You’re rounding third base in your co-ed city league softball game and are looking to score the go ahead run. As you hit the base and run towards home, your third base coach yells for you to run back to 3rd due to the accurate throw to the plate. You quickly hit the brakes and feel your cleats dig into the hard city field dirt, but your knee keeps going …POP! Everything happens so fast and before your mind is clear the ER physician is looking at you mouthing the words, “ ACL tear”. You are trying to process all the information rapidly but are handed a pair of crutches.
Has this happened to you, have you had a similar experience with a different injury, ankle fracture maybe? If you have never used crutches… you’re lucky!
People do not typically know how to fit crutches to their height and usually will follow the height recommendations on the side of the crutch adjustments. SPOILER ALERT: these height adjustments are usually wrong. Have you every experienced: numb hands, raw armpits, aching back or a fall? Patients using crutches during their first appointment at my clinic often complain of these symptoms. Many people have never experienced how to use crutches and are not familiar with the fitting procedure.
What areas are necessary to learn to use crutches properly?
- Crutch fit: Crutch fitting begins with the patient standing erect with their arms at their sides. The crutch tip is placed at the outside part of the shoe about at toe break. What is toe break? Bend knee and lift heal where toes are still in contact with the ground. Break in shoe is toe break. The top of the crutch is resting under the arms with 2-3 fingers space between the top of the crutch and the armpit. Hand placement is found with the arms to the side while standing tall. The handles are even with the wrist.
- Crutch use with non weight-bearing: Once the crutches are fit properly, the next step is to use the crutches to move the body forward without placing weight on the leg. Crutches will first be placed in front of the body evenly. Second, stabilize your body with your arms as you allow your legs to swing through the crutches (note: only your stable leg should ever touch the ground). Once comfortable you may continue repeatedly. If performed correctly the back of your arms will become tired and sore, however the armpits should not. The pads should not press into the armpits.
- Crutch use with stairs: Stairs and crutches may become tricky however. An easy reminder is, “ Good goes to heaven, bad goes to hell.” This refers to which leg to lead with when going up and down stairs. For example, when going up stairs place the uninvolved (good) leg up on the stair first and then lift the body and crutches up to the same level of stair. This will allow the uninvolved leg to stabilize the body with pushing up to the next stair. Descending a step is a little harder. Remember the involved (injured) leg must lead down the step, however the crutches have to lead with the leg too. Step down with the crutch and the involved leg. This allows the body be stabilized by the good leg with descending. This is tricky at first but with practice it becomes more automatic.
Crutch fitting and training is a tricky experience for an individual after a significant injury. Whether you are playing co-ed softball, running a marathon or stepping off a curb, the chance of lower leg injury is prevalent. It is important to understand how to use crutches properly to stay safe. Most people will never use crutches, but if they do, make sure they are using them properly.
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