Forearm (elbow) Vs. Underarm (axillary) crutches
Adjusting forearm crutches
Walking with forearm crutches - non-weight bearing/partial-weight bearing/weight bearing as tolerate/full-weight bearing
Adjusting walking speed with forearm crutches
Walking with one forearm crutch
Sitting to standing with forearm crutches
Walking up and downstairs with forearm crutches
Forearm crutches Vs. Underarm crutches
Underarm crutches are also known as axillary crutches.
Forearm crutches are also known as elbow crutches.
In Hong Kong, medical practitioners prescribe forearm crutches predominantly for lower limb injury. But why? There are different pros and cons of using different types of crutches, and there are certain conditions that require either underarm or forearm crutches only. Let us go through the difference between the two types and hope to clarify some confusion about using them.
Characteristic of the forearm and underarm crutches
Axillary crutches have a higher pivot point than elbow crutches. Also, they are longer and, therefore, more cumbersome.
Balance and upper body strength
Crutches users need to balance themselves and support their bodyweight with the upper body strength. Underarm crutches are more manageable for those who are not very good at balance and have weak body strength.
Freedom of movement, including stairs
Forearm crutches allow one to move easier in different terrains, including stairs, compared to underarm crutches. Those crutches users who can balance themselves with forearm crutches will have more freedom of movement.
Posture
Elbow crutches encourage a more upright posture.
Side effects
Elbow crutches are better at distributing weight to the whole body. For prolonged walking, it is more comfortable. For axillary crutches, using it for a long time may lead to soreness and abrasion. Putting extra pressure on the upper arm for a long time or when one is fatigued and rest their body weight on the axillary crutches' soft pad, a permanent nerve (axillary nerve - the nerve that passes through the armpit) damage, "crutch palsy" may result.
We found that elbow crutches generally have more advantages and are suitable for the majority of people. However, always consider your physical condition, medical diagnosis, rehabilitation plan, or discuss with medical practitioners before purchasing your crutches.
Using forearm (elbow) crutches as an example, we will talk about adjusting the crutches and walking around with them.
How to adjust forearm (elbow) crutches
Adjusting the height of the elbow crutches:
Stand upright, relax your shoulders, and hang your arms loosely at your sides.
The height of the handgrips is at the level of your wrist crest.
Adjust the spring button at the leg of the crutches to fit your height.
Make sure the spring button is fully engaged.
Your elbow should be bent at around 30 degrees if you hold on to the handgrips of the crutches.
Make sure both crutches are of the same height, unless for specific medical conditions.
Final check to ensure all the spring buttons are engaged and the collars are rotated to secure the leg extensions.
Adjusting the position of the elbow crutches cuffs:
The cuffs should be adjusted to 2.5 cm to 5 cm (1-2inches) below the elbow joints.
Adjust the spring button below the cuffs to fit your forearm length.
Final check to ensure all the spring buttons are engaged and the collars are rotated to secure the cuff position.
WARNING for using elbow crutches:
Periodically check the anti-slipped rubber at the bottom of the crutches and replace it with a new one if they wear and tear.
Ensure the spring buttons of the leg extension and cuff position adjustment are fully engaged and the collars are secure.
Please do not use the cuffs to support your body weight. They are designed to add stability to the elbow crutches only.
Always follow the instructions from your physiotherapist and healthcare providers, use these guidelines alongside their advice. These guidelines are not intended to replace their instructions.
Walking with elbow crutches
Depending on your recovery stage, you may be allowed to use the crutches with different techniques. Your physiotherapist or medical professionals will tell you how much weight you can put on your injured leg.
Starting position using elbow crutches
Always stand straight and look forward when you are using crutches to prevent back pain.
We will illustrate different weight bearing conditions with a slower speed approach.
Non-weight bearing with elbow crutches
You should not put any weight on your injured leg. (you can do this by slightly bent your knee to keep your foot clear from the ground)
Place the crutches one step in front of you, make sure they are level.
Move your body forward between the crutches to the same level as the crutches, support your body weight with your arms.
Feather-weight bearing/toe-touch weight bearing with elbow crutches
You can touch the floor with the tips of your toes but should not put any weight on them.
Place the crutches one step in front of you, make sure they are level.
Let your toes of the injured leg touch the floor.
Move your body forward between the crutches to the same level as the crutches, support your body weight with your arms.
