How to Walk Correctly With Forearm Crutches

Walking correctly with forearm crutches starts with matching your gait pattern to your injury, setting the crutch height so your elbows stay slightly bent, and pushing through the handgrips rather than leaning into the forearm cuffs. Most people never receive formal instruction and end up compensating with bad habits that strain the shoulders, wrists, and spine. Research on crutch biomechanics has clarified what actually reduces joint stress and what just feels easier in the moment, and the two are not always the same thing.

Pick the Right Gait Pattern for Your Situation

Forearm crutches can be used with several distinct walking patterns, and each one offloads the injured leg differently. The pattern your physical therapist recommends depends on how much weight you’re allowed to put through your affected leg and how much balance you have. The three patterns you’ll encounter most often are the two-point gait, the three-point gait, and the four-point gait.

In a two-point gait, you move the right crutch and left foot forward at the same time, then the left crutch and right foot. It mimics the natural arm swing of walking and works well when you can bear at least some weight on both legs but need extra stability or partial offloading. A four-point gait is slower but more stable: you advance one crutch, then the opposite foot, then the other crutch, then the other foot, so three points of contact are always on the ground. Research measuring hip joint forces found that the four-point pattern lowered peak hip loads by about 12% compared to walking without crutches, while the three-point pattern cut them by roughly 13% and the two-point pattern by about 17%.¹ Both the two-point and four-point patterns also significantly reduced foot pressure compared to normal walking.²

The three-point gait is the most common pattern after a single-leg injury. Both crutches advance together with the injured leg, and you push through the grips to swing your good leg past the crutches. It provides the most offloading for the affected side. In a study comparing assistive devices, participants using forearm crutches in a three-point pattern achieved about a 56% reduction in the weight going through the injured leg.³ If you’re completely non-weight-bearing, you may use a swing-through gait, where both crutches plant ahead and you swing your body past them. This is fast but far more tiring: energy expenditure during swing-through gait runs two to three times higher than normal walking, and much of that extra cost comes not from the mechanical work itself but from the reduced efficiency of how your muscles produce force in that position.⁴

Setting Up Your Crutches Properly

Height adjustment matters more than most people realize. When you stand upright with your arms at your sides, the handgrip of the crutch should sit at the crease of your wrist. This puts your elbow at roughly 15 to 30 degrees of flexion when you grip the handle, which lets you push down effectively without locking your elbow or hunching your shoulders. If the crutch is too short, you’ll lean forward; too tall, and your shoulders ride up, causing neck and trapezius pain within hours.

The forearm cuff should sit about two to three finger-widths below your elbow. Its job is to keep the crutch from dropping when you release the grip, not to bear your weight. Pressure studies show that as you lean more heavily on crutches, the load on the forearm shifts toward the inner (ulnar) side, with average forearm pressures around 37 to 41 kilopascals depending on the region measured.⁵ That ulnar shift gets worse the more weight you put through the crutch, which is one reason you want the cuff loose enough to distribute contact rather than digging into one spot.

Where the Weight Actually Goes

One of the biggest misconceptions is that you should lean into the cuffs for support. You shouldn’t. The driving force should come through your palms and the handgrip. Studies of palmar load distribution show that the highest pressures concentrate on the radial side of the palm (the thumb side) and, concerning for long-term use, the carpal tunnel region carries the third-highest load.⁶ A wider, contoured grip spreads the load over a larger area, so if your crutches came with a thin cylindrical handle, switching to an ergonomic or anatomically shaped grip can reduce peak palm pressure.

How much weight actually flows through the crutches depends on how much you’re offloading. During comfortable walking where someone freely chooses how much to lean on a single crutch, the load tends to settle around 10% of body weight. A pilot study observed that when offloading exceeds that 10% threshold, two crutches become biomechanically necessary.⁷ In partial weight-bearing scenarios, the hand loads climb steeply. One study found that when the affected leg was fully unloaded, the hands carried roughly 103% of body weight on forearm crutches, meaning you’re actually pushing down with more force than your body weighs because of the effort needed to keep your trunk upright and moving forward.⁸ That is an enormous load for the wrists and shoulders to absorb step after step.

Getting Up from a Chair

Standing up is one of the trickier moments with forearm crutches. The instinct is to plant the crutches out wide for stability, but research into sit-to-stand safety suggests the opposite: keeping the crutches closer to your body than you might during walking produces a more controlled rise.⁹ A practical approach is to scoot to the edge of the chair, position both crutches on the side of your stronger leg (or one in each hand if partial weight-bearing is allowed), plant your strong foot flat on the floor, and push up through the chair arm or seat with one hand while the other hand holds the crutch grip. Once standing, slide your arms into both cuffs before stepping away. Rushing this transition is where falls happen.

Navigating Stairs

The classic memory aid is “up with the good, down with the bad.” Going upstairs, lead with your stronger leg, then bring the crutches and your weaker leg up to meet it. Going downstairs, the crutches go first alongside the weaker leg, and the strong leg follows. If a handrail is available, hold both crutches in one hand by the grips and use the other hand on the rail. Many people find this more secure than trying to plant two crutch tips on narrow stair treads.

On inclines, shorten your stride and keep the crutch tips slightly ahead of you going uphill and slightly behind going downhill. The goal is to keep your center of gravity between the crutch tips and your feet at all times. Wet or icy slopes are high-risk because standard rubber crutch tips lose traction quickly. Field testing of improved crutch tip designs found that anti-slip tips made from rubber-wood composites roughly tripled perceived traction and reduced estimated slip risk by 70 to 75% compared to conventional tips.¹⁰ Even without specialty tips, checking your rubber tips for wear every few weeks and replacing them when the tread is smoothed out is one of the simplest safety steps you can take.

