Why should a walking aid, such as a cane, be used in the hand opposite to the affected knee for patients with knee pain?

Using a Walking Aid in the Hand Opposite to the Affected Knee

A walking aid, such as a cane, should be used in the hand opposite to the affected knee because this creates a more stable three-point gait pattern that reduces load on the painful knee joint, decreases pain, and improves function. 1

Biomechanical Rationale

When using a cane in the hand opposite to the affected knee:

• The cane creates a wider base of support, improving stability during ambulation
• Weight is transferred through the cane during the stance phase of the affected limb
• This reduces the external knee adduction moment (KAM), which is a key measure of medial knee joint loading 2
• Studies show a dose-response effect: greater body weight support (BWS) through the cane results in greater reduction of knee joint load 2

Clinical Evidence

The American College of Rheumatology strongly recommends cane use for patients with knee osteoarthritis when the disease causes significant impact on ambulation, joint stability, or pain 1. Research supports this recommendation:

• Daily cane use for two months significantly reduces pain (mean difference of 2.1 on a 0-10 scale) and improves function in patients with knee OA 3
• Proper cane use can provide 7-10% body weight support, which can be increased to 15-20% with proper training 4, 2
• Greater reductions in knee load are achieved when the cane is placed more laterally from the body 2

Proper Technique for Maximum Benefit

For optimal effectiveness:

1. Height adjustment: The cane should be properly sized so the handle is at wrist height when standing upright with arms at sides
2. Hand placement: Hold the cane in the hand opposite to the affected knee
3. Timing: Move the cane forward simultaneously with the affected leg
4. Placement: Position the cane slightly lateral to the body for maximum load reduction 2
5. Weight transfer: Apply 10-20% of body weight through the cane during the stance phase of the affected limb 4, 2

Common Pitfalls to Avoid

• Using the cane on the same side as the affected knee: This fails to create the proper three-point gait pattern and doesn't effectively reduce knee load
• Improper height adjustment: A cane that's too tall or short can cause shoulder, wrist, or back discomfort
• Insufficient weight bearing: Many patients don't place enough weight through the cane to achieve significant load reduction 4
• Inconsistent use: Patients should be encouraged to use the cane regularly, not just on "bad days"

Training Considerations

Brief training sessions can significantly improve the effectiveness of cane use:

• A 10-minute training session can increase body weight support through a cane by 25-28% 4
• Training should focus on proper technique and adequate weight transfer through the cane
• Using bathroom scales during training helps patients learn to transfer at least 10% of their body weight through the cane 4

By using a cane in the hand opposite to the affected knee, patients can experience significant improvements in pain, function, and quality of life while reducing dependence on pain medications 3.