Dominic Stone
Crutches are a type of walking aid designed to increase the user's base of support. They transfer weight from the legs to the upper body and are used by people who cannot use their legs to support their weight. Crutches are typically used by individuals with lower extremity injuries or neurological impairments. The use of crutches requires strength in the abdominal, arm, and hip flexor muscles. There are several types of crutches, including axilla, elbow, forearm, gutter, and platform crutches. Crutch users may adopt different walking patterns, such as the two-point, three-point, or four-point gait, depending on their stability and weight-bearing capacity.
| Characteristics | Values |
|---|---|
| Definition | Medical devices designed to aid in ambulation |
| Function | Transfer body weight from the legs to the torso and arms |
| Types | Axilla, Forearm, Platform, Elbow, Gutter, Triceps |
| Gait Patterns | Two-point, Three-point, Four-point, Swing-through |
| Height | Adjustable overall height and handgrip height |
| Use | Assist individuals with lower extremity injuries and/or neurological impairment |
| Contraindications | Age, wrist problems, weak upper body strength, coordination issues |
| Complications | Undue muscle stress, cramps, fatigue, injury |
| Preparation | Strengthen abdominal and arm muscles |
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What You'll Learn
- Crutches aid in ambulation by transferring weight from the legs to the torso and arms
- Crutches are used by people who cannot use their legs to support their weight
- Crutch gait patterns: two-point, three-point, four-point, and swing-through
- Crutch exercises to strengthen abdominal and arm muscles
- Crutch contraindications: age, wrist problems, weak upper body strength, and neurological conditions
Crutches aid in ambulation by transferring weight from the legs to the torso and arms
Crutches are medical devices designed to aid in ambulation by transferring body weight from the legs to the torso and arms. They are primarily used to assist individuals with lower-extremity injuries or neurological impairments. Crutches increase the user's base of support and are often used by people who cannot use their legs to bear their weight, including those with short-term injuries or lifelong disabilities.
There are several types of crutches, including axilla (or underarm) crutches, elbow crutches, forearm (or Lofstrand) crutches, and gutter crutches. Axilla crutches are the most common type and are designed to transfer most of the user's body weight to the arms and torso. They are best suited for individuals with strong upper bodies and good coordination. Forearm crutches, on the other hand, are recommended for long-term use as they distribute the user's weight more evenly across the upper arms.
The height of crutches is adjustable to suit the user's needs. Axilla crutches, for example, should be positioned with a 2-3 finger distance between the axilla and the axilla pad, with the elbow flexed between 20-30 degrees. Similarly, the height of forearm crutches can be adjusted to the user's comfort, typically ranging from 29 to 35 inches (74 to 89 cm) from the handgrip to the floor.
Using crutches requires learning a new gait pattern. The three-point gait, for instance, is used when one of the lower extremities cannot fully bear weight. In this pattern, the crutches move forward first, followed by the affected limb, and then the weight-bearing limb steps through beyond the crutches. This ensures that there are always three points of contact with the floor, providing stability. Another gait pattern is the two-point crutch gait, which is less stable and requires good balance. In this pattern, the crutches and the non-weight-bearing limb advance as one unit, followed by the weight-bearing limb.
To walk with crutches, the user typically positions the crutches forward and uses their abdominal muscles to pull their pelvis towards their hands, preventing their legs from pushing backward. Then, they walk their hands towards their feet, maintaining their balance on the crutches. This process requires strength and coordination, so it is important for healthcare professionals to evaluate the user's abilities before issuing crutches.
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Crutches are used by people who cannot use their legs to support their weight
Crutches are medical devices designed to aid individuals who cannot use their legs to support their body weight. They transfer weight from the legs to the torso, arms, and sometimes, the knee or thigh. Crutches are typically used by people with lower-extremity injuries or neurological impairments. They are also used by people with lifelong disabilities.
There are three main types of crutches: axilla, forearm, and platform. Axillary crutches, also known as underarm crutches, are positioned with 2-3 fingers of distance between the axilla and the axilla pad, with the elbow flexed between 20-30 degrees. They include an axilla bar, a handpiece, and double uprights joined by a single leg. Forearm crutches, also known as elbow crutches, have a single upright, a forearm cuff, and a handgrip. The height of the handgrip is adjustable. Platform crutches, also known as gutter crutches, are composed of a padded forearm support, a strap, and an adjustable handpiece with a rubber ferrule. They are used for patients who are partial weight-bearing and are useful for those with rheumatoid conditions.
In addition to these three main types, there are also triceps crutches, which are made of aluminum and are designed for patients with paralyzed shoulder muscles. Spring-loaded crutches are another variation of axillary crutches, with a curved underarm pad that is open in the front. They include a spring mechanism at the bottom, allowing the user to propel themselves further.
Crutches can be made from various materials, including wood, metal, aluminum, titanium, and carbon fiber. It is important that crutches are adjusted to fit the user properly, as this can reduce the risk of adverse events and injuries related to crutch use. Users should also be educated on the proper use of crutches to avoid injuries such as crutch palsy, which can occur when too much weight is rested on the shoulder rest.
There are several different walking patterns, or gaits, that individuals using crutches may adopt. The one crutch gait utilizes only one crutch, which is placed on the side of the uninjured leg. The two-point gait, or two-point crutch gait, involves the use of two points of contact with the floor: the crutches and the affected limb as one point, and the uninvolved leg as the other point. The three-point gait is used when one of the lower extremities is unable to bear weight, with three points of contact with the floor: the crutches as one point, the involved leg as the second point, and the uninvolved leg as the third point. The four-point gait is used when there is a lack of coordination, poor balance, and muscle weakness in both legs, providing four points of support. The swing-through gait is the fastest mode of crutch ambulation but requires the most floor space, as the user swings their legs in front of the crutches.
