When a medical professional orders non-weight bearing (NWB), the injured limb must not bear any of the body’s weight, not even for a second of pressure on the floor. This is the most restrictive weight-bearing status, often prescribed after a fracture, ligament repair, or certain surgeries to allow bone and soft tissue to heal without mechanical stress. Crutches serve as a necessary mobility tool, acting as extensions of the arms to provide support and stability while protecting the injury. Successfully using crutches requires a precise technique that transfers all body weight from the legs to the upper body and arms, demanding proper adjustment and consistent adherence to the NWB rule.
Preparing the Crutches for Safe Use
Properly fitting the crutches is foundational to safety and preventing secondary injuries, such as nerve damage. The overall height must be adjusted first, ensuring the top of the crutch pad rests approximately one to two inches below the armpit when standing upright. This distance prevents the crutch from pressing directly into the axilla, where nerves and blood vessels are vulnerable to compression.
The body weight must be supported by the hands and arms, not the underarm pads. The hand grips should be positioned so the elbow is slightly bent, ideally at an angle between 15 and 30 degrees, when the hands rest naturally on the grips. Ensure the hand grip aligns with the crease of the wrist when the arm hangs at the side. This placement ensures the strongest muscles of the upper body bear the full load during movement.
Mastering the Non-Weight-Bearing Gait
The method for horizontal movement with NWB crutches is known as the three-point gait, which uses the two crutches and the single uninjured leg as the three points of contact. To begin, advance both crutches simultaneously forward about one foot, establishing a stable base ahead of the body. The injured foot must be kept elevated, often with the knee slightly bent, to ensure it does not accidentally contact the ground.
Next, shift your weight entirely onto the hand grips, pressing down firmly with straight arms. The body is then swung forward, landing the uninjured foot on the floor slightly ahead of the crutch tips or directly in line with them. This sequence—crutches forward, then hop—is repeated, maintaining a smooth, rhythmic motion while keeping the gaze focused forward. This pattern ensures the injured limb remains suspended and protected, transferring the load safely through the arms and the uninjured leg.
Navigating Stairs and Transitions
Navigating stairs requires a deliberate technique to maintain balance and NWB status. When ascending, the principle is to lead with the uninjured limb, often remembered as “up with the good.” If a handrail is available, hold the crutches together in the hand opposite the rail, using the rail for additional support.
Step up with the uninjured foot first, bearing all weight through that leg and the crutch-holding arm, before bringing the crutches and the injured leg up to the same step. Conversely, descending stairs follows the rule of “down with the bad.” The crutches and the injured leg move to the lower step first. The uninjured foot then follows, with body weight supported by the arms pressing down on the crutches and the handrail. If no handrail is present on stairs, both crutches must be used, placing them on the step below before lowering the uninjured foot.
Transitioning to Sitting
For transitioning from standing to sitting, back up until the uninjured leg is touching the front edge of a stable chair. Gather both crutches and hold them in one hand, positioned on the side of the uninjured leg for stable support. Reach for the chair’s armrest or seat with the free hand. Keeping the injured leg extended forward, slowly lower the body into the seat, reversing the process to safely stand back up.