Do Crutches Make You Stronger? The Reality of Strength Gains

Crutches place significant muscular demands on your upper body and core, and the energy you burn while using them can rival or exceed the cost of running the same distance. But calling that a “strength workout” stretches the truth. The muscles doing overtime are working to compensate for an injured limb, not following a progressive overload program, and the limb you’re resting loses muscle and bone surprisingly fast. The net result is more of a lopsided trade-off than a training stimulus.

Your Trunk and Arms Work Harder Than You Think

The most immediate physical reality of crutch walking is how much more your torso muscles have to do. A simulation study comparing normal walking to crutch-assisted walking found that average trunk muscle activation jumped from about 1% during regular walking to 31% when using a single crutch and 9% with two crutches.¹ That single-crutch figure is striking: your trunk is working roughly 30 times harder to stabilize your body with one support point than it does during a normal stride. Two crutches distribute the load more evenly, but the demand still dwarfs what your core handles during ordinary walking.

Electromyographic (EMG) studies confirm this pattern. Research measuring abdominal and oblique muscle activity during non-weight-bearing gait found that both the rectus abdominis and the external obliques were most active during the swing phase, when the body is suspended between the crutches and one leg has to swing forward without touching the ground.² Your core is essentially doing a dynamic stabilization exercise with every step.

There is a catch, though. Research on adolescents with spastic diplegia who used crutches found that while pelvic tilt increased and stride time lengthened, erector spinae activity and lower trunk extension actually decreased during crutch walking.³ In other words, the crutches shifted how the trunk muscles worked rather than uniformly ramping everything up. Some muscles fire more, others fire less, and the overall pattern changes depending on the person’s gait and disability. It is not a clean “total core workout.”

Energy Expenditure Comparable to Running

If crutch walking feels exhausting, your body is confirming what researchers have measured for decades. Oxygen consumption during underarm crutch walking is roughly double that of normal walking at similar speeds.⁴ Non-weight-bearing crutch walking on level ground registers at about 4.6 METs, which puts it in the moderate-to-vigorous exercise category, while crutch-assisted stair climbing hits roughly 5 METs. Heart rates during level crutch walking averaged around 117 beats per minute in one study.⁵ For context, 117 bpm is what many people hit during a brisk jog.

A direct comparison between axillary crutch walking and running over one kilometer highlights the mismatch between effort and speed. Steady-state heart rate was actually somewhat lower during crutch walking than running, but the metabolic cost per unit distance was about 75% higher with crutches because you move so much more slowly.⁶ Participants rated crutch walking as the most stressful of the three activities, beating both walking and running on perceived exertion scales. The cardiovascular system treats crutch walking more like an upper-body exercise than a lower-body one, with heart rates elevated disproportionately compared to oxygen use, a pattern confirmed by separate heart rate monitoring studies that found walking heart rates jumped between 29 and 59% above resting levels.⁷⁸

Both crutch types, standard and rocker-bottom axillary, produced slower walking speeds, greater oxygen use, higher relative exercise intensity, and reduced gait efficiency compared to normal walking.⁹ So yes, you are getting a cardiovascular workout on crutches. The question is whether that kind of exertion translates into meaningful fitness adaptation, or whether it just makes you tired and sore in ways that don’t really help you once you’re healed.

The Injured Leg Pays the Price

While your arms and core are working overtime, the leg you’re protecting is quietly deteriorating. Muscle loss during non-weight-bearing immobilization happens faster than most people expect. One imaging study tracked patients after lower-limb fractures and found that thigh muscle cross-sectional area dropped from about 86 to 77 square centimeters, roughly a 10% loss, while calf muscles shrank from about 53 to 49 square centimeters.¹⁰ And this wasn’t just muscle disappearing: intramuscular fat also increased, meaning the remaining tissue was qualitatively worse, not just smaller.

Research specifically on limb unloading in healthy volunteers showed that removing weight-bearing stress from one leg caused a 7% drop in muscle cross-sectional area and a 6% decline in muscle density, along with a 22% loss in concentric strength and a 16% loss in eccentric strength.¹¹ Strength was still down 11% four days into recovery. The speed of deterioration is the real story: your injured leg doesn’t wait patiently while you heal. It starts weakening within days.

This is the central problem with the “crutches make you stronger” idea. Yes, your upper body and core are loaded more heavily. But your lower body is simultaneously losing tissue. The net change in total body strength is probably negative for anyone who spends more than a week or two on crutches, especially because most people are not deliberately trying to maximize upper-body adaptation during this time. They are just trying to get to the bathroom and back.

Bone Loss Adds Another Layer

Muscle isn’t the only tissue that deteriorates. Bone mineral density in the unloaded leg also drops, and it recovers slowly. A study measuring tibial bone density in patients after hip surgery found that even brief periods of non-weight-bearing caused significant bone loss, and it took one to one and a half years to recover baseline density.¹² The loss hit the spongy interior bone first, then spread to the denser outer cortex. Patients who were perimenopausal, on corticosteroids, or who had prolonged bed rest on top of crutch use lost bone even faster.

This is worth knowing because people who feel their arms getting sore on crutches may assume the experience is making them tougher overall. In reality, the skeleton of the resting leg is weakening in a way that increases fracture risk during the transition back to full weight-bearing. The recovery timeline for bone is much longer than the recovery timeline for muscle, so even after you feel strong again, the bone may not have caught up.

