The majority of temporary crutch users use an underarm style crutch because they require a minimum of training to use correctly, and substantially less upper extremity strength than other types of crutches. Crutches are most likely to be the appropriate walking aid when a person must not bear any weight on one leg, as would be the case with a broken leg, ankle, or foot.
FITTING UNDERARM CRUTCHES
Proper fitting of underarm crutches requires two adjustments.
1. Overall height (from rubber tip to underarm pad).
2. The distance from the hand grip to the underarm support.
Adjust the overall height of the crutch first. With the user standing erect, looking straight ahead with shoulders squared, place the crutch tip 6 to 8 inches forward of the toes and the same distance out to a position approximately one inch below the front of the underarm. When adjusting the height ensure that the crutch is not pressed too tightly under the arm. Crutches that are set too high will cause unnecessary pressure and irritation under the arms. However, the crutch height should not be so short as to cause the user to have to stoop in order to obtain support.
Once the overall height is adjusted properly you should then adjust the handgrip position to provide approximately a 20 to 30 degree bend in the elbow. This can usually be achieved by having the user stand straight with eyes straight ahead, shoulders squared, and arms hanging relaxed at the sides. You can then place the crutch vertically beside the user and adjust the handgrip to a position slightly above the wrist.
This adjustment technique will encourage the user to support most of the weight with the hands and arms, not the underarms. This is very important. Prolonged and excessive pressure on the underarm will cause severe soreness and possible numbness of the arm.
INSTRUCTION FOR USE
There are several methods of using crutches. These methods are called crutch gaits. If you have had the benefit of instruction on the use of your crutches by your physician or therapist follow those instructions carefully. Otherwise, what follows are some basic instructions for using underarm crutches.
The most frequent reason for using crutches is to relieve all weight bearing on one leg. For this situation your physician or physical therapist will probably want you to use the three-point gait. This method might be described as an "assisted hop".
The three-point gait begins by standing with your weight distributed evenly between your strong leg and the two crutches. The knee of the injured leg is bent slightly to keep that foot off the floor completely. Shift all weight to the strong leg momentarily while the two crutches are moved forward several inches. All weight is then supported by the crutches while the strong leg is swung forward to a point between the crutches. As you gain confidence you may swing the strong leg through to a point several inches in front of the crutches. This is called a swing-through three point gait and can provide faster ambulation.
If you physician or physical therapist chooses any other gait for you, such as the two point gait or the four point gait, they will likely arrange for some special training in those methods.
It is possible for some crutch users to negotiate steps. DO NOT attempt this unless it has been recommended by your physician or physical therapist.
Assuming that you are using the more common three-point gait going up stairs involves shifting the crutch that would be next to the banister to the other hand. Holding both crutches in one hand, shift the weight to the crutches and the banister and hop onto the step with the strong leg. Bring the crutches up onto the step beside the foot. Repeat this procedure until you complete the stairs.
If no banister or handrail is available leave the crutches in their normal position in each hand and face the stairs squarely. Putting all weight on the crutches, hop onto the first step and swing the crutches up alongside the foot. In either case, remember, when going up stairs, the strong foot always goes first, followed by the crutches.
Going down stairs requires the same basic procedure with one major exception. First, place the crutches on the next step down, then carefully and slowly follow with the strong leg and foot.
To sit down in a chair you should approach the chairs so that the strong leg is close to the seat. Grasp both crutches in the opposite hand and place the strong side's hand on the armrest of the chair. Place the crutches at the back of the chair. Then pivot on the strong foot until the back of the strong leg touches the seat. Place the other hand on the other armrest and lower yourself into the chair. To rise out of the chair simply reverse the above sequence.
The rubber tips on your crutches should be inspected regularly. Worn or damaged tips, underarm pads, and handgrips should be replaced immediately. The security of all adjustment mechanisms should also be checked frequently.