Monday, 23 June 2008
[EDITORIAL NOTE: The TGB Geriatrician is a semi-monthly column written by Dr. Bill Thomas (bio) for Time Goes By to give us the information we need to help us navigate the health issues of aging. Dr. Thomas also writes his own blog at Changing Aging.]
In 1992, The New York Times took a look at the research AARP was doing on walking canes:
”Many people who use canes injure themselves because they don't do the necessary research before buying one. That is an early conclusion of a continuing study on canes sponsored by the American Association of Retired Persons.
“According to Dr. Margaret Wylde, vice president of the Institute for Technology Development in Oxford, Miss., which is conducting the study, the conclusion is based on a review of recent medical and rehabilitation literature and on more than 1,000 letters solicited from A.A.R.P. members who are regular cane users.
“Some of the most serious damage, Dr. Wylde said, can result from the cane's grip. Carpal tunnel syndrome, a painful ailment, can result from any repetitive motion like typing or using a cane.”
There are two reasons people use walking canes.
- To improve balance by providing a third contact point with the ground
- To redistribute weight away from an injured or arthritic lower limb
As a physician, I have never really liked walking canes. Here is one patient's experience:
”I noticed several problems within the first five minutes. My triceps were quickly fatigued as they worked to hold my weight up.
“As a result, my scapula elevated to relieve the triceps, putting strain on my rotator cuff. This "shrugging" effect could be somewhat offset by lowering the height of the handle below my waist, which served to extend the arm and reduce the amount of elevation in the shoulder.
“The handle of the cane was designed in such a way that the grip increased in broadness from the neck of the handle to the end, providing a wider, flatter surface where the palm would rest.
“Unfortunately, the result was not a more comfortable feel, but rather a terrible dorsiflexion combined with ulnar deviation in the wrist and a bruised hamate bone where the weight was concentrated. I felt tweaks of pain all day long in my wrist and shoulder which continued into the night, long after I had ended my experiment.
“Aside from design problems, there were several functional problems as well. For instance, each step was accompanied by a jarring vibration which was transferred up the entire length of the arm every time the rubber cane tip struck the concrete. The swing of the cane often had to be initiated by a flick of the wrist, resulting in a constant repetitive oscillation between ulnar and radial deviations.
“Furthermore, adjusting the cane to the correct height was difficult due to a simultaneous push of a button and pull of the shaft requiring relatively dexterous fingers; arthritic hands would be pitifully ineffective.”
PREDICTION! Elders of today and tomorrow are going to give up on the cane, abandoning it in favor of the quarterstaff.
"Gandalf the Grey carried about with him a spike brown staff which served partly as an agency of his power, as can be seen when he faced the Balrog in Moria. Besides functioning as a useful walking stick, it was also thought to symbolize what he was and his position in the Istari."
There are three reasons I think elders can and will retire the old-time walking cane and embrace the quarterstaff:
- The cane places the greatest strain on the smallest muscles and joints (the wrist and forearm). Repetitive use can easily lead to wrist and forearm injury.
- The quarterstaff transfers the weight into the shoulder girdle itself. The shoulder joint and its surrounding muscles are much better prepared to handle the load than are the wrist and forearm.
- Imagine a scene: an older woman using a bent-top walking cane crosses a building lobby, trying to reach the elevator before the doors roll closed. Now imagine the same scene with the older woman striding across the lobby with the aid of a seven-foot, oak quarterstaff. People hold the door open not because of chivalry, not out of a desire to help little old ladies, but rather because she just looks so damned cool.
Elders are obligated to give younger people clues about how deep and mysterious elderhood can be.
I would like any elders or elders-to-be who read this post to go out and get hold of a walking staff (it does not matter if you NEED one). Go out in public with it and follow your normal routine and have somebody take a picture of you using it. Send the photo to Ronni.
I'll close my appeal with a quote from one of America's greatest walkers...
"Although the vast majority of walkers never even think of using a walking staff, I unhesitatingly include it among the foundations of the house that travels on my back. I still take my staff along almost as automatically as I take my pack. It is a third leg to me - and much more besides.
“On smooth surfaces, the staff helps maintain an easy rhythm to my walking and gives me something to lean on when I stop to stand and stare. Over rough going of any kind, from tussocky grass to pockety rock, and also in a high wind, it converts me when I am heavily laded from an insecure biped to a confident triped…
“It may well be, too, that the staff also gives me a false but subconsciously comforting feeling that I am not after all completely defenseless against attack by such enemies as snakes, bears and men."
- - Colin Fletcher, The Complete Walker III, 1984 (page 78)
[AFTERWORD from Ronni: For about the last six or seven years of her life, until she died in 1978, Margaret Mead and I lived across the street from one another in Greenwich Village. I didn't get to spend as much time with her as I would have liked, but we sometimes walked several blocks together on our errands around the neighborhood.
She always used a quarterstaff, although I didn't know it was called that. She looked magnificent and powerful striding down the block, especially in the colder months when she wore a full-length cape. I've known since then that when the time came, I would use a staff and not a cane. Now, with Dr. Thomas's permission for us to do so even if we don't require one yet and the Colin Fletcher quote, I may start sooner.]
[At The Elder Storytelling Place today, Ronni Prior explains why she left the Country Life.]
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