Because using crutches can be difficult and inconvenient, you may wonder when you can stop using your crutches.
No matter how much you may want to stop using your crutches, it’s important to continue to use them until your healthcare provider tells you you can stop.
Your doctor will give you discharge instructions so you know how to use your crutches, how long you should be on crutches, and when you can stop using them. In general, different injuries require different amounts of time to ensure proper healing. Sprained ankles usually require approximately two weeks to one month of recovery time, broken bones take an average of six weeks, and torn or ruptured ligaments can take as much as six months of recovery time.
While these time frames are the average, you should always heed the advice of your doctor regarding how long you should continue to use your crutches. If you’ve recently had an injury or surgery, your doctor will likely schedule a followup appointment with you to review your healing progress and provide updated recommendations for when you can stop using crutches.
How Do Crutches Work?
Crutches are meant to help you keep weight off your affected or injured leg so you can still move around while you heal. Correctly using your crutches takes practice, but understanding how they work and following the general techniques for using crutches will help you adjust to your time on crutches more easily and make your crutches more comfortable to use.
Crutches work by using your arms to support the weight of your lower body so you can keep weight off any injured or affected limbs. Crutches only work if one of your legs is injured and the other is able to support your body weight. This is because your uninjured leg will be required to carry most of your weight. It’s also important to understand that your body weight should not be supported by your underarms. If you rely on your underarms for support, you may end up with nerve damage from putting too much pressure on the area.
The correct method of using crutches involves standing up straight with your crutch tips two to three inches in front of your feet and adjusting your crutches so the top pad falls around one inch below your armpits. As you prepare to move with your crutches, your hands should be on the hand grips with a slight bend in the elbow and no bend in your wrist. Place the crutch tips in front of your toes and practice gently swinging your body through your crutches to move. You should keep the knee of your injured leg bent as you swing your body to prevent it from touching the ground, and land on your uninjured leg.
While it will take a little practice to get the hang of your crutches, learning to use them correctly will keep you more comfortable while you recover and help you get around more efficiently.
Does Using Crutches Build Muscle?
Using traditional crutches requires the use of your upper body strength. As with any exercise that requires exertion, using your crutches will build and strengthen some of your muscles, especially in your arms and torso. However, using traditional axillary crutches is not an ideal method of building muscle because it can cause pain and nerve damage in your arms, and pain in your wrists.
Incorrectly using crutches or using crutches for long periods of time can lead to nerve damage, which is why you should only use crutches if you actually need them and have been recommended to use crutches by your doctor.
Do People Still Use Crutches?
People all over the world and throughout history have used crutches and continue to do so to help them stay mobile during recovery.
Injured people of Ancient Egypt and the Middle Ages have been depicted using crutches that look much the same as the ones we use today. These historical crutches used a long pole or stick and often had a top that could be used to support weight.
Today, crutches offer greater comfort, safety, and are easier to use than they were in the past. Modern crutches feature better grips, additional padding for comfort, and construction for lightweight materials for easier transportation. Other crutches allow you to bend your knees and provide support that way, while still others use your forearms to help you get from place to place.
Do Crutches Hurt?
Traditional forearm or axillary crutches aren’t well-known for being comfortable. Prolonged use of crutches often causes soreness in the arms and can even cause considerable discomfort and pain to your underarms, hands, shoulders, and forearms. If used incorrectly or for long periods of time, underarm crutches can even cause permanent nerve damage in your underarms. This is because using crutches incorrectly and placing pressure on your armpits places pressure directly on your radial nerve and pushes it up against your humerus.
Make sure you’re following your doctor’s instructions on how to correctly use your crutches to avoid unnecessary pain and possible nerve damage.
What Is the Purpose of Crutches?
Crutches are designed to help keep weight off your injured foot or leg and help you maintain mobility while you recover. To correctly use crutches, you need to make sure that you’re using them correctly and keeping all weight off of your injured leg.
Different crutches can be used to assist with different types of injuries. Traditional crutches and forearm crutches work for individuals who have good upper-body strength and leg injuries ranging from the hip to the foot. Other crutches such as knee scooters and knee crutches are ideal for individuals who have below-the-knee injuries.
Do You Have to Be On Crutches for a Sprained Ankle?
Sprained ankles are a very common injury, but whether or not you will need to use crutches depends on the severity of your sprain. Severe sprains can involve muscle, ligament, or tendon tears that take weeks or months to recover from and often require the use of crutches. Ankle sprains are designated different grades depending on the severity of your sprain. There are Grade 1, Grade 2, and Grade 3 sprains.
- Grade one sprains usually involve some mild pain, swelling, and stiffness in your ankle. While walking or jogging may be painful with a Grade 1 sprain, they don’t usually require the use of crutches.
