How to Go Up and Down Stairs With Crutches

The standard rule taught in physical therapy clinics everywhere is “up with the good, down with the bad.” When climbing stairs on crutches, your uninjured leg steps up first; when descending, your injured leg and the crutches go down first. That simple phrase captures the core technique, but actually executing it safely involves details that matter more than most people expect, especially regarding handrail use, crutch placement, and knowing how much more energy stairs demand compared to flat ground.

The Step-by-Step Technique for Going Up

Stand at the base of the stairs with both crutches tucked under your arms or gripped in your hands, depending on the type. If a handrail is available, hold both crutches in the hand opposite the railing and grip the rail with your free hand. If there is no railing, keep one crutch under each arm.

To ascend, push down through your crutches and your uninjured leg simultaneously, then step your good leg up onto the next step. Once that foot is securely planted, bring the crutches and your injured leg up to the same step. You are not trying to alternate steps like normal walking. Both the crutches and your injured leg always trail behind your good leg, arriving on the same step your good leg just claimed. Repeat this one step at a time.

The reason for leading with the strong leg is straightforward: going up requires you to lift your body weight, and your healthy leg is the only one that can reliably push you upward. If you tried to lead with the injured leg, you would need to put weight through it to push off, which is either painful or medically prohibited depending on your injury.

The Step-by-Step Technique for Coming Down

Descending reverses the order. Stand at the top of the staircase and, if a handrail is present, gather both crutches into the hand away from the railing. Lower your crutches onto the step below first, then bring your injured leg down to that same step. Finally, step your good leg down to join them. Again, you move one step at a time, never skipping steps or trying to alternate feet.

Going down feels scarier for most people, and there is a real reason for that. Your body weight is essentially falling onto the lower step with each movement, and your arms and one good leg have to control that descent. Lowering the crutches first gives you support before your center of gravity shifts forward over the edge. If you feel unsteady, pause on each step with both feet and the crutches all on the same level before proceeding.

Why a Handrail Changes Everything

If you have access to a handrail, use it. A railing provides stability that two crutches on narrow stair treads simply cannot match. The technique shifts: you hold both crutches in one hand like a bundle (gripping the hand pieces together) and use your other hand on the rail. The railing essentially replaces one crutch’s job while offering far better balance. Your free hand manages the crutches, moving them one step at a time alongside your injured leg.

The trade-off is that bundling both crutches into one hand feels awkward and slightly unwieldy. The crutch tips can catch on steps or each other. Practice this transfer at the bottom of the stairs before committing to a full flight. Some people prefer to leave one crutch at the bottom and carry only one up, switching back to two at the top. That works fine as long as you have somewhere safe to lean the spare.

Partial Weight-Bearing Changes the Rules Slightly

Everything described so far assumes you are non-weight-bearing on the injured side, meaning you cannot put any load through that leg at all. If your surgeon or physiotherapist has cleared you for partial weight-bearing, the same “good up, bad down” sequence applies, but you may place some weight through the injured leg as it follows. This makes the process significantly less exhausting because your arms share the workload with both legs rather than doing nearly all of it.

If you have been given a toe-touch or featherweight restriction, treat it the same as non-weight-bearing for stair purposes. The small amount of contact allowed under those restrictions is not enough to meaningfully support you on a step, and the risk of accidentally loading the leg increases on an incline. When in doubt, ask your physiotherapist to walk you through the stairs in person before you attempt them at home.

Why Stairs Feel So Much Harder Than Walking on Flat Ground

If you have been getting around on crutches for a few days and then encounter a flight of stairs for the first time, the jump in difficulty can be startling. This is not in your head. Research measuring oxygen consumption during crutch use found that non-weight-bearing crutch walking on flat ground required about 16.4 ml/kg/min of oxygen, while climbing stairs pushed that to roughly 17.9 ml/kg/min. In metabolic terms, flat crutch walking rated about 4.6 METs and stair climbing about 5.1 METs, placing stair climbing with crutches solidly in the moderate-to-vigorous exercise category.¹ For context, five METs is roughly equivalent to a brisk cycling pace. You are working genuinely hard, and it is normal to be winded at the top.

Separate research comparing different mobility aids found that axillary crutches were actually more energy-efficient than a walker for stair climbing, even though walkers tend to be easier on flat ground. The likely explanation is that crutches allow a more fluid rhythm on steps, while a walker’s bulk makes stair negotiation clumsy and slow.² If you have both a walker and crutches at home, switching to crutches just for the stairs is a reasonable strategy.

