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All About Crutches

Recently I had the misfortune to spend an extended period of time on crutches. On the positive side, using crutches kept me mobile and fit, it taught me humility, and it educated me on what it’s like to go through life disabled.

SideStix crutchAs part of that education, I learned a whole lot more about crutches than I ever expected to know.

If you ever need to spend more than a few days on crutches, it’s worth doing your homework. Choosing the right crutches and learning how to use them in multiple scenarios can make your life much easier and happier.

But, unfortunately, at least in the U.S., you can’t necessarily count on your doctor or physical therapist to know what you need to know.

So here is what I’ve learned, the hard way….

Design

I was on crutches for a couple of weeks in college due to a sprained ankle. Though memories are fuzzy, the experience left me, as it does many people, with a deep distaste for the contraptions. That’s because I used a typical pair of underarm (or axillary) crutches bought at the nearby drug store. They were heavy, awkward, and potentially bruising to my underarms. I was happy to get off them, and they left me with the feeling that I wanted to avoid crutches at all costs, especially for long-term use.

Recently I needed to be non-weight-bearing on one leg for an extended period due to an aggravated hamstring injury. It became too much for a simple cane and staying in a bed or chair all day was a fate worse than death to me. A doctor friend suggested I try forearm crutches (also known as Lofstrand or Canadian crutches). I had never heard of them, though I realized I had seen them in use occasionally, generally by people with long-term disabilities. In the U.S., for reasons of culture and habit, forearm crutches are almost never prescribed for short-term use. Thus they are perceived as only for the chronically disabled.

That’s very unfortunate, because forearm crutches are far superior to underarm crutches in almost every way. Forearm crutches are shorter, lighter, and more ergonomic. They function like an extension to your arms and turn you into a sure-footed four-legged creature as necessary. They have cuffs which allow you to quickly use your arms for numerous daily tasks while you stand in place, with the crutch dangling from your forearm. Grabbing the crutch to move again is a simple maneuver.

With practice and some training, a previously athletic person can resume long walks and even ambitious trail hiking using forearm crutches. Attempting those activities with underarm crutches would be so awkward and taxing as to defeat even the most determined patient.

So those are the two main styles of crutches. There are other more specialized options available including crutches designed to cradle the knee while giving you a “peg leg” below, and crutches designed to cradle the entire elbow, as if you were leaning at a bar. I used the knee style several years ago when I had an ankle injury. Though it was a slight improvement over underarm crutches, it was bulky and awkward for most activities, and I would now strongly prefer forearm crutches instead.

Use

Many people are reluctant to use a cane or crutches for fear of being dependent, or appearing old and infirm. But if you really need these devices, you’re better off swallowing your pride. Fact is, you’re less likely to get injured, and more likely to recover, if you’re using the correct assistive devices. And you’ll be happier and less dependent on others if you can get around and take care of yourself efficiently under your own power!

Crutches can be a lifestyle-saving tool. But ease into them and build strength slowly. You don’t want to add an upper-body injury to your problems. My first few weeks on forearm crutches, I had slight shoulder pain and some lower-back tightness, so I limited my walking. Within a month I worked my way up, very gradually, to mile-long walks and hikes. Within two months, I could hike five miles on steep, rocky trails.

It’s important to understand the different gaits you can use with crutches, depending on the nature of your condition. In my case, a mixture of gaits has proven useful. In brief, the 2-point gate is like walking with two strong canes, the 3-point gate (which can be “swing-to” or “swing-through”) is for removing most or all weight from one leg, and the 4-point gate is the slowest/most supportive, turning you into a slow-moving, 4-legged animal. Trying to visualize these gaits from text is needlessly frustrating. Search YouTube for instructional videos and see the illustrations at Walk Easy.

