Getting Comfortable With Your Crutches

Sally Madeley-Carr, OT
11 Aug 2020

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If you're using crutches for the first time because you're recovering from an injury, or due to a chronic condition, there may be things you can do to make them more comfortable.

There are numerous types of crutches available, many of which differ markedly from the standard NHS models. As key mobility aids for many people across the UK, it's important to make sure you're getting the most out of them and that you're aware of the extra pieces of equipment which may improve comfort.

Because of the variations in design, each can be set and enhanced in different ways, so here we'll run down each type and talk about the things to think about in order to improve comfort.

Under-arm 'axilla' crutches

Axillary or 'axilla' style of crutch is hugely popular in the USA but less so in the UK, Europe and the rest of the world.

Its design is derivative of the original wooden crutch, with a horizontal resting pad right at the top, which fits under the armpit, with a split shaft below and a second horizontal pad for the hand to grip at around hip height.

Modern models are almost all manufactured using aluminium because of its light weight and rigidity. Previously, wood and even steel were used, with the steel in particular being rather heavy and unwieldy. Indeed, using steel for this kind of crutch would risk causing secondary injury purely because of the force required to use it.

While aluminium is an excellent material, partly because of its weight but also its anti-corrosive properties, most people still find axillas more difficult to use than elbow crutches.

We'll come on to the design of elbow crutches soon, but one of the key differences is that axilla models simply require more material in their construction. This makes them intrinsically heavier.

The technique required to walk with them is also different. A common mistake is applying pressure through the armpit, resting one's weight on the top pad.

This can lead to pinching nerves or inhibiting blood flow, so is to be avoided. It is important to size the crutches correctly so that a gap of at least the width of two fingers is present between the armpit and the pad.

Axilla crutches can usually be adjusted in two ways. The vertical shaft at the bottom can be altered in length so that the overall height of the device can be set as required. Also the handle height can be set in a similar way, adjusting using a second pin-clip mechanism.

With these two adjustments, the crutches can be set to suit most people's frame and stature.

The user's weight should be channeled through the arms and hands, without much pressure through armpit.

Some people feel it helps comfort by bolstering the padding at the top of the crutches. This can either be done using a specially made piece of material or by wrapping towelling around that area.

The problem with this is that it tends to significantly increase the height of the crutch and require more space in the armpit area. Because of the dangers associated with pinching in this area, it may not be a good idea in many cases.

The lower 'handle' of the crutches is somewhat different. With pressure going through the hands as you walk, extra padding in this area can be a good idea.

Simply increasing the diameter of the pad spreads weight across a larger surface area, improving comfort.

Again, you can use towelling taped to the grips for this purpose, or Essential Aids supplies specialist crutch pads which do a similar job, fixing by velcro.

Cushioning the grips can also be a benefit when using forearm crutches, and well come on to this shortly.

'Forearm' or 'elbow' crutches

Forearm crutches are sometimes referred to as 'Lofstrand' crutches, 'Canadian' or simply 'elbow' crutches. As with the axilla versions, sizing correctly is a vital part of making sure your forearm crutches are as comfortable as possible.

This design is the most popular in the UK and most of the world, excluding the USA. It has two main shafts: the main long one at the bottom and a second short one which fits behind the user's arm.

Forearm crutches tend to be lighter in weight and most people find them easy to control. They do require a certain amount of upper body strength in order to balance and use correctly. Like axilla models, most modern designs are made from non-corrosive aluminium.

They are adjustable in total height via the variable length of the main bottom shaft. It comprises two tubes, one inside the other, which slide together or apart and fix at the desired point via a simple pin-clip.

In terms of setting the correct height of the handle, as a general rule, it should be set at the height of wrist crease, when your arms are hanging at ease to your sides. Once weight is then placed on the arm, it should be at a soft angle and have a very slight bend at the elbow.

Not having the arm fully straight is a key thing to think about when setting the height of the handle. In some cases, the upper shaft of the crutches also adjusts in length.

This means the plastic 'cuff' can be set to support the back of the forearm at the most comfortable and supportive position. The top of the cuff should be around two or three inches below the point of the elbow. Again, a pin-clip mechanism will allow you to set this top shaft at the desired length.

As with the axilla models, as you use the forearm crutches, the elbow should have a gentle bend of around 15 to 20 degrees.

This type of crutch comes with either an open or closed cuff. While open cuffs flare out, the latter wraps around the forearm so that if you release your grip on the handle, the crutch is caught by the cuff and doesn't fall to the floor.

This is a useful feature for those who may have difficulty picking things up from the ground.

Handle comfort

The handles themselves come in various styles and choosing the right ones may have a dramatic impact on comfort.

Standard NHS models usually come with plastic grips. These tend to be quite narrow and you may find that they dig-in to the palms of your hands, particularly if used for sustained periods.

If this is a problem, many are now available with wide handles which spread weight much more evenly, reducing the extent to which they cut in-to your hands.

Some of these handles are not just wider than standard, but they also have an 'ergonomic' design. Here, the contours of the plastic match that of your hand, again helping with the even spread of downward pressure. Handles with similar characteristics are found on 'fischer' handled walking sticks.

The comfort of crutch handles can also be enhanced by using a plastic which is softer to the touch than standard PVC. In combination with ergonomic handles, this can be very effective.

This is the case with the 'Soft Grip Comfort Handle Crutches' at Essential Aids.

These popular models feature the contoured handles and plastic which is easy on the surface of the hands. They are also available in various colours, a vast improvement on standard-issue grey!

Essential Aids' has some pads which fit over the handles of elbow crutches, making them wider and softer to the touch. Again, if you're using them for long periods and you're finding they dig-in to your palms, they might well make a difference.

The Harley Crutch/Comfort Pads are some of Essential Aids' best sellers among crutches accessories. Made from visco elastic memory foam, they mould to the user's hands and provide excellent weight distribution.

They have a waterproof outer covering and fix to the handles by means of velcro straps. They are particularly effective if you suffer from arthritis or other conditions which increase hand pain when pressure is applied.

Arthritic or platform style mobility aids

For people with severe arthritis which makes holding conventional crutches too painful to be practical, Essential Aids supplies special crutches.

These 'Elbow Crutches - Arthritic have a unique design which prevents weight being transferred through the hands, instead channelling it through the arms and shoulders.

This style of crutch has a distinctive horizontal 'platform' or 'trough' at the top, with a vertical handle at the end. The shafts of these mobility aids extends downwards from the middle of the trough down to the ground.

The user rests their forearms in the troughs and a strap holds them in place. This leaves the hands free to grasp the handles but without the burden of body weight. The exact positioning of the trough in relation to the handle can be set using a simple adjustment mechanism, meaning it caters for different arm lengths.

As the person's weight is spread through the relatively wide area of the forearm, this style of walking aid can make a big difference to those with arthritic hands.