Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 114: Walking With a Cane After Knee Replacement (Which Hand, What Pattern, and When You May Be Ready)

Transcript

Episode 114: Walking With a Cane After Knee Replacement (Which Hand, What Pattern, and When You May Be Ready) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

• 0:00
  That may feel backward at first, or it might
• 0:01
  feel weird to put the cane in your left hand
• 0:03
  if you're right handed. People often want to
• 0:06
  put the cane right beside the knee that hurts.
• 0:11
  Are you ready to get back to what you love after
• 0:13
  knee replacement? The Total Knee Success podcast
• 0:16
  is your trusted guide with practical tips, evidence
• 0:19
  -based strategies, and no fluff. It's not personal
• 0:22
  medical advice, just solid education to help
• 0:25
  you manage pain, regain mobility, and get back
• 0:28
  to living the life you love. Let's dive in. Welcome
• 0:34
  back to the Total Knee Success podcast. I'm Michelle.
• 0:37
  In the last episode we talked about walking with
• 0:39
  a walker after knee replacement and we ended
• 0:42
  with an important question. How do you know when
• 0:44
  you're ready for less support? Maybe walking
• 0:47
  with a walker is getting easier. You're standing
• 0:49
  more upright, putting more weight through your
• 0:51
  surgical leg, and relying less on your arms.
• 0:54
  So when might it be time to move to a cane? This
• 0:57
  is part two of our four -part walking series.
• 1:00
  We'll keep curbs and stairs for episode 115 and
• 1:03
  then finish the series with hills, grass, gravel,
• 1:06
  and other uneven ground. By the end of this episode,
• 1:09
  you'll have a better idea of how to recognize
• 1:11
  readiness for a cane, how to fit and use it,
• 1:13
  and what to notice as you work toward needing
• 1:15
  less support. Let's start with readiness. Moving
• 1:19
  from a walker to a cane isn't based on the calendar
• 1:21
  alone. Some people are given specific instructions
• 1:24
  to use a walker for a period of time, and it's
• 1:27
  important to follow that. Timing also depends
• 1:29
  on how your walking looks and feels, how steady
• 1:32
  you are, how much you're relying on your arms,
• 1:35
  and whether your surgical leg is accepting your
• 1:37
  weight. Those are useful signs to discuss when
• 1:40
  deciding whether you're ready for a cane. Keep
• 1:42
  following any specific instructions you were
• 1:44
  given about weight bearing or walking aids. A
• 1:47
  walker lets you use both arms and provides a
• 1:49
  wider base of support. A cane provides less assistance.
• 1:53
  A single point cane has one contact point with
• 1:56
  the floor. A quad cane has four small feet. The
• 1:59
  type recommended for you should fit your balance,
• 2:02
  arm strength, and walking style. That choice
• 2:05
  includes how much support you need when you put
• 2:07
  weight through your surgical leg. You should
• 2:09
  be allowed to have full weight bearing or weight
• 2:11
  bearing as tolerated in order to advance to a
• 2:14
  cane. The cane is used for light support and
• 2:17
  balance only. If you're still depending heavily
• 2:19
  on both arms and your leg is giving way, ask
• 2:22
  your therapist to reassess the support you need.
• 2:25
  before changing devices. And as always, this
• 2:28
  information is for general education only. Talk
• 2:31
  to your therapist about how you should proceed
• 2:34
  with a cane. Once you're ready, using the cane
• 2:37
  can become pretty natural. We'll start with the
• 2:39
  fit, then hand placement, and then work through
• 2:41
  the sequence. Let's check the cane height. A
• 2:45
  cane that's too tall can make you hike your shoulder.
• 2:48
  A cane that's too short can make you lean too
• 2:50
  far forward toward it. A common fitting guideline
• 2:53
  is to stand upright with your arms relaxed and
• 2:56
  the cane end on the floor with the handle next
• 2:58
  to your wrist. Set the handle height to around
• 3:01
  the wrist crease, leaving a slight bend at the
• 3:03
  elbow when you hold it. The best fit also takes
• 3:06
  your posture and the type of cane into account.
