Elbow crutches, also known as Lofstrand or forearm crutches, offer significant support and mobility for individuals who have limitations on how much weight they can bear on one or both legs. Unlike axillary crutches that require support beneath the armpits, these devices feature a cuff that encircles the forearm, which allows for greater freedom of movement and easier use on stairs. They are often prescribed for long-term use because they help build core strength and upper body coordination, contributing to a more natural and balanced walking pattern. Using them safely and effectively requires meticulous attention to proper fitting, mastering specific movement techniques, and confidently handling environmental changes.
Proper Sizing and Adjustment
Achieving the correct fit is the foundation of safe and comfortable crutch use, preventing secondary injuries. The first adjustment focuses on the forearm cuff, which should be positioned approximately one to two inches below the crease of the elbow when the arm is extended. This placement allows the elbow to bend and straighten without obstruction, ensuring the crutch remains securely attached during movement.
The second adjustment is the handgrip height, which needs to be precisely set to support your body weight through your hands. To find the correct height, stand upright with your shoulders relaxed and your arms hanging naturally at your sides. The handgrip should align with the crease of your wrist. When you grip the handle, your elbow should be slightly bent at an angle between 15 and 30 degrees. This slight bend allows for optimal power transfer from your upper body to propel yourself forward and absorb impact during the gait cycle.
Walking Techniques and Gait Patterns
Movement on level ground relies on mastering a gait pattern that accommodates your specific weight-bearing restriction. For many users, particularly those who are non-weight bearing, the three-point gait is the first technique to learn. This pattern requires the user to advance both crutches forward first, creating a stable tripod stance.
The injured or non-weight bearing leg then moves forward, remaining suspended between the crutches so that no weight is placed upon it. The strong, unaffected leg steps forward to align with the crutches and the injured leg. This sequence is slow and highly stable, focusing on transferring all body weight through the handgrips and the strong leg. Maintaining proper posture is paramount; the user should look forward, not down at their feet, and keep the crutches close to the body.
A more advanced pattern, often used by those who can bear partial weight or who seek greater speed, is the swing-through gait. Both crutches are advanced forward simultaneously. The user transfers their weight to the handgrips and swings their body and unaffected leg past the crutches. This creates a faster, more fluid movement that requires greater upper body strength and coordination. Both gaits require the user to push down through the handgrips to bear weight, minimizing strain on the wrist and elbow joints.
Navigating Transitions
Navigating obstacles and changing positions, such as moving between levels or sitting down, introduces higher risk and requires specific, deliberate maneuvers. The general rule for managing stairs is encapsulated by the mnemonic, “Up with the good, down with the bad,” which dictates the order of leg and crutch movement. This rule ensures that the strongest limb always takes the initial load during the most strenuous part of the movement.
Stairs (Up and Down)
When ascending a step, the user must first place their full weight onto the crutches and the strong leg. They then lead by stepping up with the strong leg onto the next step. Once the strong leg is firmly planted, the crutches and the affected leg are brought up to join it. The entire sequence for going up is a series of controlled lifts using the strong leg as the primary engine.
To descend a step, the order of movement reverses to prioritize safety and control. The crutches are lowered to the step below first, followed immediately by the affected leg, which remains non-weight bearing or partial weight bearing. The strong leg steps down last, providing a steady anchor and controlling the body’s descent. Using a handrail, if available, can significantly enhance stability; the crutches should be held in the hand opposite the railing to allow the other hand to grasp the rail.
Sitting Down
The process of sitting down must be slow and controlled to prevent a fall. First, back up to the chair until you feel the seat against the back of your unaffected leg, confirming your distance. Both crutches are then gathered and held securely in the hand on the side of the affected leg. The user reaches back with their free hand to grasp the armrest or edge of the chair, keeping the affected leg extended slightly forward. By pushing down through the hand holding the crutches and the hand on the chair, the user slowly lowers their body into the seat, ensuring the descent is steady.
Standing Up
To stand up, the process is reversed, beginning from the edge of the chair. Both crutches remain held together in one hand, positioned on the side of the affected leg. The free hand is placed on the armrest of the chair for support. The user leans forward, pushing down simultaneously with the hand on the armrest and the hand holding the crutches, while driving upward with the strong leg. Once standing and fully balanced, the user can place one crutch back into each arm, ready to resume walking. This maneuver relies on the combined strength of the upper body and the unaffected leg to achieve vertical balance.