) affects 24% of the population and can be extremely limiting [1]. Walking canes are a self-management strategy recommended for knee OA by several key clinical practice guidelines [[2], [3], [4]]. In addition to providing symptomatic relief [5], use of a walking cane following instruction has been shown to reduce surrogate measures of knee joint loading [6,7]. The extent of total body-weight support (BWS) transferred through the cane relates to the magnitude of reduction in measures of knee joint loading. Thus, ensuring adequate BWS is taken through the cane is an important consideration for people with knee OA when using this treatment strategy.

The knee adduction moment (KAM) is an external surrogate measure of knee joint loading [5,[8], [9], [10], [11]], reflecting the distribution of load between the medial and lateral tibiofemoral compartments [12]. Reducing the KAM is often the target of interventions in knee OA [13,14] as both peak KAM and KAM impulse have been associated with structural degeneration [[15], [16], [17]]. Previous studies have demonstrated that walking cane use in people with knee OA can reduce the peak KAM by up to 16.7% and the KAM impulse by up to 32% [7]. The KAM-reducing effect of a cane has been demonstrated to be proportional to the amount of body weight support transferred onto the cane [7]. Thus, it is reasonable to infer that increasing BWS transferred through the cane during walking will better reduce medial knee joint loads. In people with knee OA who had on average 13 years of cane experience, BWS of 9% of total body weight was reported prior to training [6]. However, BWS transferred through a walking cane remains unknown in people with knee OA who are inexperienced cane users. We suggest that BWS of 10% is a reasonable target that has been previously demonstrated as feasible for participants to achieve, and one that significantly decreased the KAM [7].

Timing of BWS during stance also warrants consideration in walking cane use. The cane typically first touches the ground around foot contact, and the peak in BWS through a cane occurs on average at around 60% of the stance phase [7]. However, this does not coincide with the timing of either of the two peaks in the KAM - typically the first and largest peak occurs at around 26% of stance while the second, generally smaller peak occurs at 78% of stance [7]. Thus, teaching people to transfer BWS through the cane earlier may be more effective in reducing the largest KAM peak.

Cane advice and training by clinicians is variable. It is our experience that more detailed training including timing of BWS and the amount of BWS is less likely to be given by clinicians. Therefore, the primary aims of this study were to: i) describe measures of BWS (peak, average, impulse, time of peak BWS relative to cane-ground contact duration, and duration of BWS) through a cane in people with knee OA without training and ii) test the hypothesis that measures of BWS (peak, average and impulse) would increase following a brief training session conducted by a physiotherapist. Secondary aims were to determine if time of peak BWS occurred earlier in cane-ground contact following training and if the duration of cane contact increased following training.

Section snippets

Methods

An observational study design was used to investigate how people used a walking cane and a pre-post study design was used to investigate the immediate effect of a brief training session. This study was approved by the Human Research Ethics Committee and participants provided written informed consent.

Results

Seventeen people participated in this study. The cohort had a mean age of 63.5 years and most were female (76%). Overall, participants had mild-to-moderate symptoms and the majority (94%) had bilateral knee pain (Table 1). Participants used the cane on average 3.5 h per day (range 30 min. to 12 h) during the week before training. Ninety-four percent (16/17) had their cane set to the incorrect height, as inspected visually before training. Specifically, the criteria to determine this were

Discussion

Our study aimed to describe peak BWS transferred through a cane in people with knee OA before training and to determine if measures of BWS improved following a brief, simple cane technique training session. We found an average peak BWS of 7.2% total body weight before training. Overall, 10 min of training increased measures of BWS and increased duration of cane contact with the ground. However, inspection of individual participant data suggests that only 29% (n = 5) of individuals in the study

Conclusion

The results have shown that without training, cane users are offloading a mean of 7.2% of their total body weight during walking. A brief and simple training session by a physiotherapist increased body weight offloading immediately after training by on average 2.1% of total body weight. Further research is needed to determine the clinical implications of such an improvement and if a longer session, more frequent training sessions or the use of more sophisticated biofeedback result in a greater

Author contributions

JH, MH, TW, KLB conceived the idea for the paper. JH, CM and TW contributed to data acquisition. JH, MH and TW performed data and statistical analysis. JH and MH wrote the first draft of the article. All authors provided scientific input and revised the paper. All authors approved the final version of the manuscript.