• 3:09
  Take a look at the rubber end too. If it's worn,
• 3:12
  smooth, cracked, or loose, have it replaced.
• 3:15
  Good contact with the floor helps the cane provide
• 3:17
  support. With a quad cane, all four feet should
• 3:21
  contact the floor before you put any pressure
• 3:23
  on it. Now, which hand should you use? If you've
• 3:27
  had one knee replaced, you generally use the
• 3:29
  cane in the opposite hand of your surgical leg.
• 3:32
  So if your right knee was replaced, the cane
• 3:34
  is generally in your left hand. If your left
• 3:37
  knee was replaced, the cane is generally in your
• 3:39
  right hand. That may feel backward at first,
• 3:41
  or it might feel weird to put the cane in your
• 3:43
  left hand if you're right -handed. people often
• 3:46
  want to put the cane right beside the knee that
• 3:48
  hurts. Holding the cane in the opposite side
• 3:51
  lets you use it for support while your surgical
• 3:53
  leg accepts weight. That can reduce the demand
• 3:56
  on your leg and help you maintain a more natural
• 3:59
  walking pattern. You may hear your therapist
• 4:02
  call this reciprocal walking. Reciprocal means
• 4:05
  alternating, a natural movement pattern where
• 4:08
  opposite sides of the body move in a synchronized
• 4:11
  alternating rhythm. One leg steps forward, then
• 4:14
  the other, your arms naturally swing with the
• 4:16
  opposite leg. Using the cane opposite your surgical
• 4:19
  leg fits that pattern as you bring the cane and
• 4:22
  your surgical leg forward together. Another painful
• 4:25
  joint, difficulty using an arm, a condition affecting
• 4:28
  your nerves or movement, or specific surgical
• 4:31
  instructions may call for a different setup.
• 4:35
  Now let's work through it step by step. Start
• 4:37
  with this slower version while you're learning.
• 4:39
  One way to work on that sequence is to walk along
• 4:41
  a counter. Put your free hand on the counter
• 4:44
  so you have some extra support while you focus
• 4:46
  on the sequence. Use the cane in the hand opposite
• 4:49
  your surgical knee as instructed or alternate
• 4:53
  instruction if you were given that by your therapist.
• 4:56
  Use a stable counter with enough space beside
• 4:58
  it for your feet and the cane. Walk at a pace
• 5:01
  that lets you stay balanced. If you need substantial
• 5:04
  support from the counter and the cane together
• 5:06
  to stay upright, talk to your therapist about
• 5:08
  this. They can help determine whether that practice
• 5:11
  is appropriate or whether you need the walk or
• 5:13
  still for now. Move the cane a short distance
• 5:16
  forward and set the end firmly on the floor.
• 5:19
  Next, step forward with your surgical leg taking
• 5:21
  the support you need through the cane and some
• 5:24
  through the counter if needed. Then step forward
• 5:27
  with the other leg. Cane, surgical leg, other
• 5:32
  leg. Keep the cane close enough so that you can
• 5:35
  stay upright as your surgical leg comes forward.
• 5:38
  Your foot should come roughly equal to where
• 5:40
  the cane was placed on the floor. The support
• 5:43
  is there when your surgical leg accepts weight.
• 5:47
  Breaking the sequence into three parts gives
• 5:49
  you the time to coordinate the support and the
• 5:51
  step and kind of get used to it. As you get comfortable,
• 5:54
  you can bring the cane forward along with your
• 5:56
  surgical leg followed by the other leg. The rhythm
• 6:00
  can become smoother as you coordinate that movement.