Shoulder Loads and Wrist Injuries

The forces passing through your shoulders during crutch walking are large enough to cause real damage, especially over weeks or months. In-vivo measurements using instrumented implants found that shoulder joint loads during crutch walking peaked at up to 170% of body weight, with particularly high forces in patients using forearm crutches.¹³ A separate biomechanics comparison found that crutch walking produced significantly higher peak forces and loading rates at the shoulder than using a walker.¹⁴ The dominant force direction was upward into the shoulder joint, meaning the rotator cuff and surrounding structures absorb repeated compressive impacts with every swing-through step.

For short-term users recovering from an ankle sprain or knee surgery, this is typically manageable. The concern is for long-term or chronic crutch users. In populations who rely on crutches for years, carpal tunnel syndrome becomes a real occupational hazard. Research in long-term crutch users with polio sequelae found a direct correlation between the hand holding the crutch and the hand that developed carpal tunnel syndrome.¹⁵ A broader study in the same population found that the relative risk of developing median nerve compression at the wrist was nearly five times higher for people who used a combination of canes, crutches, and wheelchairs, compared to those who didn’t.¹⁶ Almost half of that patient cohort had wrist pain.

The implication is clear: the “strength” your arms and hands gain from crutch use comes alongside repetitive stress that can produce nerve damage, tendinopathy, and chronic joint pain. Muscle overload without recovery and progressive programming isn’t training. It’s overuse.

Axillary Versus Forearm Versus Hands-Free Devices

Not all crutches stress the body equally, and the type of device you use changes which muscles get worked and how hard your cardiovascular system has to push. This matters if you’re trying to decide which device might preserve your fitness, or at least do the least harm.

Axillary (underarm) crutches allow you to transfer body weight through the stronger scapular and shoulder girdle muscles, with the crutch anchoring high on the trunk. Forearm crutches route force through the smaller forearm muscles and elbow joint, which are less stable. A prospective comparison found that axillary crutches allowed for longer strides, higher cadence, and faster speeds, while forearm crutches produced a greater increase in heart rate, indicating more effort for the same distance.¹⁷

Hands-free single crutches, which strap to the lower leg and let you walk with a bent-knee gait, are a newer category. They demand notably more from the muscles of the injured leg itself. EMG studies comparing a hands-free single crutch to standard axillary crutches found significantly greater muscle activity in the rectus femoris, gluteus medius, and lateral gastrocnemius on the injured side when using the hands-free device.¹⁸ A similar comparison against knee scooters showed greater peak EMG in the rectus femoris, lateral gastrocnemius, and gluteus medius with the hands-free device.¹⁹

From a pure muscle-activation standpoint, hands-free crutches are arguably the only assistive device that might slow lower-limb atrophy, since they keep the thigh and hip muscles engaged. But they also come with trade-offs: they require balance, they aren’t suitable for all injuries, and they don’t eliminate the cardiovascular burden. In a comparison of energy expenditure across devices, knee scooters produced the lowest energy cost and heart rate, followed by hands-free crutches, with standard axillary crutches demanding the most.²⁰ Patient-reported dyspnea and fatigue were also dramatically lower with hands-free crutches compared to standard axillary crutches, with fatigue scores roughly half as high and heart-rate changes about 40% smaller.²¹

Why the “Workout” Framing Misleads

People sometimes approach a crutch period with a silver-lining attitude: at least my arms will get jacked. The problem with this framing is that strength adaptation requires progressive overload, adequate recovery, and balanced loading. Crutch walking provides none of these. The load is repetitive and unchanging, the tissue doesn’t get recovery days, and the pattern is deeply asymmetric. What crutches actually produce is more like what happens to a warehouse worker doing the same lift thousands of times a day: some muscular conditioning, yes, but also cumulative stress on tendons, nerves, and joints that can outrun the adaptation.

The cardiovascular demand is real, but it is not efficient cardio. You burn more calories per meter traveled than a runner does, but you cover far less ground and the perceived exertion is disproportionately high. Nobody uses crutch walking as a deliberate training modality because the effort-to-benefit ratio is terrible compared to almost any actual exercise.

If you want to preserve or build upper-body strength during a lower-limb injury, seated resistance training, wheelchair-accessible gym equipment, or even resistance bands will give you more controlled, progressive stimulus with far less injury risk. Crutches are a mobility tool, not a gym.

Your Brain Misjudges Speed on Crutches

An underappreciated risk of crutch use has nothing to do with muscles or joints. Research on gait imagery found that both young and older adults significantly overestimated how fast they could walk on crutches. People imagined themselves moving faster than they actually were, and the gap was larger in older adults.²² The practical consequence is that crutch users may misjudge how long it takes to cross a street or navigate a crowded space, increasing fall risk. This mismatch between perceived and actual ability is especially relevant for anyone who feels their arms getting stronger on crutches and assumes that means they’ve “mastered” the device. Physical confidence on crutches can outpace actual competence, and the asymmetric gait pattern makes falls more dangerous because you can’t catch yourself the way you normally would.

Falls on crutches are particularly hazardous because both hands are occupied, eliminating the protective reflexes that typically soften a fall. Older adults, who already face elevated fall risk, are dealing with a device that makes their balance worse while simultaneously making them believe they’re moving more quickly and capably than they are. For anyone on crutches, the honest advice is to treat the device as a compromise that gets you through recovery, not as an opportunity to get stronger. The real training starts when you can safely load both legs again.