The range of motion, can they walk on their toes and their heels? Are they using a gait-assistive device? Where did they get it? Who prescribed it? And are they using it appropriately? For example, somebody has a left knee problem. The cane, if they using a cane, goes in the opposite side. Am I right, orthopedic surgeons?
Okay. That’s how I was trained. Why? Because they can press down on the opposite side to unload the affected side. Now, you see some of these rascals, they come in with cane, it’s too short…like that. When they come in with a big… I had this one guy, he came in with this, it’s a wooden stick, it was a tree branch. It was. He shaved it down, shellacked it. He got one of these rubber stoppers that you buy at Home Depot for the chairs, put it on the knee. He looked like Moses coming down off the mountain. So, I said, “What would this is?” He said, “Oh yeah, I needed something to walk.” For me, he looked nice, but he looked like Moses.
All right. And some of the other testing that I do. Here, somebody coming in with a self-prescribed stick, another cane. Now, a cane if it’s used properly, like I said, it’s on the opposite side. I look at the cane to see if there’s any wear and tear. If they’re using the cane, I expect to see some wear on the rubber tip, I expect to see some scratches because canes don’t stand up by themselves unless you have a hurricane now and then you see on TV. that that’s a clever idea. So, in any event, is it being used? If they using it right, the top of it should come at the area of the greater trochanter. The elbow is used in a flexed position of 30 to 40 degrees, okay? Not like this, not like that.
Then, who prescribed it? Did they tell you to stop it or whatever? But some of these rascals, they come in with what I call an “Uncle Louie cane.” You never heard of it. That’s a Tony Dorta [SP] definition. Uncle Louie worked on the docks in Brooklyn, New York. He hurt his back years ago. Someone prescribed the cane. He wore it for a while. He got better and it went up into the closet. Twenty years later, somebody in the family decides that they’re gonna use a cane, so they take out the cane from the closet and they start using it. So that’s what I call an Uncle Louie cane.
Excerpted from SEAK’s stream on-demand course, “How to Start, Build, and Run a Successful IME Practice”