Crutches are mobility aids that transfer a person’s weight from the lower extremities to the upper body, allowing movement when full weight cannot be safely borne on one or both legs due to injury or surgery. Selecting the appropriate crutch type for a specific recovery phase is the first step toward effective rehabilitation. Understanding the different designs and how to use them correctly significantly impacts comfort and the speed of recovery.
Choosing the Right Crutch Type
The most widely recognized mobility aid is the axillary, or underarm, crutch, typically issued for short-term use after an acute injury. Axillary crutches are generally easy to learn and require less initial upper body coordination than other types. The design transfers body weight to the arms and torso, but users must always bear weight on their hands, not directly on the axilla pad, to avoid nerve damage.
Forearm crutches, also known as Lofstrand or Canadian crutches, are often recommended for long-term use or for individuals with permanent mobility challenges. This design features a cuff that encircles the forearm and a handgrip, allowing greater maneuverability and the ability to use the hands without dropping the crutch. While they offer more stability and are less likely to cause nerve compression in the armpit, they require greater upper body strength and coordination to master than axillary crutches.
The third main category is the platform, or trough, crutch, which is the least common type. This design includes a horizontal platform that supports the forearm, often with straps, and a handgrip. Platform crutches are reserved for individuals who cannot bear weight on their hands or wrists due to conditions like severe arthritis or other upper extremity limitations. They provide more stability than the other types but offer less maneuverability.
Ensuring Proper Height and Fit
Correctly adjusting the crutch height is paramount for safety and injury prevention. The overall crutch height should be adjusted so the top of the axillary pad sits about two to three finger-widths (1 to 2 inches) below the armpit. This clearance prevents pressure on the brachial plexus nerves, which can lead to “crutch palsy,” characterized by tingling or numbness in the arm and hand.
The handgrip placement determines how a user bears their weight. The handgrip should be set at the level of the wrist crease when the arm hangs naturally at the side. This height ensures the elbow is flexed at a slight angle, typically about 30 degrees, when the hand is on the grip. This slight bend allows the hands and arms to absorb the body weight efficiently during walking.
The final fitting element involves positioning the crutch tips on the floor. For axillary crutches, the tips should rest about 6 inches outside the feet to form a stable base, often described as a tripod stance. Once all measurements are set, the user should be able to push down through the handgrips to move forward without feeling pressure in the armpits.
Walking Techniques and Maneuvering Stairs
Safe movement with crutches relies on selecting the appropriate gait pattern based on the prescribed weight-bearing status. The most common pattern for non-weight-bearing injuries is the three-point gait, where both crutches and the injured leg move forward simultaneously, and then the unaffected leg steps through. This approach ensures the injured limb remains suspended.
For injuries where partial weight-bearing is allowed, a modified three-point gait is used. Here, the crutches and the injured leg move forward, and the injured leg bears some weight before the unaffected leg steps past the crutches. The four-point gait is the slowest but most stable pattern, requiring sequential movement of the left crutch, right foot, right crutch, and left foot. This gait is typically used when both legs are weakened or for balance issues.
Maneuvering stairs safely is summarized by the mnemonic, “up with the good, down with the bad.” When ascending, the unaffected leg steps up first, followed by the crutches and the injured leg. When descending, the crutches are placed on the lower step first, followed by the injured leg, and finally the unaffected leg steps down to join them.
To sit down, the user backs up until the unaffected leg touches the chair, then shifts both crutches to the hand on the injured side. They use the free hand to stabilize on the chair armrest, pushing down on the crutch handgrips with the other hand as they lower themselves slowly. The process is reversed for standing up, leaning on the crutches and the chair for support before transferring the crutches back under the arms.
Preventing Discomfort and Nerve Damage
Despite proper fitting, prolonged crutch use can lead to localized discomfort. Hand and wrist pain is a frequent complaint, as the hands bear the majority of the body weight during ambulation. Specialized hand grips with contoured shapes or gel padding can help distribute pressure more evenly across the palm and minimize the risk of nerve compression in the wrist.
The risk of axillary nerve compression, or crutch palsy, is the most serious complication of using underarm crutches. Users should watch for warning signs like numbness, tingling, or weakness in the arm or hand, which indicate pressure on the brachial plexus. Using padded covers on the axillary pads can reduce chafing and skin irritation.
The tips of the crutches are the only point of contact with the ground, making their condition important for preventing falls. Standard rubber tips can be replaced with specialized non-slip or articulating tips, which are designed to absorb impact and maintain better ground contact on various surfaces. Regularly checking the tips for wear significantly improves safety.