Tips for Ambulating with Crutches
Who’s ever been given crutches by your doctor only to have to learn how to use them yourself?
More often than not, patients are just given crutches to use by their doctor without any explanation on how to use them. Maybe you think it wouldn’t be that hard, but have you ever tried to use crutches for 1 day? How tiring is that? Using crutches requires some coordination, endurance, and strength in your shoulders, wrist, core, and hips. Not to mention some balance. Definitely harder than it looks. Especially if you are in a city where a lot of walking and stairs are involved.
Below I have put some helpful tips on how to ambulate with crutches.
- Before you do anything — Size the crutches for you first! And don’t go by the height that the crutches say they are, those markers are almost never right. You can use it as a starting off point, but then adjust as needed.
The crutches when placed under your arm should be at a height that gives you 2-3 finger-width between your armpit and the top of the crutch. Also, when your arms are by your side, your wrist crease should line up with the handlebar of the crutch. (This rule applies for canes and walkers as well –it’s lower than you think!)
2-3 finger width under arm pit to size
Line up hand bars with crease of wrist
Same rule applies for measuring a cane
2. Walking with crutches if you can’t put any weight through the injured leg is called 3-point gait. Firstly, think of squeezing your arms in towards your chest to keep your crutches from slipping out. The non-weight bearing limb should be slightly bent with the knee in front of the standing leg and the foot behind it. Make sure your crutches are about 6 in. from the outside of your foot and your elbows should be at ~30* bend.
CORRECT – Knee in front of crutch and foot behind
INCORRECT – Crutches more than 6″ from foot
INCORRECT – Shoulders elevated; leaning on crutch
3. To ambulate, advance your crutches first and then bring your standing leg to the crutches, keeping your standing knee soft. (This is called step-to gait pattern). Once you get comfortable with ‘step-to’, you can advance to ‘swing through’ –having your standing foot come slightly past where the crutches land.
The goal should be to eliminate the up/down motion when you are using crutches, so from the waist up, you can’t tell you are using crutches.
Also, make sure you keep your wrist straight (you’ll realize very fast if you are not, b/c your wrist will get sore)
INCORRECT – Wrist is not straight
CORRECT – Keep wrist straight
4. Changing directions – make sure to always turn towards the involved limb (non-weight bearing limb) b/c it’s less torquing on your knee. Always take 3-4 little turns to change directions (once again, less torque on the knee)
5. You may realize this is very tiring, and you are right! This takes a lot of energy expenditure, so be prepared for that.
6. Sit<>stand – if non-weight bearing when you go stand up, make sure your injured leg is kept straight out in front of you, and use your ‘good’ leg and arms to get up from the chair. Same thing applies when going to sit down –make sure you straighten your ‘injured’ leg out in front of you first before you go to sit down. This gets the injured leg out-of-the-way and allows you to sit down easier.
7. Do you have any stairs to navigate? Even 1 or 2 to get into a house or to step up or down from a curb? Using crutches and stairs seems scary, but if you have good balance and coordination you should be able to if you had to. When going up, think ‘good leg’ goes up first and then bring the crutches up after you. If you have a rail to hold on to, definitely use the rail with one arm and a crutch with the other.
Coming down stairs, keep the standing knee soft and bring your crutches down 1 stair at a time first, then bring the standing leg to it. Make sure you get your hand that is on the rail down in front of you. This way if you were going to fall forward, your arm is already in front of you to catch yourself. This takes practice. If you don’t feel comfortable, make sure someone is there to spot you and if all else fails butt scoot up or down!
8. Don’t ignore your standing leg -it’s working really hard! Make sure to give it some TLC. Stretch the hip – fig. 4 stretch, hamstring stretch, quad stretch, and gastroc stretch. Strengthen that ankle, knee and hip. Perform thera-band ankle 4-way, SLR x 4, and practice balance exercise on the standing leg even before you need to use crutches in order to strengthen that leg (obviously if it’s a traumatic injury you may not have time to practice, but if you are scheduling surgery where you know you will need the use of crutches afterwards, prepare in advance!)
Ankle Thera-band exercise -4 directions
Figure 4 Stretch/ Piriformis stretch
IMPORTANT NOTE WITH THE USE OF A CANE – If you are transitioning off crutches and using a straight cane to help take some pressure off the injured side, always carry the cane on the opposite side of injury! People always do this wrong. Don’t just put the cane in your dominant hand. It doesn’t matter if it’s an injured foot/ankle, knee, or hip –always opposite! This mimics a more normal gait pattern b/c when your left arm swings forward, your right foot comes forward at the same time. Thus if your right foot is injured, you will bring your left arm forward with the cane at the same time as the injured right foot. Otherwise you will walk around like House MD –he used the cane wrong by the way, more robotic like.
DISCLAIMER: These are some helpful tips I have gathered for people to use. Before using crutches, make sure you consult your doctor or health care provider to ensure correct use of crutches.