Conflict of interest

None to declare.

Acknowledgements

This study was supported by funding from the National Health & Medical Research Council (Program Grant #1091302). MH is supported by a Sir Randal Heymanson Research Fellowship from The University of Melbourne. KLB is supported by a NHMRC Principal Research Fellowship (APP1058440).

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  • M. Simic et al.Contralateral cane use and knee joint load in people with medial knee osteoarthritis: the effect of varying body weight support

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  • T.E. McAlindon et al.OARSI guidelines for the non-surgical management of knee osteoarthritis

    (Video) How To Use A Cane With A Bad Knee

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  • D. Pereira et al.The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review

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  • L. Fernandes et al.

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  • A. Jones et al.

    Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial

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  • R.L. Routson et al.

    A smart cane with vibrotactile biofeedback improves cane loading for people with knee osteoarthritis

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  • M. Simic et al.

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  • Cited by (3)

    • A novel walking cane with haptic biofeedback reduces knee adduction moment in the osteoarthritic knee

      2021, Journal of Biomechanics

      Knee osteoarthritis is a leading cause of ambulatory disability in adults. The most prescribed mobility aid, the walking cane, is often underloaded and therefore fails to reduce knee joint loading and provide symptomatic relief. For this study, a novel walking cane with haptic biofeedback was designed to improve cane loading and reduce the knee adduction moment (KAM).

      To determine; 1) the short-term efficacy of a novel walking cane using haptic biofeedback to encourage proper cane loading and 2) the effects of the novel cane on KAM.

      Cane loading and KAM, peak knee adduction moment (PKAM), and knee adduction angular impulse (KAAI)) while walking were calculated under five conditions: 1) naïve, 2A) after scale training (apply 20%BW to cane while standing, using a beam scale), 2B) scale recall (attempt to load the cane to 20%BW), 3A) after haptic training (vibrotactile biofeedback delivered when target cane load achieved), and 3B) haptic recall (attempt to load the cane to 20%BW with vibrotactile biofeedback delivered). Compared to the naïve condition all interventions significantly increased cane loading and reduced PKAM and KAAI. No differences between haptic recall and scale recall condition were observed.

      The haptic biofeedback cane was shown to be an effective and simple way to increase cane loading and reduced knee loading. Haptic biofeedback and scale training were equally effective at producing immediate short-term improvements in cane loading and knee loading. Future studies should examine the long-term effects of scale training and canes with haptic biofeedback on knee joint health, pain, and osteoarthritis disease progression.

    • Effect of cane use on bone marrow lesion volume in people with medial tibiofemoral knee osteoarthritis: randomized clinical trial

      2019, Osteoarthritis and Cartilage

      To evaluate effects of daily cane use for 3 months on medial tibiofemoral bone marrow lesion (BML) volumes in people with medial tibiofemoral osteoarthritis (OA).

      In this randomized controlled trial (RCT), 79 participants with medial tibiofemoral OA were randomized to either a cane group (using a cane whenever walking) or control group (not using any gait aid) for 3 months. The cane group received a single training session by a physiotherapist, using a biofeedback cane to teach optimal technique and body weight support and motor learning principles to facilitate retention of learning. The primary outcome was change in total medial tibiofemoral BML volume (per unit bone volume) measured from magnetic resonance imaging (MRI) at 3 months. Secondary outcomes were BML volumes (per unit bone volume) of the medial tibia and femur, and patient-reported outcomes of overall knee pain, knee pain on walking, physical function, perceived global symptom changes and health-related quality of life. MRI analyses were performed by a blinded assessor.

      Seventy-eight participants (99%) completed the primary outcome. Mean (standard deviation) daily cane use was 2.3 (1.7) hours over 3 months. No evidence of between-group differences was found for change in total medial tibiofemoral BML volume (mean difference:−0.0010 (95% confidence intervals:−0.0022, 0.0003)). Most secondary outcomes showed minimal differences between groups.

      Daily use of a cane during walking for 3 months aiming to reduce knee joint loading did not change medial tibiofemoral BML volumes compared to no use of gait aids.

      Australian New Zealand Clinical Trial Registry (ACTRN12614000909628).

    • Artificial Intelligence-Enabled Caregiving Walking Stick Powered by Ultra-Low-Frequency Human Motion

      2021, ACS Nano

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    © 2018 Elsevier B.V. All rights reserved.

