A Stick is the first thing many of us reach for when we become unstable, but why? Well, quite simply, we are afraid we may fall and a stick seems to be the perfect solution, but is it? There are issues with relying on sticks as, over time, you become more unstable.
The purpose of a stick is perhaps one of the most misunderstood areas in both general medicine and the public. The purpose of sticks, crutches and other walking aids is, in fact, to try to ‘normalise’ gait, through offering enough support to allow the person to walk normally again. That is to say, evenly loading the left and right sides and allowing an equal stride length to occur. In addition, preventing the person from limping, or using other gait compensations that can lead to uneven loading and the favouring of one side. These gait compensations all lead to further problems, which we will explore below.
Why use a stick?
So of you find yourself in a situation where you feel sticks will be helpful for confidence or support, or are offered a stick by a healthcare practitioner, the real question is…. Why do you need that stick in the first place? What has gone so wrong with your mobility and balance that you are unable to walk, or walk confidently without it. Finding out the answers to this is more important in the long term than resorting to a stick, as the reasons are nearly always reversible.
Common reasons why people move onto a stick include:
- Pain from both Osteo and Rheumatoid arthritis.
- Feeling unstable, vertigo and dizziness.
- Inability to lift feet, history of trips or falls.
That’s just a few of the more common reasons; all of which can be dealt with in their own right without the need to turn to a stick, at least in the long term.
At this point it is important to note, that if things have reached a point where you need a stick, then use it as you need it, but then set out to discover how you got to this point and what can be done to reverse it. Once you start down the road of using sticks, you begin to introduce a number of further issues that will eventually put you into a vicious circle of decreasing balance, mobility and confidence. We explore these below.
Centre of balance issues with a Stick
The body spends its life time performing an incredible and dynamic balancing act over an extremely small base of support…the feet. This is how various postural inefficiencies can develop over many years, as people move segments of their bodies about to make sure their body as a whole stays over the base of support. This can lead to some interesting postures, such as head and shoulders forward, with a lean backwards at the waist and an anterior tilt of the pelvis. These positions tend to be crept into over a number of years, so can go unnoticed, until the point that there is nowhere else left for the body to go, and balance suddenly becomes an issue. With work, postural adaption like this can be improved or reversed, however, what happens if you turn to a stick?
What happens if you turn to a stick?
When used for support, a stick tends to be used in front of the body, rather than to the side. This leads to a forward lean (on top of an existing forward lean!), which moves the centre of gravity forward of our base of support. This is a real problem, it makes it very difficult to lift the leg and the foot a decent distance from the ground. This not only makes walking harder work, but significantly increases the likelihood of tripping on low level things such as the edges of paving slabs, rugs, carpets and doorways. A more common reason for a fall is a loss of balance at a step or a threshold, as the stick is lifted to clear the item, and that balance/ support point is momentarily gone. The longer you spend in this situation, the worse it becomes in terms of both balance and mobility. This can lead to less walking, as it is hard work, which leads to a loss of fitness and strength. This, in turn leads, to even less ability to lift the legs and feet, and even more reliance on the stick. This cycle continues until you need two sticks, as one is no longer sufficient for support. Eventually the sticks become inadequate so a walker is introduced instead and so it goes on. Sound familiar?
How does a stick affect Balance senses.
Using a stick also resets our balance senses, and that really is a problem. As with our centre of balance, we spend our lives performing that incredible balancing act, not on two feet but on one foot at a time. That is only possible through a series of balance senses, which are known to deteriorate with age, but that deterioration is stoppable and to a good degree, reversible with simple exercises.
The issue with introducing a stick is that we have just changed from a life-time of learning to balance on two points of contact if standing still, or one point if walking, to a third point of contact, the stick! This works until the stick is abandoned, possibly just for a few seconds to open a door, or step over a threshold. At this point there is now an increasing likelihood that a loss of balance and a fall will occur, and that’s on top of the issues mentioned above of a forward lean that develops through the use of a stick. So we are now in a situation where we have a poor centre of balance mixed with altered balance senses. It’s all getting very likely to go wrong!
So what can I do other than use a stick?
If you are used to a stick, you cannot rush the changing in the use of it. You will need to undertake various exercises, to allow your balance senses to retrain, and will have to reset your movement and balance pattern away from stick use. Careful changes in the way the stick is used, ultimately leading to a gradual weaning off a stick is necessary, whilst of course addressing the background causes that took you onto the stick in the first place. This is the job of a physiotherapist working in a hospital based falls and balance unit, which are not common enough in existence
However, we can help with this and if you would like to stop using or reduce your reliance on your stick. We can gently retrain your centre of balance, balance senses, strength and postural issues using simple at home exercises, until you don’t need the stick any more.
See how we can help you with your risk of Trips and Falls here
For more information on falls prevention take a look at this NHS information page.
