Mastering Crutches: A Comprehensive Guide to Comfortable and Safe Use
Adjusting to crutches can be a challenging but necessary part of the recovery process after an injury or surgery. Using crutches properly is crucial for preventing further injury and ensuring a smooth recovery. This comprehensive guide provides detailed steps and instructions to help you master crutches, ensuring comfort, safety, and confidence as you navigate your daily life.
## Understanding Crutches: Types and Components
Before diving into the techniques, let’s familiarize ourselves with the different types of crutches and their components:
* **Axillary Crutches:** These are the most common type, fitting under the armpits. They consist of:
* **Axillary Pad:** The padded area that rests under the armpit. (Important: The weight should be borne by your hands, not your armpits to avoid nerve damage.)
* **Handgrip:** The handle you grip for support and balance.
* **Lower Shaft:** The adjustable part that determines the crutch’s overall height.
* **Rubber Tip:** The rubber foot that provides traction and prevents slipping.
* **Forearm Crutches (Lofstrand Crutches):** These feature a cuff that wraps around the forearm, offering more freedom of movement. They are often used for long-term disabilities.
* **Cuff:** The support that encircles the forearm.
* **Handgrip:** The handle you grip for support and balance.
* **Lower Shaft:** The adjustable part that determines the crutch’s overall height.
* **Rubber Tip:** The rubber foot that provides traction and prevents slipping.
* **Platform Crutches:** These crutches support the forearm on a horizontal platform and are useful for individuals with limited hand or wrist strength.
This guide will primarily focus on axillary crutches, as they are the most frequently prescribed.
## Preparing for Crutch Use: Essential Steps
Before you start walking with crutches, follow these crucial steps:
### 1. Getting the Right Fit:
Proper crutch height is essential for comfort and preventing shoulder, arm, and back pain. Follow these steps to ensure a correct fit:
* **Wear Your Usual Shoes:** Put on the shoes you typically wear to ensure accurate height adjustment.
* **Stand Upright:** Stand tall with your shoulders relaxed.
* **Position the Crutches:** Place the crutch tips about 4-6 inches to the side and slightly in front of your feet.
* **Adjust the Height:** The top of the crutch (the axillary pad) should be approximately 1-2 inches (2-3 finger widths) below your armpit when you are standing upright. This prevents pressure on the nerves in your armpit.
* **Adjust the Handgrips:** Adjust the handgrips so that your wrists are slightly bent (about 15-30 degrees) when you hold them. This allows for optimal weight distribution and reduces strain on your wrists and hands. Your elbows should be slightly flexed.
* **Have Someone Check:** It’s helpful to have a physical therapist or healthcare professional verify that your crutches are properly fitted.
### 2. Practicing Weight-Bearing:
Before taking your first steps, practice weight-bearing on your good leg and using the crutches for support. This helps you get a feel for the required balance and coordination.
* **Stand Between Parallel Bars (Optional):** If available, parallel bars can provide extra stability during practice.
* **Distribute Weight:** Place most of your weight on your good leg and use the crutches to assist with balance.
* **Engage Your Core:** Tighten your abdominal muscles to stabilize your body and improve balance.
* **Small Movements:** Practice shifting your weight slightly from side to side and forward and backward.
### 3. Strengthening Exercises:
Strengthening certain muscle groups can make crutch use easier and more comfortable. Consider these exercises:
* **Wrist Exercises:** Rotate your wrists in both directions to improve flexibility and strength.
* **Hand Exercises:** Squeeze a stress ball or hand exerciser to strengthen your hand muscles.
* **Arm Exercises:** Perform gentle bicep curls and triceps extensions with light weights or resistance bands.
* **Core Exercises:** Practice planks and abdominal crunches to strengthen your core muscles.
## Mastering Crutch Walking Techniques
Now that you’ve prepared, let’s learn the proper crutch walking techniques.
### 1. The Three-Point Gait (Non-Weight-Bearing):
This gait is used when you cannot put any weight on your injured leg.
* **Starting Position:** Stand with your weight on your good leg and the crutch tips slightly in front of you.
* **Advance Crutches:** Move both crutches forward simultaneously about 12 inches.