- Grade two sprains are more serious and may include bruising, greater swelling, loss of or minimal movement in the joint, and moderate pain. Grade 2 sprains often include partial ligament tears. They may require the use of crutches, but you should consult with your doctor prior to using crutches.
- Finally, Grade three sprains are the most serious and usually involve complete ligament tears. There will be severe swelling and pain and you will likely need to use crutches.
Your doctor will recommend the best course of action for recovery from a sprained ankle.
Crutches are medical devices designed to aid in ambulation, by transferring body weight from the legs to the torso and arms. They are mainly used to assist individuals with lower extremity injuries and/or neurological impairment. This activity describes the types of crutches, their indications, and contraindications and highlights the role of the interprofessional team in proper evaluation and training of patients needing ambulatory devices.
Objectives:
Describe the indications for crutches.
Review the contraindications of crutches.
Summarize the types of crutches available.
Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients needing an ambulatory device.
Crutches are medical devices designed to aid in ambulation, by transferring body weight from the legs to the torso and arms.[1] They are mainly used to assist individuals with lower extremity injuries and/or neurological impairment. Most crutches classify into the following three categories: axilla, forearm, and platform.
Indications for crutches are any temporary or permanent condition where compromise of lower extremity balance and weight bearing exists with a patient who has sufficient upper body strength and coordination to support and move their own body weight.
Age is a common contraindication to crutch use. The very old and very young may not possess the needed torso strength and coordination to use crutches successfully. Any musculoskeletal or neurological condition that reduces the mobility, strength, and sensation can potentially be a contraindication to the short term or long-term use of crutches.
Axilla crutches are the most common type.[2] Their ease of use makes them an excellent option for most individuals. They are best for short-term use. The design is intended to transfer most of the user’s body weight to the arms and torso. Axilla crutches are not ideal for individuals with wrist problems, weak upper body strength, or impairment of coordination. Most health care facilities discharge patients with axilla crutches for immediate use.
Forearm crutches are better for long-term use. The weight of the user is transferred mainly to their entire upper arms. The user needs good upper body strength to use these crutches properly. Individuals with long-term disabilities looking to be more active or participate in sports may choose forearm crutches as an option.
Platform crutches are the least common of the three. The weight of the patient is transferred mainly to the user’s forearms. The platform allows the user more stability than the axilla and forearm crutches, but the platform crutch has less maneuverability. They are intended for long-term use. Individuals with long-term disabilities from severe neurological impairment of their lower extremities with decreased stability may choose platform crutches as an option.
All crutches should undergo proper fitting to the user to avoid serious injury.
Axilla crutches: The shoulder pad should sit 2 inches (2 finger widths) below the axilla when the shoulder is relaxed. The hand grip should be adjusted to allow for a 30-degree flexion to the elbow. The crutch should sit about 6 inches outside of your feet, with instruction provided not to rest axilla directly on the shoulder pad.
Forearm crutches: The hand grip should allow for 30-degrees of elbow flexion. The cuff should be 1.5 inches below the elbow, and the crutch should sit 4 inches outside of the patient's feet.
Platform crutches: The platform can vary by design from a flat surface with hand grips to a fully adjustable composite with elbow guards and hand grips. The fitting should ensure that the angulation promotes stability and does not allow for elbow rubbing.
Patients can receive training for different gait patterns depending on their current injury and coordination level.
One crutch gait: This pattern utilizes only one crutch. Crutch positioning is on the side of the uninjured lower extremity. The crutch and the injured leg are advanced forward. Then the uninjured leg proceeds while the crutch supports the user's weight.
Two-point gait: The left crutch and right leg move forward followed by the right crutch and left leg.
Three-point gait: This is the most used technique. The left and right crutch along with the injured leg are both advanced while the uninjured leg supports the body weight. Next, the uninjured leg is advanced.
Four-point gait: This technique provides the most support. The left crutch is advanced followed by the right leg, right crutch and at last the left leg.
Swing-to gait: The left and right crutch are advanced. Then the left and right legs are advanced.
The user’s strength and coordination should undergo evaluation before issuing them a set of crutches. The use of the wrong crutches can lead to injury. Most injuries are a direct result of falling.
Crutch palsy is observable in axilla crutch users who rest their weight on the shoulder rest. The pressure on the brachial plexus can result in palsy to the radial and ulnar nerves. Extra padding on the shoulder rest can aid in preventing crutch palsy. Education should be provided to patients to discourage supporting body weight on the shoulder rest. With treatment, this can be a repairable injury.[3][4][5]
Crutches are vital in the short-term and long-term management of orthopedic and neurologic injuries. Through offloading body weight to the injured extremity optimal conditions are provided to allow healing of acute injuries. Crutches provide ambulatory support and mobility options to those with neurologic injuries or chronic orthopedic injuries enabling the individual to stay mobile and active. Crutches are a vital adjunct for those with acute and chronic injuries to maintain mobility and independence.
