Cane & Walker Use

A patient uses a cane on the wrong side and falls. The error wasn't strength — it was which hand held the cane. Side selection is the single most tested detail.

A cane is held on the strong (unaffected) side, opposite the weak or injured leg. This shifts the center of gravity toward the strong side and reduces force on the affected hip or knee by up to 25%. The gait sequence is cane-and-weak-leg together, then strong leg — creating a stable tripod at every step. When ascending stairs: strong leg first, then weak leg with cane. Descending: cane and weak leg first, then strong leg. The mnemonic is 'up with the good, down with the bad.' Cane height is set so the elbow flexes 15–30 degrees when the hand grips the handle, with the cane tip level with the greater trochanter. A standard walker (pickup walker) provides maximum stability for clients with significant balance deficits or bilateral weakness. The client lifts the walker forward 6–12 inches, then steps into it — never beyond the front bar. Rolling walkers allow a smoother gait but are contraindicated when the client cannot reliably control speed or braking. Before ambulation, assess the rubber tips on all contact points for wear, lock wheelchair brakes, and apply a gait belt. The nurse walks slightly behind and to the affected side.

Key Distinctions

Don't confuse cane side selection with crutch axillary placement — the cane goes in the hand opposite the affected leg, not on the same side. Students mix up stair sequence: 'up with the good' means strong leg leads going up; 'down with the bad' means weak leg and cane lead going down. A pickup walker requires lifting with both arms; if the client lacks upper-body strength, a rolling walker isn't automatically safer — it may roll away.

Clinical Pearl

Think 'C-A-N-E: Contralateral Aid for the Non-affected Extremity side.' If the left knee hurts, the cane lives in the right hand — always opposite.