    FAQs

    Should you use a cane with osteoarthritis? ›

    Use of a cane is one of a number of non-drug treatments for knee OA, which include weight reduction, exercise and taping. People with knee osteoarthritis (OA) who have pain and difficulty with walking. bilateral disease should use frames or wheeled walkers rather than canes.

    How much body weight does a cane support? ›

    You can support up to 25% of your weight with a cane. You can support up to half of your weight with some walkers.

    What is the best cane for knee problems? ›

    Most people with arthritis only need single-point canes. Those with a neurological impairment, significant weaknesses or balance limitations are best suited to quad canes, because they can handle more weight. When being fitted, wear your walking shoes and stand tall with your arms at your sides.

    What are the disadvantages of using a cane? ›

    The potential drawbacks of using a cane include:
    • They provide less support than walkers.
    • Over time could lead to repetitive strain issues.
    • They could get stuck in cracks and on uneven surfaces.
    • Improper sizing could create additional aches and pains.
    • They are not ideal for major mobility issues or immediately post-surgery.
    3 Dec 2018

    How can I walk with severe knee arthritis? ›

    Using crutches, walking poles or a stick can help with pain, balance and your posture. You could try Nordic walking, it's very good exercise for the joints and by using poles you have extra support.

    Is it better to walk with a cane or a walker? ›

    If you have pain or weakness on one side of your body that makes it hard to walk or balance, a cane may be helpful. If you have poor balance or feel unsteady on your feet, a walker may give you more support.

    What cane do physical therapists recommend? ›

    Single Point Cane

    By far the most commonly recommended walking cane for people who simply need a little more stability. You can find these canes with traditional curved handles, the very comfortable 'derby style' handle, and even with an offset handle.

    Is it better to use a walking stick or a cane? ›

    Walking sticks are seen as more of an accessory and are only really used when occasional support is needed such as when hiking or walking on rough terrains. Walking canes on the other hand are used on a long-term basis helping to make mobility easier by reducing pressure on the individual's legs.

    What can I use instead of a cane? ›

    The walking stick encourages the patient to stand straighter, have better posture, and walk with a more natural stride (within the limits of the condition requiring the assistive device). I have prescribed walking sticks to several patients who have found them to be more helpful than a cane.

    What is the best walking cane for balance? ›

    Use a quad cane

    The four tips of a quad cane offer a wider base that provides support, stability, and balance.

    Should a cane be on the strong or weak side? ›

    If you are using a cane because one leg is weak or painful, hold the cane on the opposite side from the weak or painful leg. For example, if your right hip is sore, hold the cane in your left hand. If you are using the cane for a little help with balance and stability, hold it in the hand you use less.

    Does walking with a cane help knee pain? ›

    The correct cane can help relieve pressure on sore knees, hips, ankles and feet, as well as improve balance. Walking canes come in even more varieties than candy canes. Materials, colors and handle styles are a matter of preference. Cane type and size, however, are options that affect function and safety.

    Will a cane help with knee arthritis? ›

    Abstract. Background: Walking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading.

    What can you not do after knee replacement? ›

    You shouldn't downhill ski or play contact sports such as football and soccer. In general, avoid sports that require jerking, twisting, pulling, or running. You should be able to do lower-impact activities, such as hiking, gardening, swimming, playing tennis, and golfing.

    What is the best kind of cane to use? ›

    Most people do well with a cane that has a single tip. A quad cane, which has four tips, can provide a broader base of support but is often more awkward to use. Quad canes may help reduce falls in people who are recovering from strokes.

    Do you need a prescription to use a cane? ›

    The short answer is, no. You could go online and purchase any cane from Amazon, Walmart, or your local drug store. Walking sticks are available to the public and do not require a prescription to be acquired.

    What should you not do with osteoarthritis of the knee? ›

    What Exercises Should You Avoid for Hip and Knee Osteoarthritis?
    • Running, especially on uneven surfaces.
    • Tennis, basketball, and other activities where you change direction quickly.
    • Step aerobics and other workouts that involve jumping.
    14 Dec 2017

    What is the best exercise for osteoarthritis of the knee? ›

    Knee Osteoarthritis Exercises
    • Hamstring Stretch. 1/14. Stretching keeps you flexible and improves your range of motion, or how far you can move your joints in certain directions. ...
    • Calf Stretch. 2/14. ...
    • Straight Leg Raise. 3/14. ...
    • Quad Set. 4/14. ...
    • Seated Hip March. 5/14. ...
    • Pillow Squeeze. 6/14. ...
    • Heel Raise. 7/14. ...
    • Side Leg Raise. 8/14.
    22 Feb 2022

    What is the best treatment for severe knee osteoarthritis? ›

    Non-steroidal anti-inflammatory drugs (NSAIDs)

    Some topical NSAIDs are available without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.