Axillary Crutches Versus Forearm Crutches on Stairs

The two most common crutch types are axillary (underarm) crutches and forearm (Lofstrand or elbow) crutches. In many countries, underarm crutches are the default after an acute injury, while forearm crutches are more common in Europe and among long-term users. A natural question is whether one type handles stairs better than the other.

A prospective study comparing the two found that participants reported axillary crutches had an easier learning curve and felt superior for balance and stability. Objective posturography testing confirmed lower effort scores for backward tilts with axillary crutches compared to forearm crutches.³ For someone new to crutches after a fracture or surgery, underarm crutches generally feel more intuitive on stairs because the armpit rest provides a passive stability checkpoint even when your arms are tired.

That said, research on energy cost found no meaningful difference in oxygen consumption or heart rate between underarm and forearm crutches during stair climbing.⁴ Physiologically, your body works about equally hard with either type. The real difference is perceived confidence and ease of learning. If you already own forearm crutches and feel comfortable with them, there is no reason to switch just for stairs.

What Your Hip Muscles Are Doing on the Stairs

You might assume that crutch stair-climbing is all about your arms, but your hip stabilizers are working harder than you think. A study using electromyography to measure gluteus medius activation during stair ascent with elbow crutches found that how you position the crutch relative to your legs makes a measurable difference. When the crutch was on the same side as the loaded leg, the gluteus medius in all three of its portions fired significantly harder. When the crutch was on the opposite side, activation dropped.⁵

This matters practically for two reasons. First, if you are recovering from a hip replacement or have been told to strengthen your hip abductors, the way you use the crutch on stairs is quietly either helping or undermining that goal. Second, the gluteus medius is the muscle that keeps your pelvis level when you stand on one leg. If it fatigues during a long flight of stairs, your pelvis may drop on the unsupported side, making you feel unsteady. Building rest stops into a long staircase is not laziness; it is protecting your balance.

Protecting Your Wrists and Shoulders

Short-term crutch use rarely causes lasting problems, but extended time on crutches, especially with stairs, can take a toll on your upper limbs. The repetitive loading pattern of crutch gait has been linked to shoulder joint wear, wrist pain, carpal tunnel syndrome, and hand numbness. The primary culprits are the repetitive impact each time the crutch hits the ground and the sustained wrist extension required to grip the handles.⁶

Stairs amplify these forces. Each step up requires a strong push through the crutch tips, and each step down demands that your arms absorb your dropping weight. A few practical steps can help:

• Padded grips: Aftermarket foam or gel grip covers reduce the pressure on your palms and wrists. They cost very little and make a noticeable difference over a full day of crutch use.
• Correct crutch height: If the crutches are too tall, your shoulders hunch; too short, and you lean forward, increasing wrist strain. With your arms relaxed at your sides, the top of an underarm crutch should sit about two finger-widths below your armpit, and the handgrip should be at wrist level.
• Avoid armpit pressure: Never rest your body weight on the underarm pad. The crutch tops are for lateral stability only. Your weight belongs on the handgrips. Pressing into the armpit can compress the brachial plexus nerves and cause tingling or weakness in your hands, a condition sometimes called “crutch palsy.”
• Rest between flights: If you live in a multi-story home, give your shoulders and wrists a break on landings. Fatigued arms are less effective shock absorbers.

When You Should Not Attempt Stairs at All

Not every situation on crutches is compatible with stairs. If you are heavily sedated from pain medication, stairs introduce a fall risk that no technique can fully mitigate. The same goes for very steep or narrow staircases where the treads are not deep enough for a crutch tip and your foot simultaneously. Spiral staircases with pie-shaped steps are especially tricky because the narrow end of each step gives almost no room for crutch placement.

If you have only one functional arm, standard two-crutch stair technique is not feasible. In that case, a single crutch and a railing, or scooting up and down on your backside, may be the safest option. Scooting is slow and undignified, but it is stable: you sit on a step, place your crutches beside you, and use your good leg and free arm to lower or raise yourself one step at a time. Many physiotherapists teach this as a backup method even for people who can use two crutches, because fatigue or pain may make the standing technique unsafe partway through a flight.