Advances in crutch technology are ongoing. The crutches are separated into their component parts and examined separately. The shoulder rest of the axilla crutches can lead to crutch palsy. Manufacturers have added softer and more pliable padding to the shoulder rest. However, the addition of extra padding can reduce the space between the axilla and shoulder rest leading to what it was intended to prevent. U- shaped or concave shoulder rest helps to solve the reduced space issue.[6]
Hand grips are part of each class of crutches. They serve as a significant connection between the crutch and the user. Hand grips have always been adjustable in the up, down, forward and back positioning depending on the crutch. Newer crutches have added more grip positions, which reduces the strain on the user’s wrist and aid in improved stability. New advances in design include more comfortable grips.[7]
The ailments of the crutch user are variable. The user’s musculoskeletal and/or neurological impairments limit the amount of weight that they can carry. Thus, the crutch should add the least amount of weight. The old wooden crutches are no longer in use. Lighter weight composites such as aluminum, titanium, and carbon fiber are now the norm in designs.[8]
Crutches are mainly intended to aid the user with their mobility. Engineers are looking at designs that will help move the user forward. User assistant features such as spring-loaded main tubes and struts are stated to increase the user’s momentum.[9] Unfortunately, not all studies have supported this particular engineering feature.
Rubber tips connect the user to the ground. Larger rubber tips are used to provide added stability. Newer composites can give a more streamlined design. They can offer more grip with less surface area. Pivoting tips may allow for more maneuverability.[10][11]
In addition to the prescribing physician, the therapist, nurse, and pharmacist can also evaluate the patient for the need for crutches. In fact, most pharmacies sell crutches and other ambulatory devices. an interprofessional team approach among all the entities just mentioned can assist the patient in crutch selection, fitting, and use to achieve optimal patient outcomes.
Before the potential user tries to use the most technological advance crutch, they must undergo proper fitting. The user must also remember that not all the technical advances have scientific proof to back up their claims.
Review Questions
1.
Nagasaki T, Katoh H, Arizono H, Chijimatsu H, Chijiwa N, Wada C. Analysis of Crutch Position in the Horizontal Plane to Estimate the Stability of the Axillary Pad in the Axilla during Single-crutch Walking. J Phys Ther Sci. 2014 Nov;26(11):1753-6. [PMC free article: PMC4242948] [PubMed: 25435693]
2.Potter BE, Wallace WA. Crutches. BMJ. 1990 Nov 03;301(6759):1037-9. [PMC free article: PMC1664010] [PubMed: 2249056]
3.Feldman DR, Vujic I, McKay D, Callcott F, Uflacker R. Crutch-induced axillary artery injury. Cardiovasc Intervent Radiol. 1995 Sep-Oct;18(5):296-9. [PubMed: 8846468]
4.Furukawa K, Hayase T, Yano M. Recurrent upper limb ischaemia due to a crutch-induced brachial artery aneurysm. Interact Cardiovasc Thorac Surg. 2013 Jul;17(1):190-2. [PMC free article: PMC3686390] [PubMed: 23529749]
5.Amin A, Singh V, Saifuddin A, Briggs TW. Ulnar stress reaction from crutch use following amputation for tibial osteosarcoma. Skeletal Radiol. 2004 Sep;33(9):541-4. [PubMed: 15205926]
6.Shoup TE, Fletcher LS, Merrill BR. Biomechanics of crutch locomotion. J Biomech. 1974 Jan;7(1):11-9. [PubMed: 4595087]
7.Dooley A, Ma Y, Zhang Y. The Effect of a Shock Absorber on Spatiotemporal Parameters and Ground Reaction Forces of Forearm Crutch Ambulation. Assist Technol. 2015 Winter;27(4):257-62. [PubMed: 26151882]
8.MacGillivray MK, Manocha RH, Sawatzky B. The influence of a polymer damper on swing-through crutch gait biomechanics. Med Eng Phys. 2016 Mar;38(3):275-9. [PubMed: 26852356]
9.Zhang Y, Beaven M, Liu G, Xie S. Mechanical efficiency of walking with spring-loaded axillary crutches. Assist Technol. 2013 Summer;25(2):111-6. [PubMed: 23923693]
10.Basford JR, Rhetta HL, Schleusner MP. Clinical evaluation of the rocker bottom crutch. Orthopedics. 1990 Apr;13(4):457-60. [PubMed: 2185461]
11.Nielsen DH, Harris JM, Minton YM, Motley NS, Rowley JL, Wadsworth CT. Energy cost, exercise intensity, and gait efficiency of standard versus rocker-bottom axillary crutch walking. Phys Ther. 1990 Aug;70(8):487-93. [PubMed: 2374777]