Is a cane used for ambulation typically used on the contralateral (opposite) side of the affected limb?

Cane Placement for Ambulation: Contralateral Side to the Affected Limb

A cane should be held contralateral (opposite) to a weak or painful lower extremity and advanced simultaneously with the contralateral leg to provide optimal support and weight redistribution. 1

Rationale for Contralateral Cane Placement

Biomechanical Benefits

• When placed on the opposite side of the affected limb, a cane:
  • Redistributes weight from a lower extremity that is weak or painful
  • Improves stability by increasing the base of support
  • Provides tactile information about the ground to improve balance 1
  • Reduces peak vertical force on the affected limb by 7-11% compared to walking unaided 2

Evidence for Contralateral Placement

Research demonstrates that contralateral cane use offers several advantages:

• Increases stride length and cadence compared to ipsilateral use 3
• Results in faster mean velocity during ambulation 3
• Improves gait symmetry in patients with asymmetric gait patterns, particularly in stroke patients 4

Proper Cane Technique

Height and Positioning

• The top of a cane should be at the same height as the wrist crease when the patient is standing upright with arms relaxed at their sides 1
• The cane should be held in the hand opposite to the affected limb
• The patient should advance the cane simultaneously with the affected leg 1

Gait Pattern

For optimal biomechanical advantage:

1. Hold the cane in the hand opposite to the weak/painful leg
2. Move the cane forward at the same time as the affected leg
3. Step through with the unaffected leg
4. Repeat the sequence

Clinical Considerations

Patient-Specific Factors

While contralateral placement is generally recommended, clinicians should consider:

• Patient's strength and endurance
• Balance capabilities
• Cognitive function
• Environmental demands 1

Special Populations

• In stroke patients: Contralateral cane use significantly improves symmetry in those with asymmetric gait (p=0.028) 4
• In joint replacement patients: Contralateral cane use results in greater stride length and cadence, leading to faster mean velocity 3

Common Pitfalls to Avoid

• Incorrect cane height (too high or too low)
• Using a damaged or inappropriate device
• Holding the cane on the same side as the affected limb (reduces biomechanical advantage)
• Lack of proper instruction on cane use 1

Follow-up and Maintenance

• Clinicians should routinely evaluate patients' assistive devices to ensure:
  • Proper height and fit
  • Good maintenance condition
  • Correct usage technique 1

By following these evidence-based guidelines for contralateral cane placement, patients can maximize the benefits of cane use for improved mobility, stability, and pain reduction.