The need for crutches often follows an unexpected injury or surgery, temporarily changing how you navigate the world. Learning to use crutches correctly is important for maintaining mobility and preventing further injury during recovery. This guide provides clear, practical instructions to help you move safely and comfortably. Mastering the proper setup and technique will allow you to confidently manage flat ground, stairs, and various environments.
Essential Crutch Setup
The first step toward safe crutch use involves adjusting the device to fit your body precisely. Stand upright and let your arms hang naturally to set the correct overall height. The top of the crutch pad, also called the axillary rest, should sit about two finger-widths, or approximately two inches, below your armpit. This small space is important because resting your entire body weight on the axillary pads can compress the nerves and blood vessels in your armpit, potentially leading to crutch palsy.
Once the overall height is correct, the next adjustment is the handgrip position. The handgrip should align with the crease of your wrist when your arm is fully extended at your side. When you press down on the grips, your elbows should have a slight bend, ideally between 15 and 30 degrees. This slight bend ensures your arm muscles are engaged to effectively absorb your body weight.
The entire weight of your body must be supported through your hands and wrists, not the armpit. Using your hands to bear weight protects the delicate brachial plexus nerves. Before walking, ensure the crutch tips are positioned slightly out to the sides and in front of your feet, creating a stable “tripod” base for balance.
Walking on Level Surfaces
The most common method for moving when an injury prevents you from putting any weight on a limb is the three-point non-weight-bearing (NWB) gait. This technique involves moving both crutches and the injured leg forward as a single unit. After establishing this forward placement, shift your body weight onto the handgrips and swing your uninjured leg forward. The key is to keep the injured foot completely clear of the floor throughout the movement to prevent pressure on the healing limb.
When performing the swing, you should not land the uninjured foot ahead of the crutch tips, but rather bring it to a point in line with or slightly ahead of them. This controlled placement helps maintain your center of gravity and prevents you from overbalancing. If you have been cleared for partial weight-bearing (PWB), you can lightly touch the ground with the injured foot for balance, but the movement sequence remains similar: crutches and injured foot move, then the uninjured foot follows.
Maintaining a steady rhythm and short, deliberate steps is more effective than attempting long strides. A slower, more controlled pace reduces the risk of fatigue and loss of balance. Always look forward, not down at your feet, to anticipate obstacles and promote better posture.
Managing Stairs and Curbs
Navigating vertical obstacles like stairs requires a specific sequence to maintain stability and control. A simple way to remember the sequence is the phrase “up with the good, down with the bad,” referring to your uninjured and injured legs, respectively. When ascending stairs, you first step up with your uninjured leg onto the next step. The crutches and your injured leg then follow, joining the uninjured foot on the same step.
For descending stairs, the crutches and the injured leg lead the movement down to the lower step. Once the crutch tips are securely placed on the lower surface, use your arms to support your weight as your uninjured leg follows down. This method ensures that the stable, uninjured leg is always the last to move when going down and the first to move when going up, providing maximum support.
If a sturdy handrail is available, use it to increase stability. Consolidate both crutches into the hand opposite the rail, gripping the handrail with the other hand. This technique allows you to use the rail as a fixed anchor point while still having the crutches to support the injured side. For single-step curbs, treat them exactly like a single stair, applying the “up with the good, down with the bad” principle.
Safety and Injury Prevention
A consistent safety check of your equipment is a preventative measure that should be performed before each use. Always inspect the rubber tips, or ferrules, at the bottom of the crutches for excessive wear or damage. Worn-out tips can lose their grip, significantly increasing the risk of a slip, especially on smooth surfaces. Ensure all adjustment bolts and locking mechanisms are tight to prevent the crutches from collapsing or shifting unexpectedly during use.
A major risk of improper use is damage to the axillary nerve, often resulting in temporary weakness or numbness in the arm and hand. To prevent this, consciously remind yourself to support your body weight through the handgrips, minimizing any downward force into the axillary pads. Using your arms and shoulders, rather than hanging on the pads, keeps pressure off the nerve bundle.
Be highly aware of your environment, as crutches change your balance and reaction time. Avoid walking on wet floors, loose rugs, or cluttered pathways, which are common tripping hazards. When you must move on slippery ground, take very small steps and ensure the crutch tips are placed firmly before shifting your weight.