Partial-weight bearing with elbow crutches
Your medical professional will let you know how much weight you should put on your injured leg.
Partial-weight bearing usually guides by percentage, e.g., 25%/50% of your body weight. Your therapist can guide you to feel the weight you can put on your leg with a scale. For a 60kg weight person, 25% of your body weight equals 15Kg. Gradually increase the weight putting on your injured leg until 15kg and do not exceed that level.
Place the crutches one step in front of you, make sure they are level.
Put your affected leg on the floor, one step behind the crutches.
Move your body forward between the crutches to the same level as the crutches. Support your body weight with your arms and partially with the affected leg.
Weight bearing as tolerated and full-weight bearing
It is the stage when you can put as much weight as you can tolerate until you can fully bear your body weight. Your doctor or therapist usually allows you to put more weight on your injured leg to prevent muscle weakness when healing meets a certain satisfactory level.
Place the crutches one step in front of you, make sure they are level.
Put your affected leg on the floor, one step behind the crutches.
Move your body forward between the crutches to the same level as the crutches. Support your body weight with your arms and affected leg (as much as you can). Walk as normal as possible similar to the partial-weight bearing.
Adjusting walking speed with elbow crutches
Depending on your physical condition, you can adjust your walking speed.
Fast speed:
Start with the crutches 3-5cm/1-2 inches outside of each foot.
Move one leg (left leg) with the opposite crutch (right crutch), like your normal walking rhythm. Place the crutch (right) one step in front of you.
Repeat step 2 with your right leg and left crutch, try to walk with even stride length between the injured and non-injured leg.
Slower speed with more support:
Start with the crutches 3-5cm/1-2 inches outside of each foot and one step in front of you.
Move your injured leg to the same level as the crutches. You can combine steps 1 & 2 if feeling comfortable. (Moving the injured leg with both crutches at the same time.)
Support your body weight with the crutches (or crutches + injured leg according to the percentage of weight you are allowed to bear).
Step your non-injured leg slightly in front / at the same level (the slowest speed with most support) of the crutches.
Walking with one crutch (partial or full-weight-bearing)
Walking with one crutch allows you to move around more conveniently and free one hand for daily activities. However, walking with one crutch required you to bear more weight on the injured leg. Consult your doctor or therapist before you do so.
Put the crutch on your healthy side (opposite to the injured side). To help you lean away from your injured side.
Move the injured leg (left leg) with a crutch (right crutch), like your normal walking rhythm. Place the right crutch one step in front of you.
Step past the crutch with your healthy leg by partially supporting your body weight on the crutch and partially on your injured leg. You can also put full weight on your injured leg with the crutch for balance only.
Try to walk with even stride length between injured and non-injured legs.
Sitting to standing with elbow crutches
Do not put weight on the cuffs they are not designed for weight bearing.
Hold the two crutches with one hand on your good side in the "H" shape. Grab and weight bear on the handles.
Put the other hand (injured side hand) on the arm of the chair/ bed (make sure they are stable).
Push yourself up.
Put your forearm into the cuffs and start walking.
Before you sit down, remove your forearms from the cuffs, reverse the above procedure. Make sure the chair or place you intend to sit is lined up right behind you stably.
Stairs walking with elbow crutches
Going up
Stand close to the handrail.
Hold on to the handrail with one hand.
Hold both crutches with another hand. Do this by keeping your arm in the elbow crutch cuff that supports you, turn the other crutch horizontally, and hold it together with the supporting crutch. Make sure you hold the center of the spare crutch for easier balance.
If there is no handrail, keep the crutches on both sides as if you are walking on level ground.
Go up with the good leg, support your body with the handrail and supporting crutch(es).
Lift up your injured leg, followed by the crutch(es), ensure the supporting crutch(es) is placed safely on the next step.
Going down
Stand close to the handrail (with the injured leg closer to the handrail if you have a choice for better safety).
Hold on to the handrail with one hand.
Hold the crutches the same way as you go upstairs.
If there is no handrail, keep the crutches on both sides as if you are walking on level ground.
Lower the crutch(es) first. Make sure the crutch(es) are safely placed.
Lower your injured leg.
Lower the good leg and support your body weight with the handrail or supporting crutch(es).
Remember the saying, "Good to heaven, bad to hell".
If you find it difficult to handle the crutches, don't worry. Let the healthcare professionals help you.
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