• 6:04
  Once you've got the sequence, pay attention to
• 6:06
  your step length. Often the step with your non
• 6:09
  -operative leg is a little too short because
• 6:11
  you might be tentative about putting weight on
• 6:13
  your surgical leg. You bring the other foot forward
• 6:15
  just a little, then quickly shift your weight
• 6:17
  away again. If you're steady with the support
• 6:21
  you have, a slightly bigger step with your non
• 6:23
  -operative leg may help your steps become more
• 6:26
  even. Keep it within a comfortable range where
• 6:29
  you can maintain your balance. Make sure you're
• 6:31
  balanced as you're doing all of this walking.
• 6:34
  With your free hand on the counter for support,
• 6:36
  That can help you maintain your safety. If the
• 6:39
  adjustment makes you less steady or increases
• 6:41
  your pain, return to the step length that felt
• 6:44
  comfortable. Your therapist can watch what you're
• 6:47
  doing and tell you what they see. Sometimes it's
• 6:49
  hard to evaluate your own movements. You may
• 6:51
  feel as though your steps are even when one is
• 6:54
  shorter or you may be leaning more than you realize.
• 6:57
  Having someone observe gives you specific feedback
• 7:00
  for your next steps. Now let's look at what the
• 7:03
  cane is helping you do. Sometimes the cane is
• 7:06
  helping with balance. Sometimes it's helping
• 7:08
  because you're having a little bit of pain or
• 7:10
  because your leg is not used to supporting you
• 7:13
  100 % yet. And sometimes the biggest difference
• 7:16
  is what happens to your walking pattern without
• 7:18
  it. Imagine two people at a similar point after
• 7:22
  surgery, both having their walking assessed.
• 7:25
  The first person uses the cane lightly, their
• 7:27
  steps are nearly even, and their surgical leg
• 7:29
  accepts weight with good control. During that
• 7:32
  assessment with less support, their walking pattern
• 7:34
  stays much the same. The second person depends
• 7:38
  more heavily on the cane, leans their body toward
• 7:40
  it, and takes a quick step off their surgical
• 7:42
  leg. During the assessment with less support,
• 7:45
  their limp becomes much more pronounced. Their
• 7:48
  walking shows different needs for support, even
• 7:51
  though their surgery dates may be the same. Usually,
• 7:54
  it's really a matter of a little more time and
• 7:56
  a little more practice. This is where working
• 7:58
  with your therapist can be especially helpful.
• 8:01
  Gait training is part of their expertise. They
• 8:04
  can identify which changes will help you regain
• 8:06
  a more natural rhythm, so your practice focuses
• 8:08
  on what your walking needs. That's one reason
• 8:12
  I like a cane when it provides enough support.
• 8:14
  It can help you practice a smoother walking pattern
• 8:17
  as your strength and control improve. Pay attention
• 8:21
  to the quality of the steps you repeat throughout
• 8:23
  the day. Your walking pattern can continue changing
• 8:25
  as your strength, motion, and coordination improve.
• 8:30
  What should you watch? Start with step length.
• 8:33
  Are the steps reasonably similar in length or
• 8:35
  does one foot barely pass the other? Then notice
• 8:38
  how long you spend on your surgical leg. Do you
• 8:41
  immediately hurry off that side? Notice your
• 8:44
  upper body. Are you leaning from side to side
• 8:46
  or leaning to one side? Look at your surgical
• 8:49
  knee. Does it stay bent throughout the time you're
• 8:52
  standing on that leg? Notice whether your foot
• 8:55
  scuffs the floor or lands with a slap. These
• 8:57
  details help you describe what you're experiencing.
• 9:00
  Beyond just saying that your walking feels different.
• 9:04
  Knee stiffness, quadricep muscles that aren't
• 9:06
  activating as well after surgery, swelling, pain,
• 9:09
  limited endurance, and habits from before surgery
• 9:11
  can all affect your walking after surgery. Rehabilitation
• 9:15
  works on those pieces while the cane provides
• 9:18
  appropriate support. The amount of support you
• 9:21
  need can also change with the environment. Outside,
• 9:24
  you may have longer distances, uneven pavement,
• 9:27
  crowds, or fewer places to sit. If your steps
• 9:30
  become less steady as you get tired, you may
• 9:32
  benefit from more support for those longer walks.