    When using a walker which leg goes first? ›

    Make sure all 4 tips or wheels of your walker are touching the ground before taking a step. Step forward with your weak leg first. If you had surgery on both legs, start with the leg that feels weaker. Then step forward with your other leg, placing it in front of the weaker leg.

    What is the standard gait procedure for walking with a cane? ›

    Hold your cane in the hand that's opposite the side that needs support. Position the cane slightly to the side and about 2 inches forward. Move your cane forward at the same time as you step forward with your affected leg. Hold the cane steady in place as you walk forward with your unaffected leg.

    What is the best cane for seniors? ›

    The 10 Best Walking Canes for Seniors
    1. HurryCane Freedom Edition Folding Cane. ...
    2. HoneyBull Walking Cane. ...
    3. Hugo Mobility Quadpod. ...
    4. Carex Soft Grip Cane. ...
    5. Harvy Derby Scorched Cherry Hardwood Cane. ...
    6. Travelon Walking Seat and Cane. ...
    7. Duro Med Wooden Walking Canes. ...
    8. Self Defense Plain Jane.
    25 Jul 2022

    When do you know it is time for a walking cane? ›

    Among the most apparent signs you may require a cane is that walking is becoming difficult. You may have developed a noticeable limp, or you may drag one foot consistently. Both of these create an imbalance, causing you to rely on one leg or foot than the other.

    Which cane is better offset or straight? ›

    Offset canes offer a greater selection of height adjustments and also have removable/replaceable rubber tips. 4. Quad Canes or broad-based canes focus on balance support with comfort just as an offset cane, but quad canes offer additional stability support. The base of a quad cane has four points meeting the ground.

    Is a wooden or metal cane better? ›

    Wood: Wood is considered the best and most used walking cane material. Wood is regarded as the most versatile choice for crafting stable, durable, and sturdy walking canes.

    Is a walker safer than a cane? ›

    Walkers provide ultimate stability, but four-point canes also support healthy balance and spine safety. How much flexibility do you need in a device? Walkers should not be used on stairs, so a cane may be a better choice if you want the flexibility to go up and down stairs.

    What can you use instead of a walking stick? ›

    Crutches. If a walking stick is not quite supportive enough, crutches may be an effective alternative. One or two crutches can be used at any one time and, rather than putting pressure on the wrist as walking sticks do, crutches spread the pressure over the lower arm instead.

    Do you use a cane on the side that hurts or the opposite side? ›

    Hold the cane in the hand opposite the side that needs support. For example, if your right leg is injured, hold the cane in your left hand.

    What to know before buying a cane? ›

    Consult a physician to understand which type of cane is best for your needs. Decide on the type of cane and the type of grip that will suit you. Choose a cane that is durable and has a lot of good reviews from others. Size your cane so that it's comfortable and doesn't risk causing additional injury.

    Do you need to be disabled to use a cane? ›

    Yes. If you need an assistive device (including a cane) to help you walk, you are disabled. Even if you CAN walk without it.

    What are the benefits of walking with a cane? ›

    Canes Help with Balance and Provide Support

    Canes provide support while standing and walking so you will not tire out as quickly. They also improve your balance while in use to help prevent falls and injury. Some people use canes for assistance after surgery or when they have an injury.

    Which hand do you hold a cane in? ›

    The most common question about using a cane is, "Which hand should I hold it in?" The answer is the hand opposite the leg that you had surgery on, or that is the weakest. The tip or all 4 prongs need to be on the ground before you put your weight on your cane. Look forward when you walk, not down at your feet.

    When do you switch from walker to cane after knee replacement? ›

    You will be using a walker for the first 2-3 weeks to get around. You can transition to a cane or no supportive devices per physician orders. A majority of people are doing well and getting back to most activities by 3 months, but it can take 6 months to a year to fully recover depending on many conditions.

