Each week I have the same discussion with a new patient–my own “Ground Hogs Day experience.” The conversation revolves around the use of a cane or walker after having surgery. “But I don’t need it, I won’t fall,” my patient says with mix of conviction and doubt. No one wants to use an assistive device. For some, it carries a stigma of “being old” or an aura of helplessness.
Maybe it’s the stigma, maybe it’s vanity, but 90% of my post surgical patients put up a short term fight. We usually discuss the reasons behind the “why” of using a cane or walker after surgery. It usually results with my patients rolling their eyes and saying, “ok, well how long will I be using this thing?” The reasons for using an assistive device after surgery reaches far beyond safety. No longer should we think of ditching our walking aides with pride, particularly when doing so creates a walking pattern that displays a definitive limp. While walking with a limp may not seem like a big deal, it may lead to a secondary injury or permanently change how you walk.
Leading to Potential Injury
If you think about it, walking with a limp is an “abnormal” walking pattern. Limping places abnormal stress on the rest of the body. Without the use of a walking aid many patients will lean away from their injured side. Leaning places increased stress throughout the body from the ankle all the way to the back. Flexing to one side will compress one side of you back, which may lead to muscle tightness. In the short term, a cane or walker allows for improved posture as it can distribute weight more evenly, protecting other joints.
In a continued attempt to purge the cane my patients argue: “It is not painful to walk without a cane.” A limp isn’t only caused from pain. Weakness or lack of motion will cause deviations while walking. Without strength in your outer hip muscles your body is unable to support your weight while standing on one foot (which we do every step we take). This will force a shorter step, your upper body to lean, and a wider stance to compensate. Similar changes will occur if there is tightness in the hip or knee following injury or surgery. Once again, using a cane, crutch, or walker will lessen the effects of any weakness or lack of motion.
Forming Bad Habits
Limping also creates a concern of poor walking habits. Limping is a difficult habit to break once formed. Our brain and our muscles make a constant feedback loop. Without the automatic feedback loop we would have to think about each step we take. Once we learn how to walk it becomes an automatic process. After months of limping, the brain begins to think that walking pattern is the new normal.
That means even if you have the strength, balance, and flexibility to walk correctly your brain tells your body to limp. As a therapist breaking the “habitual limp” is by far one of the most challenging and frustrating tasks of the day. For patients this means every step you take has to require thought and effort. That doesn’t sound like an easy road to recovery to me.
A cane, crutch, or walker for a short period of time is a worthwhile sacrifice to prevent harmful habits and protect other body parts. There are no bonus points for getting rid of a cane before you are ready in the rehab world. Using the appropriate level of support throughout the rehab process can actually speed recovery, decrease pain, improve mobility, and promote optimal recovery.
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