Crutch Walking

1. Inform the client you will be teaching crutch ambulation.

Rationale:  Reduces anxiety. Helps increase comprehension and cooperation,

promotes client independence.

2. Assess the client for strength, mobility, ROM, visual acuity, perceptual difficulties
and balance. Note: nurse and therapist often collaborate on this assessment.

Rationale: Helps determine the clients capabilities and amount of assistance required.

3. Adjust crutches to fit the client. With the client supine, measure from the heel to the
axilla. With the client standing, set the crutch position at a 4-5 inches lateral to the
client and 4-6 inches in front of the client. The crutch pad should fit 1.5 – inches
below the axilla (3 finger width). The hand grip should be adjusted to allow for  the
client to have elbows bent at 30 degree flexion.

Rationale: Provide broad base of support for the client. Space between the crutch pad
and axilla prevents pressure on radial nerves. The elbow flexion allows for space
between the crutch pad and axilla.

4. Lower the height of the bed.

Rationale: Allows the client to sit with feet on the floor for stability.

5. Have the client dangle legs. Assess for vertigo.

Rationale: Allows for stabilization of blood pressure, thus preventing orthostatic

hypotension.

6. Instruct the client to position crutches lateral to and forward to feet. Demonstrate
correct positioning.

Rationale: Increases client comprehension and cooperation.

7. Apply the gait belt around the client’s waist if needed.

Rationale: Provides support, promotes client safety.

8. Assist the client to a standing position with crutches.

Rationale: Standing for a few minutes will assist in preventing orthostatic
hypotension.

Four-Point Gait

9. a. Position crutches to the side and in front of each foot.

b. Move the right crutch forward 4 to 6 inches.

c. Move the left foot forward, even with the left crutch.

d. Move the left crutch forward 4 to 6 inches.

e. Move the right foot forward, even with the left crutch.

f. Repeat the four-point gait.

Rationale: The four point gait provides greater stability. Weight bearing is on three
points at all times. The client must be able to bear weight with both legs.

Three-Point Gait

10. a. Advance both crutches and the weaker leg forward together.

b. Move the stronger leg forward, even with crutches.

c. Repeat three-point gait.

Rationale: The three point gait provides a strong base of support. This gait can be used
if the client has a weak or non-weight-bearing leg.

Two-Point Gait

11. a. Move left crutch and right leg forward 4 – 6 inches.

b. Move right crutch and left leg forward 4 – 6 inches.

c. Repeat two-point gait.

Rationale: The two pint gait provides a strong base of support. The client must be able
to bear on both legs. This gait is faster than four-point gait.
Walking UP stairs

12.a.  Instruct the client to position the crutches as if walking.

b. Place the strong leg on the first step.

c. Pull weak leg up and move the crutches up to the first step.

d. Repeat for all steps

Rationale: Prevents weight bearing on the weaker leg.

Walking DOWN stairs

13. a. Position the crutches as if walking.

b. Place weight on the strong leg.

c. Move crutches down the next lower step.

d. Place partial weight on hands and crutches.

e. Move the weak leg down to the step with crutches.

f. Put the total weight on arms and crutches.

g. Move strong leg same step as weak leg and crutches.

h. Repeat for all steps.

Rationale: Prevents weight bearing on weaker leg.

14. Set realistic goals.

Rationale: Crutch walking takes up to 10 times the energy required for unassisted

ambulation.

15. Consult with a physical therapist.

Rationale: The physical therapist is the expert on the health care team for crutch-
walking techniques.
16. Wash hands.
Rationale: Reduces the transmission of microorganisms.
Reference:
Kozier, Barbare, et.al. Fundamentals of Nursing. Philippines: Pearson Education
South Asia PTE LTD. pp. 1102-1104
Ensure proper footwear is on the patient, and
let the patient know how far you will be
ambulating. Proper footwear is non-slip or slip-
resistant footwear. If in acute care, check
prescriber’s orders for any activity restrictions
related to treatment or surgical procedures.
 2. Ensure crutch height is correct.
 3. Explain and demonstrate how to walk with
crutches.
4. From a sitting position, advise the patient to
push up from the chair’s armrest to a standing  able to bear weight on own legs, and to have good
position. Stand to gain balance. Advise the
patient to not lean on the underarm supports.
 Proper footwear is essential to prevent accidental
falls. An informed patient is part of delivering safe
patient care.
Footwear
Axilla height crutches: When standing, the there
should be two to three finger widths from the axilla
to the top of the crutch. The height of the hand grip
will be adjusted to allow the elbow to be flexed 15 to
30 degrees or to the wrist crease. There are different
crutch walking techniques that depend on the
patient’s ability to bear weight.
Forearm crutches: The elbows should be flexed 15
to 30 degrees when holding the hand grips. The
forearms should be supported roughly mid-point
between the wrist and elbow.
 An informed patient may result in reduced risk of
falls.
The patient should be cooperative and predictable,
trunk control. Apply gait belt if required for
additional support.
Pressure on the axilla can cause damage to tissues
and nerves.
5 a. Advise patient accordingly: Bear in mind any weight bearing limitations.

Ambulation method #1:

 Establish balance.
 Move both crutches forward slightly.
 Move injured leg forward.
 Push down on the crutch hand grips.
 Step through the crutches with the
good leg.
 Ensure balance is maintained.
 Repeat.

5 b. Ambulation method #2: Ambulation method #2 requires good balance and

trunk strength.
 Establish balance.
 Move the crutches and the injured leg
forward simultaneously.
 Push down on the crutch hand grips.
 Step through the crutches with the
good leg.
 Ensure balance is maintained.
 Repeat.

6 a. Ascending stairs: Strong leg – weak leg – crutches.

 Stand close to and facing the bottom Use of the hand rail may be helpful.
step.
 Step up with the strong leg.
 Ensure balance is maintained.
 Move the weak / injured leg onto the
step.
 Move the crutches up.
 Repeat.

6 b. Descending stairs: Crutches – weak leg – strong leg.

 Stand close to the top step and face the Use of the hand rail may be helpful.
stairs.
 Move crutches to the next step down
keeping weight on the hand grips.
 Step down with weak / injured leg.
 Ensure balance is maintained.
 Step down with good / strong leg.
 Repeat.
 Sitting Down: the patient will back up to the chair until they feel the chair
with the back of their non-injured leg. The patient will then move BOTH
crutches on to the INJURED side and grip the hand grips of the crutches
for support. The patient will keep the injured leg extended out and slightly
bend the non-injured leg. Then the patient will feel for the chair’s seat with
the non-injured side and sit down…all while keeping the injured leg
extended out.
 Getting Up: the patient will keep the injured leg extended out forward and
put BOTH crutches on the INJURED side and grip the hand grips of the
crutches. Then the patient will lean forward and push up with the arm of the
non-injured site on the chair’s seat and by using the hand grips on the
crutches, which is on the injured side. Once standing, the patient will bring
the crutches into the tripod position.