    How do you use a cane for a weak knee? ›

    Think of it this way: Hold the cane on your strong side and move it along with your weak side. For example, if you have an injured right knee, hold the cane with your left hand. When you place your right leg out, swing the cane out with the leg.

    What is the correct height for a walking stick? ›

    another person should turn the walking stick upside down, so that the handle is resting on the floor. Then the person should position the walking stick next to the user, and measure the distance between wrist bone and the floor – this is the height of stick that you require.

    What is the best support for an arthritic knee? ›

    A knee brace is one tool in managing the discomfort of knee osteoarthritis. A brace might help reduce pain by shifting your weight off the most damaged portion of your knee. Wearing a brace can improve your ability to get around and help you walk farther comfortably.

    How do you live with an arthritic knee? ›

    It is recommended that adults with arthritis be moderately physically active for at least 150 minutes per week. Strength training is also recommended. Further, physical activity has been proven to reduce arthritis pain. You can do low impact physical activity to reduce joint pain.

    Can you ever kneel again after knee replacement? ›

    The majority of patients expect to be able to kneel after TKR,2,4,5 however, these expectations are frequently not met,1,6 with between 50% and 80% of patients reporting that they have difficulty kneeling or do not kneel in the months and years after TKR.

    How long are you laid up after knee replacement? ›

    When can I go back to work? This depends on your job, but you can usually return to work 6 to 12 weeks after your operation.

    How long are you down after total knee replacement? ›

    Barring any complications, most patients are able to return to most normal activities and walk without the need of assistive devices between three to six weeks after surgery. Overall, it usually takes two to three months to make a complete recovery from a minimally invasive knee replacement.

    Does using a cane help with arthritis? ›

    “Canes are used to reduce the weight bearing for the arthritic joint, thereby reducing pain, or to assist with balance when the balance problem is due to impaired sensation and/or mild leg weakness.”

    Are canes good for arthritis? ›

    Ramage says most people with arthritis need only single-point canes, and those with a neurological impairment are best suited to quad canes, because they can put more weight on them. When being fitted, wear your walking shoes and stand tall with your arms at your sides.

    When should I consider using a cane? ›

    A cane can be helpful if you have minor problems with balance or stability, some weakness in your leg or trunk, an injury, or a pain. If you are elderly, using a single point cane may help you to walk more comfortably and safely and, in some cases, may make it easier for you to continue living independently.

    Does a cane help with knee arthritis? ›

    Conclusion: Use of a cane can diminish pain and improve physical functioning in patients with knee osteoarthritis.

    Why would a doctor prescribe a cane? ›

    Canes help stabilize walking by providing a little added support. They are typically recommended when one side of the body is weaker than the other. Typical causes for this include strokes, hip surgery, and knee surgery.

    Do you need a prescription for a walking cane? ›

    The short answer is, no. You could go online and purchase any cane from Amazon, Walmart, or your local drug store. Walking sticks are available to the public and do not require a prescription to be acquired.

    Does arthritis feed on sugar? ›

    Anecdotally, people with arthritis often say that sugary foods trigger their arthritis flares . Research generally backs this up. Eating excess sugar causes the body to produce more cytokines, which are inflammatory proteins.

    Does sugar have anything to do with arthritis? ›

    Consuming too much processed sugar causes the body to release pro-inflammatory proteins called cytokines, says Bruning. Cytokine levels are already high when you have inflammatory arthritis; that chronic inflammation is what causes pain, swelling, and stiffness in your joints.

    Are apples good for arthritis? ›

    Along with fiber and vitamin C, apples are packed with polyphenols, healthful phytonutrients including epicatechin, catechin, quercetin and condensed tannins (also known as procyanidins), a type of flavonoid that may make apples a suitable snack to reduce risk and help treat symptoms of rheumatoid arthritis.

    Do you put the cane on the strong or weak side? ›

    If you are using a cane because one leg is weak or painful, hold the cane on the opposite side from the weak or painful leg.

    What is the best thing to use for arthritis in your knees? ›

    For mild symptoms, topical medications applied to the knees such as diclofenac gel relieve pain and have few adverse effects. Nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen are the most effective oral medications for osteoarthritis.

    Are you disabled if you use a cane? ›

    While the use of a cane does not automatically mean you are legally disabled, it does provide strong evidence that you are unable to perform the type of activities typically associated with full-time work.

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