Using a walker is necessary when one leg is unable to bear full weight, known as non-weight-bearing (NWB) or partial weight-bearing (PWB). The walker provides an external base of support, ensuring stability and reducing the risk of falls during mobility. Its purpose is to safeguard the injured limb from undue stress while maintaining the ability to move safely. Mastering the proper technique facilitates independence and protects the affected extremity during the healing process.
Selecting the Walker and Adjusting Height
When supporting nearly all body weight, a standard (non-wheeled) or two-wheeled walker is preferred over a four-wheeled rollator. Four-wheeled models are not designed to handle the full, uneven weight transfer required during a non-weight-bearing gait. The friction from rubber tips on a standard walker or the limited roll of a two-wheeled model offers a more secure base before weight is shifted.
Correct adjustment of the walker height is necessary for safe and efficient use. The top of the handgrips should align with the crease of the wrist when the user stands upright with arms hanging naturally. This positioning ensures a slight, comfortable bend in the elbows (20 to 30 degrees) when gripping the handles. Proper height prevents the user from hunching over, which strains the back, or having the walker too high, which causes shoulder fatigue and instability.
Step-by-Step Guide to the Three-Point Gait
The method used for moving with one non-weight-bearing leg is called the three-point gait. This name refers to the three points of contact that bear the weight: the walker, and the uninjured leg. Crucially, the injured leg is kept completely off the ground or is only allowed minimal ground contact if partial weight-bearing is permitted by a physician.
The sequence begins by advancing the walker forward approximately six to twelve inches. Ensure all four tips or wheels are firmly on the ground before any weight transfer occurs. The user must press down on the handgrips to establish a secure, stable platform for the body. Moving the walker too far ahead compromises balance and forces the user to lean excessively.
After the walker is securely planted, the injured leg is brought forward in a swing-through motion. Keep the foot elevated or just skimming the floor, never allowing full weight to be placed on the limb. The injured foot should land even with the front cross-bar of the walker, preparing for the final step. The arms and shoulders bear the majority of the body weight during this transfer, relieving the stress on the lower body.
The final step involves stepping through with the uninjured leg. The user pushes down on the walker handles while simultaneously stepping past the injured limb. The uninjured foot should land even with or slightly past the injured foot, completing the forward movement. Maintaining the body’s center of gravity within the confines of the walker frame is necessary to prevent lateral sway and loss of balance.
Developing a smooth, rhythmic flow is beneficial for energy conservation and stability. The entire process should ideally be a continuous pattern rather than three distinct, jerky movements. Consistent practice helps coordinate the arms, which support the body, with the legs’ forward swing.
Safe Techniques for Sitting, Standing, and Stairs
Transitioning from standing to sitting requires careful preparation to maintain stability and protect the non-weight-bearing leg. Back up to the chair until the uninjured leg touches the seat, confirming the chair is stable. Keep the injured limb extended slightly forward to ensure it does not accidentally bear weight during the descent.
The hands must move from the walker handles to the armrests or the seat of the chair before lowering the body. Never use the walker handles for final support during the sitting maneuver, as the walker could tip forward. The uninjured leg takes the body’s weight, allowing a slow, controlled lowering onto the seat.
The reverse process is used for standing. Lean slightly forward and push up primarily with the strength of the uninjured leg and the arms pressing down on the stable chair surface. Once fully upright and steady, transition the hands back onto the walker handles. Ensure the walker is positioned directly in front of the user before standing to provide an immediate base of support.
Navigating a single step or curb without an assistant requires using a handrail if one is present, grasping it with the hand opposite the rail. The mnemonic “Up with the good, down with the bad” guides managing elevation changes. When ascending, the uninjured (good) leg is lifted first onto the step, bearing the full body weight.
When moving upward, the arms push off the walker and the handrail simultaneously as the uninjured leg lifts the body vertically. Conversely, descending a step begins by placing the walker on the lower level. Follow this by the injured (bad) leg, keeping all weight off it. The uninjured leg then slowly lowers the body down to the step below, relying on the walker and handrail for support.