to the editor: The authors of this article, Drs. Bradley and Hernandez, did not mention walking sticks as an option. At 92 years of age, my father did not want to look like an old man, so he began using a walking stick instead of a cane, believing that it would strengthen him by exercising his arm.

For several reasons, I wholeheartedly agree that a walking stick is better than a cane. I see many people who have shoulder problems from leaning on a cane. A walking stick does not put pressure on the shoulder, but rather enables the biceps muscle to hold the body up. In addition, many people using a cane bend forward and take very short steps. The walking stick encourages the patient to stand straighter, have better posture, and walk with a more natural stride (within the limits of the condition requiring the assistive device). I have prescribed walking sticks to several patients who have found them to be more helpful than a cane.

in reply: We chose to not mention walking sticks in our review article because most studies evaluating the benefits of cane use on gait, balance, joint load, pain, and function were done using standard canes, and did not include walking sticks. However, given the paucity of high-quality randomized controlled trials on assistive device use, anecdotal report is not without value, and Dr. Mendelsohn makes an important point about patient acceptability and adherence.

Our review article focused on assistive device use for patients with gait instability. Walking sticks are probably more beneficial for higher-functioning patients who are interested in the exercise benefit of walking. A small study of mountain walkers found that trekking poles reduced indices of muscle damage, assisted in maintaining muscle function in the days after a mountain trek, and reduced the potential for subsequent injury.¹ Even among hikers, though, up to 95 percent may not use the sticks with correct technique, much like patients using other assistive devices.²

One more applicable, but also small, study comparing the effect of a simple cane, a quadripod cane, and a Nordic walking stick on walking capacity, gait parameters, and patient satisfaction in those with hemiparesis found the simple cane to be most efficient and most preferred by patients.³ If a patient using a cane is having shoulder problems, then his or her technique should be reexamined. The cane height may need to be readjusted, or a walker may be the more appropriate assistive device.

Finally, although other assistive devices are covered by Medicare, walking sticks are not.