Non-Weight Bearing (NWB) is a medical directive meaning the injured lower limb, often due to a fracture or surgery, cannot support any weight. Following this order is necessary for proper healing, as pressure can disrupt a surgical repair or displace a fracture site. Using crutches correctly ensures the limb remains suspended while allowing you to move safely and independently. Mastering the correct technique is the first step toward a successful recovery and prevents reinjury.
Essential Crutch Fitting and Sizing
Properly fitting your crutches ensures safety and prevents secondary injuries. The overall crutch height should be adjusted so there is a clearance of about one to two inches, or roughly two to three finger-widths, between the top of the axilla pad and your armpit when standing upright. Maintaining this gap is paramount because resting your body weight directly on the armpit can compress the nerves and blood vessels in the axilla, potentially leading to a condition known as “crutch paralysis.”
The handgrip height should be adjusted next. When your arms hang naturally by your sides, the handgrip should align with the crease of your wrist or the top of your hip bone (greater trochanter). This positioning ensures that when you grasp the handles, your elbows are bent slightly, between 15 and 30 degrees. This slight bend allows your hands, not your armpits, to absorb and support your entire body weight during movement.
The Three-Point Non-Weight Bearing Gait
The standard method for moving on flat ground while keeping an injured leg off the floor is called the three-point non-weight bearing gait. Before initiating movement, ensure your injured leg is held up, often by keeping the knee bent, so the foot is completely clear of the floor.
The first point involves moving both crutches forward together, placing them about one step’s length in front of you. The second point involves transferring your weight entirely through your arms by pushing down firmly on the handgrips. While maintaining this pressure, swing your body forward, keeping the injured foot suspended in the air. The crutches and your hands are now supporting 100% of your body weight.
The third point is bringing your uninjured, weight-bearing leg through and landing your foot on the ground. For stability, beginners should aim to land the uninjured foot in line with or just behind the crutches. This three-point sequence—crutches forward, swing, foot lands—is repeated to move across level surfaces, with the injured leg never touching the ground.
Managing Stairs, Curbs, and Ramps
Navigating vertical changes requires a distinct technique, often summarized by the phrase: “Up with the good, down with the bad.”
Ascending Stairs
To ascend stairs, lead with your uninjured leg. Push down through the handgrips to lift your body, then step up onto the next step with your good foot, leaving the crutches and the injured leg on the lower step. Once the good foot is firmly planted, bring the crutches and the injured leg up to meet it on the same step.
Descending Stairs
When descending stairs, the sequence is reversed, leading with the crutches and the injured leg. Place both crutches down onto the step below and hold your injured leg out in front to ensure it clears the edge. Push down on the crutch handgrips to control your descent, lowering your uninjured leg to the same step as the crutches. Utilizing a sturdy handrail, if available, by holding both crutches in the opposite hand can enhance stability.
Curbs and Ramps
Managing curbs follows the same ascending and descending principles as stairs. Ramps require a modification of the flat gait. When going up a ramp, take shorter steps and lean slightly forward to counterbalance the incline. Descending a ramp requires leaning slightly backward, placing the crutches a shorter distance ahead to maintain control and prevent sliding.
Avoiding Common Mistakes and Ensuring Safety
One of the most frequent mistakes is resting your body weight on the armpit pads instead of the handgrips. This habit risks damaging the radial or ulnar nerves, which can lead to weakness or numbness in the hand and arm. Always consciously focus on pressing down with your hands to bear weight.
Before use, inspect the crutch tips (the rubber ferrules) for excessive wear or cracks. Worn tips reduce friction and increase the risk of slipping, especially on wet or smooth floors. Within your home, remove potential tripping hazards like loose rugs, electrical cords, and clutter from walkways.
Maintaining a steady gaze forward, rather than looking down at your feet, helps you maintain balance and an upright posture. When turning, use small, controlled steps to turn your entire body instead of twisting at the knee or hip, which can destabilize your stance.