* **Swing Through:** Swing your good leg forward, placing your foot even with or slightly ahead of the crutches. Do *not* place any weight on the injured leg.
* **Repeat:** Continue advancing the crutches and swinging your good leg through. Your injured leg should remain elevated and off the ground throughout the entire process.
* **Focus:** Maintain a smooth, rhythmic motion. Avoid jerky movements.
### 2. The Two-Point Gait (Partial Weight-Bearing):
This gait is used when you can put some weight on your injured leg. Consult your doctor or physical therapist for the appropriate weight-bearing limit.
* **Starting Position:** Stand with your weight distributed between your good leg and the crutches. Your injured leg can touch the ground, bearing the amount of weight prescribed by your doctor.
* **Advance Crutch and Injured Leg:** Move one crutch and your injured leg forward simultaneously.
* **Advance Opposite Crutch and Good Leg:** Move the opposite crutch and your good leg forward.
* **Weight Shift:** As you move, shift your weight from the crutch and injured leg to the other crutch and good leg.
* **Repeat:** Continue alternating sides in a smooth, coordinated motion. Remember to place only the prescribed amount of weight on the injured leg.
### 3. The Four-Point Gait (Weight-Bearing on Both Legs):
This gait is used when you can bear weight on both legs, but still require support for balance or pain relief. It is a slower, more stable gait.
* **Starting Position:** Stand with both feet on the ground, using the crutches for balance.
* **Advance One Crutch:** Move one crutch forward a short distance.
* **Advance Opposite Leg:** Move the opposite leg forward.
* **Advance the Other Crutch:** Move the other crutch forward.
* **Advance the Remaining Leg:** Move the remaining leg forward.
* **Repeat:** Continue this sequence, one point (crutch or leg) at a time. This gait is slow but provides excellent stability.
### 4. Negotiating Stairs:
Stairs can be particularly challenging when using crutches. Take your time and follow these steps carefully.
**Going Up Stairs:**
* **Position:** Face the stairs and hold the handrail if available. Place both crutches firmly on the step you are standing on.
* **Advance Good Leg:** Step up onto the next step with your good leg. Lean forward slightly for balance.
* **Bring Crutches Up:** Bring both crutches up to the same step as your good leg.
* **Repeat:** Continue this process, one step at a time. Remember “Good leg to heaven, crutches to hell”. Good leg goes up first.
**Going Down Stairs:**
* **Position:** Face the stairs and hold the handrail if available. Place both crutches on the step below you.
* **Advance Crutches:** Carefully lower both crutches to the next step below.
* **Bring Injured Leg Down (if weight-bearing):** If your doctor has allowed partial weight-bearing, carefully lower your injured leg to the same step as the crutches, bearing the prescribed amount of weight.
* **Bring Good Leg Down:** Lower your good leg to the same step as the crutches and injured leg.
* **Bring Injured Leg Down (if non-weight-bearing):** If you are non-weight-bearing, hop down to the next step with your good leg, keeping your injured leg elevated. Carefully lower both crutches to the next step *before* hopping down with your good leg.
* **Repeat:** Continue this process, one step at a time. Remember “Crutches to hell, good leg to heaven”. Crutches go down first.
**Alternative Method (if no handrail is available):**
* **Going Up:** Place both crutches on the step you are standing on. Lean forward, transfer your weight to the crutches, and hop up onto the next step with your good leg. Then, bring the crutches up to the same step.
* **Going Down:** Place both crutches on the next lower step. Lean forward, transfer your weight to the crutches, and carefully lower your good leg to the same step as the crutches. If you are non-weight-bearing, ensure your injured leg remains elevated.
### 5. Sitting Down and Standing Up:
Sitting down and standing up with crutches requires balance and coordination.
**Sitting Down:**
* **Position:** Back up to the chair until you feel it against the back of your legs.
* **Transfer Crutches:** Hold both crutches in one hand (on the side of your good leg). Lean forward slightly.
* **Lower Yourself:** Slowly lower yourself into the chair, using your free hand for support on the armrest or seat.
**Standing Up:**
* **Position:** Hold both crutches in one hand (on the side of your good leg). Place your good foot flat on the floor.