Stairs seem like a challenging obstacle for crutches. But with a little practice on forearm crutches, you can be as secure, if not more so, than using railings — which might not always be available. Begin with the mnemonic “up with the good [leg], down with the bad [leg]” but improvise from there, depending on your condition. Be careful to always look down and make sure both crutch tips are set back from the lip of the stair tread, so there is no possibility of one slipping off when weighted.

With your hands occupied, learning how to carry things with crutches is an essential life skill. For starters, keep a small day pack handy. I have one stationed near my stairs at all times. In addition to the pack you have three main options: (1) pinching small items between thumb and a finger while seating the crutch grip firmly in the palm of your hand, (2) pressing larger flat-ish items between an arm and your torso, and (3) looping the handles of a bag or carrying sack over the crutch grip before placing your hand on it.

Lastly, if you must travel while on crutches, note that you can fairly easily pull modern luggage that has wheels and an extended handle by inserting the crutch through the handle so it rests in the “V” at the back of the crutch grip, then walking with the crutch as normal.

Products

Being an engineer and gear freak, I may have spent more time researching and trying crutch options than anybody else on the planet. In particular, I’ve identified good entry-level and state of the art forearm crutch options. Here are the details.…

You can get your feet wet with decent quality, low-end forearm crutches on Amazon for about $50. Vive and Drive make similar-looking items. I purchased and used the Vive crutches for several weeks and found them to be a good value. I’d recommend looping a small cord or webbing across the cuff loops so the crutch can hang feely when your arm is in use. And, for extended use, I highly recommend wrapping the hard plastic grips with bicycle handlebar or similar padded tape, for comfort. In the very long run, these crutches may wear or break at the adjustment points. But they should give you at least a few months of hard use, while you assess your situation and your need for higher-end solutions.

Note: I do not recommend the common Medline aluminum forearm crutches, though they are cheap and sturdy. They are also clunky and over-designed, and the single-size cuffs were too large to be functional for me. Furthermore the Medline look like generic hospital equipment and are, frankly, depressing. You can do much better for long-term use.

The lightest forearm crutches on the planet are those manufactured and sold by INDESmed in Spain. These are an incredibly elegant design consisting of a single thin shaft (in aluminum for about $120 or carbon fiber for about $500), with infinitely adjustable grip and cuff that slide up and down and then lock to the shaft. The carbon fiber model weighs an amazing 12 ounces per crutch, and the aluminum version is only slightly heavier. The INDESmed crutches are my go-to tool for operating around the house and on short errands around town. The light weight is incredibly liberating. They are also right/left interchangeable so it doesn’t matter how I grab them. And the folding open-closed Cuff is very flexible. The only downside in my view is that the crutches are too light and don’t have enough grip padding for serious long-distance walking/hiking. For all other purposes, they get my highest recommendation.

The finest forearm crutches in the world, to my knowledge, are those made by SideStix in Canada. This company, founded by an amputee (who has climbed Mt. Denali!) and a structural engineer, has spent a decade perfecting the forearm crutch for long-term and long-distance users. What they’ve achieved is the pinnacle of strength, functionality, and comfort. If you are on crutches for the duration, you owe it to yourself to move onto custom-built SideStix. Their Boundless model, which I use for all my hiking, has a sizable, leather-padded cuff, integrated shock absorber, ergonomic grip, carbon fiber shaft, and burly articulating/rotating tip. In addition to the stock features, SideStix offers a full array of accessories for different kinds of terrain, including ice, mud, sand, and snow. All aspects of this company, from its products to its web site to its customer service, exist to improve the lives of mobility-challenged customers. Their quality, care, and concern shows through everything they do. At about $800, the top-of-the-line Boundless is not cheap, but if walking far and living life to the fullest is important to you, the price is minimal.

Finally, two other companies are worth a quick mention: Walk Easy has a broad array of functional-looking forearm crutches, similar to the entry-level Amazon models, but with more features and options, for slightly more money. And Thomas Fetterman makes beautiful, strong, and light custom titanium forearm crutches.