• 9:36
  If you're using a cane after knee replacement
• 9:37
  and your goal is to progress off of that cane
• 9:40
  and return to walking with no device, the transition
• 9:43
  might be quick or you might need a lot of practice.
• 9:46
  Timeframes are very individual. Some people reach
• 9:50
  a stage where they don't need their cane for
• 9:52
  a short trip across the room, but still use it
• 9:54
  for community walking. Knee stiffness, swelling,
• 9:58
  pain, sleep, and fatigue can also affect your
• 10:00
  steps at different times of day. Notice when
• 10:02
  walking feels easier and when you rely more on
• 10:05
  the cane. Now we come to the question of when
• 10:08
  can you use the cane less? Your therapist can
• 10:11
  assess whether your walking stays controlled,
• 10:13
  whether your surgical leg supports your weight,
• 10:15
  and what happens when you turn, stop, change
• 10:18
  direction, or walk farther than just a few steps.
• 10:22
  Include the places you actually want to go in
• 10:25
  that discussion and that decision. A short trip
• 10:28
  across the bedroom or within your home is a different
• 10:31
  demand from walking through a parking lot, entering
• 10:34
  a restaurant and heading back out after sitting
• 10:36
  for a while. During that time frame, a larger
• 10:39
  limp, shorter steps, more leaning or reaching
• 10:42
  for furniture can show that you still benefit
• 10:44
  from some support. You may gradually use less
• 10:47
  support in some settings while keeping the cane
• 10:49
  for longer distances or more demanding environments,
• 10:52
  and that's okay. For some people, ongoing cane
• 10:56
  use remains the most appropriate choice. For
• 10:59
  others, they progress to no assistive device,
• 11:02
  no walker, no cane, no support needed. I encourage
• 11:05
  you to work toward your individual goals. In
• 11:08
  the end, it's important to be walking safely
• 11:10
  with the support that fits you. There are also
• 11:14
  changes that deserve medical attention. Contact
• 11:17
  your healthcare team promptly if you have new
• 11:19
  or repeated knee buckling, significant dizziness,
• 11:21
  a fall, or a major change in your ability to
• 11:23
  walk. Use the support you've been instructed
• 11:26
  to use while getting the guidance. Seek emergency
• 11:29
  care for chest pain, sudden or unexplained shortness
• 11:31
  of breath or fainting. Follow any additional
• 11:33
  urgent symptom instructions your surgical team
• 11:36
  has given you. And here's what I'd love for you
• 11:39
  to take away from this episode. A cane can help
• 11:42
  you walk with a steadier, more even rhythm while
• 11:44
  your leg regains strength and control. Readiness
• 11:47
  for less support depends on your walking pattern
• 11:51
  and where you're going. If you're at the point
• 11:53
  where you're using less support and thinking
• 11:55
  about how you want your walking to look and feel
• 11:57
  again, my book Walking Like Yourself Again After
• 12:00
  Knee Replacement goes deeper into that process.
• 12:03
  You'll find the link in the show notes. If you'd
• 12:06
  like ongoing knee replacement education and updates,
• 12:08
  You can join the free Totally Success Insider
• 12:11
  email newsletter. The signup link is in the show
• 12:14
  notes. In episode 115, we'll start with curbs
• 12:18
  using a walker, then a cane, and then move to
• 12:20
  stairs with a rail and cane. We'll cover taking
• 12:23
  one step at a time, alternating feet, and what
• 12:26
  to notice as you need less support. Thanks for
• 12:29
  joining me. I'm Michelle, and this has been the
• 12:32
  Totally Success podcast. This podcast is for
• 12:38
  educational purposes only. Discover more at TotalMeSuccess
• 12:42
  .com and be sure to subscribe and share because
• 12:46
  every step forward takes you closer to living
• 12:48
  the life you love.