Protecting Your Shoulders and Nerves

Forearm crutches are gentler on the armpit nerves than axillary (underarm) crutches, but they bring their own injury profile. The forearm cuff itself is the main culprit: a narrative review of crutch-related injuries found that forearm crutch use was most commonly associated with compressive nerve damage caused by the cuff pressing against the forearm. In the cases reviewed, improper fitting or technique contributed to injury in the majority of them.¹¹ A cuff that’s too tight or sits too high on the forearm can compress the posterior interosseous nerve, causing weakness in finger and wrist extension. The fix is simple: the cuff should be snug enough that the crutch doesn’t fall off when you open your hand, but loose enough that you can slide your arm in and out without effort.

Shoulder problems are a longer-term concern. People who rely on crutches for months or years subject their shoulders to forces the joint wasn’t designed to absorb repetitively. A study of people who depend on upper-extremity assistive devices found extremely high rates of rotator cuff damage: 93% had tears of the supraspinatus tendon, nearly half had infraspinatus tears, and about three quarters had issues with the joint where the collarbone meets the shoulder blade.¹² Those numbers come from a surgical cohort, so they skew toward more severe cases, but the pattern is clear: chronic crutch use wears down the rotator cuff. If you’re using forearm crutches long-term, shoulder-strengthening exercises (external rotation work, scapular stabilization) are not optional extras. They’re maintenance for a joint under unusual demand.

Managing Energy and Speed

Walking with forearm crutches is slower and more physically demanding than unaided walking, regardless of technique. A comprehensive review of crutch-assisted gait confirmed that even with modern design improvements, crutch walking remains energetically inefficient and places additional strain on the upper limbs.¹³ For short-term users recovering from a fracture or surgery, this is a temporary annoyance. For people who use forearm crutches as a permanent mobility aid, energy management becomes a daily strategic consideration.

Practical pacing means planning rest stops, especially for outings longer than a few minutes. Your heart rate on crutches at a comfortable pace can match what you’d experience during a brisk workout without them. Carrying a backpack rather than a shoulder bag keeps your hands free and your trunk balanced. Small details like wearing shoes with firm soles (no flip-flops), keeping your path clear of loose rugs, and choosing routes with fewer steps make a measurable difference in how far you can go before fatigue sets in.

Learning to Partial Weight-Bear Accurately

If your surgeon has told you to put “50% weight” or “20 kilograms” through your healing leg, you might be surprised at how hard that is to gauge by feel alone. Most people either overload or drastically underload. Training with real-time feedback, like stepping on a bathroom scale while using your crutches to get a feel for what the target load actually feels like, helps considerably. Formal research into biodynamic feedback training found that people significantly reduced their errors in hitting a target load after structured practice sessions.¹⁴ If you don’t have access to a clinic with instrumented equipment, the bathroom-scale method at home is a reasonable substitute: stand with your injured leg on the scale and your crutches on the floor beside it, then lean until the scale reads the prescribed load. Repeat that enough times and your body starts to remember the feeling.

Forearm Crutches Versus Axillary Crutches

In much of Europe and for long-term users worldwide, forearm crutches are the default. In North America, axillary crutches remain common for short-term injuries. The functional differences are real. A prospective comparison measuring balance during a three-point gait found that axillary crutches provided slightly better stability when the walking surface tilted, with users exerting about 7% less balancing effort compared to forearm crutches on a backward-tilting platform.¹⁵ That stability edge makes sense: the longer shaft of an axillary crutch gives more leverage against lateral sway. But axillary crutches carry a well-known risk of compressing the brachial plexus in the armpit, which can cause numbness or weakness in the arm. Forearm crutches avoid that entirely because nothing presses into your armpit. They also leave your hands freer, since you can let go of the grip and the cuff keeps the crutch attached to your forearm, which makes opening doors or picking things up far less awkward.

For short-term post-surgical recovery where you just need to get from bed to bathroom for a few weeks, either type works. For anything beyond a couple of months, forearm crutches are generally preferred because of the reduced nerve risk, better hand freedom, and lower profile that makes them easier to maneuver in tight spaces.

The Stigma Factor and Why People Abandon Crutches Early

Technique discussions rarely mention the psychological side, but it matters. Research into crutch design and user experience has found that the clinical, medical appearance of standard crutches can clash with a person’s self-image, contributing to reluctance to use them or outright abandonment before healing is complete.¹⁶ Early abandonment is a genuine clinical problem: stopping crutch use before the bone or soft tissue has healed enough to handle full load can lead to re-injury or delayed recovery. If you find yourself leaving the crutches at home because they feel embarrassing or draw unwanted attention, it’s worth acknowledging that impulse and finding a workaround, whether that means choosing a sleeker crutch model, customizing the color, or simply planning outings for times when you feel more comfortable. The crutch is doing a job. Retiring it early because it feels conspicuous has real consequences for the joint it’s protecting.

Skin Care and Small Comfort Adjustments

Abrasions and calluses on the palms and forearms are common, especially in the first few weeks. Padded grip covers and neoprene cuff liners help, though they compress over time and need replacement. Wearing a long-sleeved shirt under the cuffs prevents direct skin friction. If you notice redness or tingling in the forearm below the cuff, the cuff is either too tight, sitting too high, or you’re leaning into it instead of driving through the handgrip. Adjust the cuff position first; if that doesn’t resolve it, check that you’re not inadvertently using the cuff as a weight-bearing surface when your hand gets fatigued. That habit often develops unconsciously during long walks and is a direct route to the nerve compression problems described above. Short, deliberate rest breaks where you take the crutches off entirely and shake out your arms do more than one long break at the end.