What is the proper method for crutches (assistive walking devices) training?

Crutch Training Guidelines

Proper crutch training requires adjustment to two finger widths below the armpit with handgrips positioned to flex the elbow 25-30°, followed by instruction on appropriate gait patterns and safety techniques to prevent falls and secondary injuries. 1, 2

Proper Crutch Fitting

• Height adjustment: Position crutches approximately two finger widths below the armpit to prevent nerve compression 1, 2
• Handgrip adjustment: Set handgrips to allow 25-30° elbow flexion with the wrist straight 2
• Weight distribution: Instruct patient to bear weight through the palms on handgrips, NOT through the axilla 1

Gait Training Based on Weight-Bearing Status

Non-Weight Bearing (NWB)

1. Position crutches slightly ahead and to the sides
2. Lift injured leg off ground
3. Swing body through crutches using upper body strength
4. Land uninjured foot ahead of crutches

Partial Weight-Bearing (PWB)

1. Position crutches slightly ahead and to the sides
2. Step forward with injured leg, placing only prescribed amount of weight on it
3. Step through with uninjured leg
4. Advance crutches forward and repeat

Weight-Bearing as Tolerated (WBAT)

1. Position crutches slightly ahead and to the sides
2. Step forward with injured leg, placing as much weight as comfortable
3. Step through with uninjured leg
4. Advance crutches forward and repeat

Stair Navigation Training

Ascending Stairs

1. Step up with the uninjured leg first
2. Bring crutches and injured leg up together afterward

Descending Stairs

1. Place crutches on the step below first
2. Lower the injured leg down
3. Step down with the uninjured leg last

Safety Precautions

• Avoid axillary pressure: Weight should be borne through hands, not armpits
• Check crutch tips regularly: Replace worn tips to prevent slipping
• Clear walking paths: Remove obstacles and secure loose rugs
• Use appropriate footwear: Wear supportive, non-slip shoes
• Maintain proper posture: Keep shoulders relaxed and back straight
• Surface awareness: Be cautious on wet, slippery, or uneven surfaces
• Fatigue management: Take breaks as needed to prevent falls from exhaustion

Sitting and Standing Techniques

Sitting Down

1. Back up to chair until legs touch the seat
2. Hold both crutches in one hand on the unaffected side
3. Use the other hand to grasp the armrest of the chair
4. Lower slowly into the chair

Standing Up

1. Hold both crutches in one hand on the unaffected side
2. Push up using the armrest and unaffected leg
3. Once standing, position crutches properly under each arm

Doorway Navigation

1. Open door toward the unaffected side when possible
2. Hold both crutches in one hand if necessary
3. Use the other hand to manage the door
4. Return to proper crutch position after clearing the doorway

Proper crutch training is essential for patient safety and mobility. While older adults rarely use crutches due to the required upper body strength 3, when indicated, thorough training can help prevent complications and ensure effective mobility during recovery 1, 4.