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Crutch gait patterns: two-point, three-point, four-point, and swing-through
Crutches are a type of walking aid that increases the size of an individual's base of support, transferring weight from the legs to the upper body. The gait pattern adopted by a user of crutches depends on factors such as weight-bearing ability, energy levels, body strength, balance, coordination, and the type of walking aid chosen.
Two-Point Gait
In the two-point gait, the crutches and the non-weight-bearing/affected limb (due to fracture, amputation, joint replacement, etc.) make up one point, and the uninvolved leg makes up the other point. The crutches and the affected limb are advanced as one unit, and the uninvolved weight-bearing limb is brought forward to the crutches as the second unit. This gait pattern is less stable as only two points are in contact with the floor, requiring good balance.
Three-Point Gait
This three-point gait is used when one of the lower extremities is unable to bear weight. There are three points of contact with the floor. The crutches serve as one point, the involved leg as the second point, and the uninvolved leg as the third point. Both crutches move forward, the affected limb then steps up to the crutches, followed by the weight-bearing limb which steps through, beyond the crutches. There are always three points of contact with the floor at any given time.
Four-Point Gait
The four-point gait is used when there is a lack of coordination, poor balance, and muscle weakness in both lower extremities. This gait pattern provides four points of support, making it slow and stable. The sequence is: crutch on the involved side, uninvolved leg, involved leg, and then crutch on the uninvolved side.
Swing-Through Gait
The swing-through gait is the fastest mode of crutch ambulation but requires the most floor space. The individual must support the trunk and legs long enough to allow the legs to swing from behind the crutches to in front of them. This gait requires confident balance when the posteriorly placed crutches are out of sight. During the swing-through gait, the crutch advances simultaneously with the injured leg, and the user lands and pivots over the crutch while lifting the impaired leg. This pattern requires more force than other gaits.
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Crutch exercises to strengthen abdominal and arm muscles
Crutches are a type of walking aid that transfers weight from the legs to the upper body. They are used by people who cannot use their legs to support their weight, either due to short-term injuries or lifelong disabilities. While using crutches, your abdominal muscles are engaged to provide stability for your trunk, move your upper torso, and hold your abdominal organs in place. Your arm muscles are also engaged to support your weight.
Abdominal Muscle Exercises:
- Lying prone, dorsiflex your ankles and toes so that your feet are vertical. Position your crutches with the tips forward, in front of your body, and put your forearms through the forearm supports. Press up on your hands and simultaneously engage your abdominal muscles to pull your pelvis towards your hands, preventing your legs from being pushed backward. Maintain this abdominal muscle action and 'walk' your hands towards your feet, trailing the crutches until your weight is over your feet.
- If you have good abdominal muscles, you can practice climbing stairs. You can climb the stairs either forwards or backward, but the forward technique is usually taught first as the patient can see where they are going.
Arm Muscle Exercises:
- Practice light walking while on crutches to get some cardio.
- The iWALK 2.0 mobility device is a handless crutch that enables you to move around the gym and get back to walking while on crutches. It provides stability without putting pressure on your arms.
- Try seated cardio workouts that you can do while in a chair. These can help you engage in a full-body workout even while injured and using crutches.
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Crutch contraindications: age, wrist problems, weak upper body strength, and neurological conditions
Crutches are a type of walking aid that increases the user's base of support. They transfer weight from the legs to the upper body and are often used by people who cannot use their legs to support their weight, from short-term injuries to lifelong disabilities. Crutches are vital in the short-term and long-term management of orthopedic and neurologic injuries.
There are several contraindications to using crutches, and these are primarily related to age, wrist problems, weak upper body strength, and neurological conditions.
Age
Age is a common contraindication to crutch use. Very old and very young individuals may not possess the required torso strength and coordination to use crutches successfully.
Wrist Problems
Axilla crutches, which are the most common type of crutch, are not ideal for individuals with wrist problems. This is because the design includes a handpiece, and the weight of the user is transferred to the arms and torso. Newer crutch designs have added more grip positions, which can reduce strain on the wrist. However, axillary crutch use has been associated with axillobrachial arterial complications due to pressure from the axillary bar.
Weak Upper Body Strength
Crutches require sufficient upper body strength to support and move the user's body weight. Individuals with weak upper body strength may not be able to use crutches safely. Forearm crutches, for example, require good upper body strength as the user's weight is transferred mainly to their upper arms.
Neurological Conditions
Any neurological condition that reduces mobility, strength, and sensation can be a contraindication to crutch use. Crutch use can result in abnormal and repetitive weight-bearing through the upper extremities, which may lead to secondary injuries. These include neurological complications such as compressive neuropathies and brachial plexus paralysis.
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Frequently asked questions
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.
Abdominal muscles are engaged when using crutches to keep the trunk upright and the torso stabilised. Additionally, arm muscles are also used when walking with crutches.
There are three main types of crutches: axilla, forearm, and platform. Axilla crutches are the most common type and are best for short-term use. Forearm crutches are better for long-term use and are a good option for individuals with long-term disabilities looking to be more active. Platform crutches are the least common type and are intended for long-term use, providing more stability but less manoeuvrability.