* **Lean Forward:** Lean forward slightly and push off from the chair using your free hand and your good leg.
* **Regain Balance:** Once you are standing, reposition the crutches under your arms and regain your balance.
## Tips for Comfortable and Safe Crutch Use
* **Use Proper Posture:** Maintain good posture with your head up, shoulders relaxed, and back straight.
* **Pad Your Crutches:** Use padding on the axillary pads and handgrips to prevent skin irritation and discomfort. Moleskin or specialized crutch pads can be very helpful.
* **Wear Comfortable Clothing:** Avoid tight-fitting clothing that can restrict movement or cause chafing.
* **Check Your Surroundings:** Be aware of your surroundings and remove any obstacles that could cause you to trip or fall. Ensure adequate lighting.
* **Take Breaks:** Rest frequently, especially when you are first starting to use crutches. Overexertion can lead to fatigue and injury.
* **Keep Crutch Tips Clean:** Regularly clean the rubber tips of your crutches to maintain good traction.
* **Replace Worn Tips:** Replace the rubber tips when they become worn or damaged to prevent slipping.
* **Inspect Crutches Regularly:** Check your crutches regularly for any signs of damage, such as cracks or loose screws. Repair or replace them as needed.
* **Avoid Slippery Surfaces:** Be extra cautious on wet, icy, or uneven surfaces. Consider using assistive devices like ice cleats if necessary.
* **Use a Backpack or Fanny Pack:** Carry essential items in a backpack or fanny pack to keep your hands free.
* **Stay Hydrated:** Drink plenty of water to prevent muscle cramps and fatigue.
* **Listen to Your Body:** If you experience pain, stop and rest. Do not push yourself too hard.
* **Consult Your Doctor or Physical Therapist:** If you have any questions or concerns about using crutches, consult your doctor or physical therapist. They can provide personalized guidance and address any specific issues you may be experiencing.
* **Shorten Your Step Length:** When using crutches, especially on uneven surfaces, shortening your step length can improve stability and reduce the risk of falls.
* **Use Handrails When Available:** Whenever possible, use handrails for added support and stability, particularly when navigating stairs or ramps.
* **Strengthen Core Muscles Regularly:** Maintaining strong core muscles is crucial for balance and stability while using crutches. Incorporate core exercises into your daily routine.
* **Protect Skin Integrity:** Inspect your skin regularly, particularly under the armpits and on your hands, for signs of irritation or breakdown. Use appropriate skin protection measures as needed.
* **Seek Assistance When Needed:** Don’t hesitate to ask for help from friends, family, or caregivers when you need it. It’s better to be safe than sorry.
* **Plan Your Routes:** Before heading out, plan your route and identify any potential obstacles or challenges, such as stairs, uneven surfaces, or crowded areas. Consider alternative routes if necessary.
* **Practice in a Safe Environment:** When learning to use crutches, practice in a safe and controlled environment, such as your home or a physical therapy clinic.
## Common Crutch-Related Problems and Solutions
* **Armpit Pain:** Ensure the crutch height is correct (2-3 finger widths below the armpit). Use padded crutch covers. Avoid leaning on your armpits; the weight should be on your hands.
* **Hand Pain:** Adjust the handgrips for proper wrist angle. Use padded handgrips. Take frequent breaks.
* **Blisters:** Wear gloves or use padding on your hands. Keep your hands clean and dry.
* **Back Pain:** Maintain good posture. Strengthen your core muscles. Take frequent breaks.
* **Slipping:** Ensure the crutch tips are in good condition and clean. Avoid slippery surfaces. Use assistive devices like ice cleats in icy conditions.
## Conclusion
Adjusting to crutches takes time and patience. By following these detailed steps and instructions, you can master crutch walking techniques, minimize discomfort, and prevent further injury. Remember to prioritize safety, listen to your body, and consult your healthcare provider if you have any concerns. With practice and perseverance, you’ll be navigating your surroundings with confidence and on the road to recovery in no time. Proper crutch use is more than just a means of mobility; it’s an investment in your overall well-being and a crucial step towards a full and speedy recovery.