Many older adults begin to have knee or hip pain and stiffness during activities of daily living including walking and transfers. This is often a result of degenerative changes and arthritis in the hip and knee that comes about with aging. As we age the hip and knee joints often degenerate at a higher pace because of the higher loads placed on the hips and knees due to body weight and ambulation. If you sustained an injury to your hip or knee earlier in life you are more likely to sustain degeneration to that joint. The degeneration often causes bones to spur, joint spaces to narrow and ligaments and tendons to grow thicker. When this degenerated joint becomes painful it is often due to inflammation and mechanical loading, this often leads to a diagnosis of osteoarthritis (OA).

Clinically, physical therapists and other healthcare practitioners may have older clients with knee and hip OA report that they feel pain with transfers off a chair to stand and/or while walking. One of the reasons these activities are often reportedly painful is the increase in mechanical load on the hip and knee joints during transfers and walking. A physical therapist might recommend some mobility aids to reduce the mechanical loading process that goes on during standing and/or walking.

The first thing the physical therapist may recommend is a Quad Cane while walking. A quad cane will reduce forces on the hip and knee while walking by increasing the base of support of the person that is utilizing a cane. Your normal base of support is as wide as your 2 feet when mot using a cane, the quad cane when used in the hand opposite your painful hip or knee will increase the base of support to your 2 feet and the cane distance from your body. The cane will secondly reduce the force on your hip and knee by supporting the painful hip or knee joint therefore reducing the force of contraction your required to use in the muscles of the hip and knee. This muscle contraction force reduction further reduces the mechanical load on the hip and knee, therefore reducing pain.

A second recommendation by the physical therapist may address the transfer that is often painful for people with hip and knee . The act of transferring on and a seat also places more mechanical load on the hip and knee joints because it entails bending the joint at end range while sitting and beginning to stand. The end-range bending increases the forces on the joints. Unfortunately, the toilet is often the most painful seat in the house as it is the lowest seat in the house.

The therapist may recommend a safety rail for the toilet. The safety rail may reduce the forces on the joints by allowing the person to use their arms on the rails to help with the transfer, in turn, reducing forces on the hip and knee. Another recommendation by the therapist may be raising the toilet seat with a raised toilet seat. This reduces the forces on the knees and hips with the rails but it also further reduces the forces by raising the seat which in turn will reduce the amount of bending on both the hip and knee joints, reducing forces and pain.

Dr. Kevin Weaver
Doctor of Physical Therapy