Outdoor stairs present additional hazards. Wet, icy, or uneven steps are dangerous for anyone, but crutch tips on a slippery surface can slide without warning. Rubber crutch-tip covers with textured treads help somewhat, and some companies sell ice-cleat attachments that fit over crutch tips for winter conditions. If the stairs are visibly icy, do not rely on grip alone; find an alternative route or ask for help.

Hands-Free Crutch Alternatives

In recent years, hands-free crutches and knee scooters have become more widely available. A hands-free crutch (sometimes called a knee crutch or pirate crutch) straps to your bent injured leg and functions as a peg leg, leaving both hands free. A crossover study comparing forearm crutches to a hands-free single crutch found that stair climbing took slightly longer with the hands-free device: about 29 seconds versus 26 seconds for a standard flight. The biggest difference appeared on inclines, where the hands-free device took roughly 33 seconds compared to 18 seconds with forearm crutches.⁷

On flat ground, many users love the freedom of having both hands available. But on stairs, the strapped-on design forces an unusual gait pattern and limits how quickly you can adjust your balance. Most hands-free crutch manufacturers recommend using a handrail alongside the device for stairs. Knee scooters, by contrast, are not designed for stairs at all and should be left at the top or bottom.

Getting Stair Practice Before You Need It

If you are having a planned surgery like a knee replacement or ACL reconstruction, practicing the stair technique before the operation dramatically reduces the learning curve. Hospitals and outpatient rehab clinics often include a short staircase in their therapy gyms specifically for this purpose. Doing a few supervised laps pre-surgery, when you are pain-free and clear-headed, builds muscle memory that your body can fall back on when you are groggy and sore afterward.

Research looking at stair negotiation as a rehabilitation tool after hip and knee replacements found that stair exercises appeared in most rehabilitation protocols studied, though the evidence on exactly how much they contributed to outcomes beyond the overall program remained difficult to tease apart.⁸ Regardless of whether stair practice alone speeds recovery, the practical reality is that most homes have stairs, and being unable to manage them safely can delay discharge from the hospital or force you onto a ground-floor-only arrangement for weeks.

Common Mistakes That Lead to Falls

Most crutch-related stair falls share a handful of causes, and almost all of them are preventable once you know to watch for them.

• Reversing the sequence: Leading with the injured leg going up, or with the good leg going down. This puts your weakest limb in the power position and is the single most common error. The mnemonic “up with the good, down with the bad” exists precisely because the instinct under stress is to do it backward.
• Crutch tips off the edge: If the rubber tip is hanging even slightly over the front of the step, it can slip off when loaded. Place each crutch deliberately, well back from the edge, before shifting your weight.
• Going too fast: Stairs on crutches are not a race. Each step should be a complete stop-and-go movement, especially when fatigued. Trying to build a rhythm as you would on flat ground increases the chance of mistiming a step.
• Carrying objects: You need both hands for crutches (or one hand and a railing). Carrying a bag, a cup of coffee, or a phone while negotiating stairs is a fall waiting to happen. Use a backpack for items you need to move between floors.
• Wearing socks without shoes: Socked feet on hardwood or tile stairs are dangerously slippery. If you cannot wear a shoe on your good foot, at least use a non-slip sock or go barefoot.

Crutch Tips and Stair Surfaces

The interface between your crutch tip and the step surface matters more than most people realize. Standard crutch tips are made of gray rubber with a flat or slightly domed bottom. On clean, dry indoor stairs, they work fine. On polished stone, wet tile, or painted wooden steps, they can slide alarmingly. If your home has a surface that makes you nervous, aftermarket high-traction tips with deeper treads are available from most pharmacies and medical supply stores. Some tips also feature a pivoting design that keeps the rubber flat against the step even if the crutch is angled slightly, which is common on narrow treads.

Carpeted stairs are generally the safest surface for crutch use because the carpet fibers grip the rubber tip well. The downside is that thick carpet can make the crutch tip feel “squishy” and less predictable. A medium-pile carpet with a firm pad underneath is close to ideal. If you have a choice of which staircase to use in a building, pick the carpeted one.

Outdoor concrete or asphalt steps tend to provide good grip but punish mistakes with harsh falls. The uneven surfaces sometimes found on older exterior staircases can catch a crutch tip unexpectedly. Walk each step with your eyes on the surface rather than looking ahead. And if the steps are covered with wet leaves or moss, treat them with the same caution you would give an icy surface.