A cane held on the correct side and sized to your body can take 20% to 30% of your weight off a painful knee with every step. That’s a significant reduction in joint stress, but it only works if the cane is the right height, in the right hand, and moving in the right sequence. Here’s how to get all three right.
Which Hand Holds the Cane
Hold the cane in the hand opposite your painful knee. If your right knee hurts, the cane goes in your left hand. This feels counterintuitive to most people, who instinctively grab the cane on the same side as the pain. But using the opposite hand is the key to how a cane actually works: it shifts the ground reaction force away from the affected leg, redistributing your weight across a wider base of support. Holding the cane on the same side as the painful knee does almost nothing to reduce the load on that joint.
How to Size Your Cane
A cane that’s too short makes you hunch. A cane that’s too tall pushes your shoulder up and reduces control. The simplest reliable method is to match the top of the cane to your wrist crease. Stand upright in the shoes you normally wear, let your arms hang naturally at your sides, and have someone measure from the floor to the crease on the inside of your wrist. That measurement is your cane length.
When you grip the cane at this height, your elbow should bend about 20 to 30 degrees. A study comparing two common fitting methods found that using the wrist crease measurement put 94% of people within that ideal elbow angle range, while measuring to the hip bone only worked for about 8% of people. If your cane is adjustable, set it to your wrist crease height, then double-check that your elbow has a comfortable, slight bend.
The Walking Sequence
Every step follows a three-beat pattern: cane, then painful leg, then good leg. Think of it as the cane arriving first to prepare support, your painful knee stepping into that support, and your strong leg following last. In practice, the cane and your affected leg will move almost simultaneously, with the cane landing just slightly ahead. Your strong leg then steps through to complete the stride.
Place the cane about one shoe-length ahead of you, not way out to the side or far in front. The tip should land roughly even with the toes of your painful-side foot as it steps forward. Keep your posture upright. It’s tempting to lean heavily over the cane, but that shifts your center of gravity in ways that make you less stable, not more. Let your arm absorb the weight, not your shoulder or trunk.
Going Up and Down Stairs
Stairs have their own rules, and a simple mnemonic makes them easy to remember: “up with the good, down with the bad.”
When going up stairs, step up first with your good leg. Once it’s on the higher step, straighten that leg and bring your cane and painful leg up to meet it on the same step. Your strong leg does the lifting work.
When going down stairs, reverse the order. Lower the cane to the next step first, then carefully step down with your painful leg, then bring your good leg down to the same step. Your strong leg controls the descent from above, which is far safer than leading with it.
If there’s a handrail, use it. Hold the rail with one hand and the cane in the other. Take one step at a time rather than alternating feet on each step. Speed doesn’t matter here. Stability does.
Choosing Between a Standard and Quad Cane
A standard single-point cane is lighter, easier to maneuver, and sufficient for most people with knee pain who mainly need load reduction. It works best on smooth, even surfaces and when your balance is reasonably good.
A quad cane, which has a base with four small feet, stands upright on its own and offers a wider base of support. It’s a better choice if you have balance problems in addition to knee pain, or if you feel unsteady when standing still. The tradeoff is that quad canes are heavier, slower to use, and the base needs to sit flat on the ground with every step, which can be awkward on uneven terrain or narrow spaces.
Common Mistakes That Reduce Effectiveness
The most frequent error is using the wrong hand. Holding the cane on the same side as the painful knee feels logical but bypasses the biomechanical advantage entirely. The second most common mistake is a cane that’s the wrong height, usually too short. People tend to undersize their cane, which forces them to lean forward and puts more strain on the wrist, shoulder, and lower back.
Other mistakes to watch for:
- Reaching too far forward with the cane, which pulls your weight ahead of your feet and increases fall risk.
- Gripping too tightly, which fatigues your hand and forearm quickly. A firm but relaxed hold is enough.
- Looking down at the cane instead of looking ahead. Your body follows your eyes, and staring at the ground shifts your posture forward.
- Wearing the rubber tip down to smooth. Check the tip regularly for cracks, splits, or flat wear patterns. A worn tip can slip on smooth floors, and replacement tips cost only a few dollars at most pharmacies.
How Much a Cane Actually Helps Your Knee
Proper cane use offsets roughly 20% to 30% of your body weight with each step. For someone weighing 180 pounds, that’s 36 to 54 pounds of force removed from the knee joint on every stride. Over the course of a day with thousands of steps, that adds up to a massive reduction in cumulative stress on the joint. This is why a cane is one of the most commonly recommended tools for knee osteoarthritis, particularly when the inner (medial) compartment of the knee is affected.
That load reduction only happens when the cane is in the correct hand and properly sized. Studies on contralateral cane use confirm that the benefit comes specifically from shifting weight through the opposite arm. If you’ve been using a cane and haven’t felt much relief, switching hands or adjusting the height may make a noticeable difference right away.