The instruction “non-weight bearing” (NWB) means the injured limb must not touch the ground or bear any weight. Standard walkers are medically unsafe for use on stairs because they cannot be reliably stabilized across multiple steps. When stair negotiation is unavoidable, this modified technique relies heavily on a sturdy handrail and requires transitioning the walker to an alternative assistive support, such as crutches or a cane. This method differs significantly from a standard walking gait and requires substantial upper body strength for safe execution.
Essential Safety Assessment Before Stair Travel
Before attempting to ascend or descend stairs, a thorough safety assessment is necessary to prevent falls and injury. The individual must confirm they can maintain the non-weight-bearing status, keeping the injured limb elevated and away from the steps. This requires a conscious effort to avoid accidental contact that could compromise recovery.
Footwear should be secure, supportive, and feature non-slip soles to maximize traction on the step surface. The handrail must be checked for sturdiness and continuity, as it will bear a substantial portion of the body weight during the maneuver. If the handrail feels loose, wobbles, or ends prematurely, the stairs should not be attempted.
A spotter or assistant is recommended, especially for initial attempts, to provide verbal cues and a safety net against loss of balance. The walker must be managed by either folding it and holding it in the hand opposite the handrail, or by leaving it at the landing and transitioning to a single crutch or cane for balance. Since the walker is too wide and unstable for a single stair step, it is used only for walking on flat ground.
Technique for Ascending Stairs (Up with the Good)
Ascending stairs requires lifting the entire body weight with the strong leg and arms, following the principle “Up with the good leg first.” The user stands close to the bottom step, placing one hand securely on the handrail and holding the assistive device in the opposite hand. The assistive device and the NWB limb remain on the lower step.
To initiate the movement, the strong, uninjured foot is placed firmly onto the next step up. The individual then pushes down simultaneously through the handrail and the assistive device, using the quadriceps and gluteal muscles of the strong leg to lift the body vertically. This powerful push generates the necessary force to overcome gravity.
Once the body is lifted, the NWB limb and the assistive device are brought up to meet the strong foot on the same step. The movement must be slow and deliberate, pausing on each step to re-establish balance before moving the hand up the rail. This sequence ensures the strong leg always performs the work of lifting while the NWB leg is protected.
Technique for Descending Stairs (Down with the Bad)
Descending stairs requires controlling the body’s downward momentum, following the principle “Down with the bad leg first.” The user must position themselves near the edge of the top step, maintaining a secure grip on the handrail with one hand and the assistive device in the other. Both the handrail and the assistive device should be positioned one step below the user.
The assistive device and the NWB limb are first lowered onto the next step, ensuring the NWB foot does not bear any weight. The body weight is then transferred and supported through the arms and shoulders pressing down on the handrail and the assistive device. This controlled lowering demands significant eccentric strength from the upper body musculature.
The strong foot is then slowly brought down to join the NWB limb and the assistive device on the lower step. This process requires a coordinated and measured descent, placing the strong foot down last to provide final stabilization. The entire sequence is repeated one step at a time. Because gravity increases the risk of a misstep, meticulous control and a firm grip on the handrail are necessary.