Crutches, such as the common axillary (underarm) or forearm styles, are mobility aids designed to redistribute body weight away from an injured or weakened lower limb. Their purpose is to allow healing by minimizing the mechanical load on the affected area while ensuring the patient remains mobile. Learning the proper technique is paramount, as incorrect usage can lead to secondary complications like nerve damage, specifically crutch paralysis, which affects the nerves in the armpit. Mastering the technique provides a stable and reliable means of movement for a safer recovery.
Achieving the Correct Fit
Proper adjustment of the crutches is a prerequisite for safety and directly prevents nerve injury. The axillary pad must be positioned approximately one to two inches—or two to three finger-widths—below the armpit crease. This spacing is necessary because weight should be borne by the hands and wrists pressing down on the handgrips, not by the delicate nerves in the armpit. Placing weight directly on the armpit can lead to compression of the brachial plexus, resulting in nerve dysfunction.
The handgrip height requires adjustment so that the elbow is bent at a slight angle, typically between 25 and 30 degrees, when the hand rests on the grip. This gentle bend allows the arm muscles to effectively absorb shock and transmit downward force during walking. Before using the crutches, always check that the rubber tips (ferrules) at the bottom are intact and clean, as worn tips significantly reduce traction and increase the risk of slipping.
Walking on Level Ground
The most common method used when one leg cannot bear weight is the three-point gait. This technique involves moving both crutches and the non-weight-bearing injured leg forward as a single unit. The uninjured leg then steps through to the crutches, completing the gait cycle. This pattern maintains a stable triangle of support with the crutches and the uninjured foot.
When moving, the user must apply pressure solely through the handgrips, keeping the injured foot elevated to prevent accidental weight-bearing. The rhythm for the three-point gait is “crutches-and-injured-leg, good-leg,” creating a consistent, alternating pattern. It is helpful to maintain an upright posture and focus the gaze forward, rather than looking down, to maintain balance.
Navigating Obstacles and Stairs
Stairs present a significant challenge and require precise coordination to prevent falls. A simple mnemonic guides the process: “Up with the good, down with the bad.” To ascend stairs, the uninjured leg steps up first, followed by the crutches and the injured leg, which remain on the lower step. When a handrail is available, both crutches should be held in the hand opposite the rail to maximize support.
Descending the stairs reverses the pattern: the crutches and the injured leg are lowered to the step below first. The uninjured leg follows, controlling the descent while the hands bear the body’s weight through the handgrips.
When transitioning from standing to sitting, the user should back up until the uninjured leg feels the chair. Gather both crutches into the hand on the side of the injured leg, and use the free hand on the chair or armrest to slowly lower yourself. A similar reversal of this process is used to safely move from a seated to a standing position. On uneven terrain or wet floors, taking shorter, more deliberate steps helps maintain maximum contact between the crutch tips and the ground, improving stability.