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How to Use Your Crutches

Being sent home from the hospital with a set of crutches can be challenging for individuals that aren’t used to moving that way. In this blog, we will review some key points that you can provide to your patients to help them move around with their crutches with greater ease. 

Sizing Your Crutches

In order to ensure that your crutches are the right fit for your patient, it is important to be aware of the following:

  • Crutches are sold in different sizes that fit a particular height range. Ensure that the crutches your patient is purchasing are made for their height.
  • Crutches are usually designed to be user-friendly, in that they will have height markers along the side (e.g. 5”4, 5”5 etc.) so that you can select the size that matches your patient’s height. However, each person’s body is different and while this is a good place to start when sizing your patient’s crutches, it is not 100% accurate. 
  • Place the crutches under your patient’s armpit, along the side of their body and have them stand up tall. The crutches should not be pushed up into their armpits; there should be 1-2 inches between the top of the crutches and their armpits. Adjust the crutches by using the snap towards the bottom of the crutches until they are at the correct height.
  • With the crutches still placed along the side of your patient’s body, under their armpits, have your patient stand up tall with their arms hanging down. The handgrip of the crutches should come to your patient’s wrist crease. There will likely be a couple of screws that you can remove and put back to adjust the height of the handgrip appropriately.
  • Remind your patient to avoid leaning down on the crutches to rest their weight. This type of pressure, under the armpits, can potentially be damaging to the vasculature passing through the axillary region. While your patient is walking, their weight should be placed through their arms and hands onto the handgrips, not through their armpits. 

Weight Bearing Status

Now that the crutches are adjusted, your patient is almost ready to get walking. The way that your patient can walk will depend partially on the weight-bearing status that they received from their doctor or surgeon. 

  1. Non-Weight Bearing - This indicates that your patient should not put any weight through the affected limb for now. In this case, your patient can suspend their foot slightly in the air so that they do not put any weight through the affected leg and their arms will take on all of their weight through the crutches.
  2. Feather Weight Bearing / Toe-Touch Weight Bearing - With this status, it is safe to place the toes of your patient’s injured leg on the ground to help maintain their balance as they walk, but their arms would still be taking on all of their weight through the crutches. Feather Weight Bearing tends to be difficult for patients to maintain as they will likely want to put more weight through the injured limb when they feel the floor beneath them. As a rehabilitation practitioner, you may choose to put your own hand or foot under the patient’s affected foot as they walk to encourage appropriate Feather Weight Bearing. If you or your patient don’t feel confident about maintaining Feather Weight Bearing, you can have them stick with Non-Weight Bearing.
  3. Partial Weight Bearing - The surgeon may specify a certain percentage of weight that is safe to put on the injured leg, e.g. 50%. In this case, your patient would estimate half of their body weight and put 50% of their weight through their injured leg, and the remaining 50% of their body weight would be supported by their arms through the crutches.
  4. Weight-Bearing as Tolerated - In this case, it is safe to put as much weight as the patient can tolerate through the injured leg. Your patient may need a set of crutches to start if they are not able to manage their full body weight. Others will find that they can walk around without aid from the beginning.

Walking with Your Crutches

Your patient is finally ready to start walking. Here are some pointers you can give them to move safely and smoothly with their new gear.

  • Initiate their movement with the crutches, followed by the injured leg and finally the uninjured leg.
  • Remind them to take it slow at first as it will be an adjustment to get used to this new way of moving. They can build up their walking endurance over time. 
  • If friends and family are around and offering help, advise them to accept the help early on, even if they are eager to be independent, in order to minimize the pain associated with their body acclimatizing to using crutches. 
  • Your patient will likely be tempted to look down at the floor to see their feet as they move. Remind them to stand tall and look in the direction that they are headed. This will help to make sure that they don’t bump into anything or fall.

Managing the Stairs with Your Crutches

The thought of going up and down the stairs with an injured leg and crutches can be daunting for patients but it will feel easier if they remember the following points:

  • If your patient requires crutches to walk around their home, they will need to carry both of them up the stairs so that they can use them on the second floor. If your patient’s hands are big enough, they can hold both of the crutches in position, under one arm. Alternatively, if your patient’s hands are smaller, they can use a T-hold by placing one crutch in its regular position and the second crutch perpendicular at the level of the handgrip so that both crutches can fit more easily in one hand.
  • A good phrase to teach your patient is; “Up with the good, down with the bad”
  • Ascending a set of stairs, your patient will place one hand on the rail (if it is sturdy) and the other hand should be holding the crutches. First, your patient will move their uninjured leg up a step, followed by their injured leg (while supporting themself through the rail and the crutch), and finally the crutch.
  • Descending a set of stairs, your patient will place one hand on the rail (if it is sturdy) and the other hand should be holding the crutches. First, your patient will move the crutch down, followed by their injured leg and finally their uninjured leg.
  • If your patient does not have a railing, the sequence of the stepping will be the same as stated above for ascending and descending, respectively. The difference is that your patient will hold onto both crutches in their typical manner instead of using just one.

In Conclusion

  • Size the crutches 1-2 inches below the armpit and the handgrip at the wrist crease.
  • Remind your patient not to rest their armpits on their crutches.
  • Make sure you (and your patient!) know their weight-bearing status.
  • Walking pattern: Crutches, injured leg, uninjured leg.
  • Stairs pattern: “Up with the good, down with the bad” OR... 
    • Going up: Uninjured/strong leg, injured/weak leg, crutches, 
    • Going down: Crutches, injured/weak leg, uninjured/strong leg

An injury is hard for your patients in many ways. By sharing these steps, you can make your patient’s recovery easier by helping them mobilize safely and comfortably using their crutches. 

 

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Blog Writers: Bella Levi, MScPT Student; Debra Posluns, MScPT Student; Linnea Thacker, MScPT Student



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