A crutch is a mobility aid that transfers weight from the legs to the upper body. It is often used by people who cannot use their legs to support their weight, for reasons ranging from short-term injuries to lifelong disabilities.
A crutch is a mobility aid that transfers weight from the legs to the upper body. It is often used by people who cannot use their legs to support their weight, for reasons ranging from short-term injuries to lifelong disabilities.
Crutches were used in ancient Egypt. [1] [2] In 1917, Emile Schlick patented the first commercially produced crutch; the design consisted of a walking stick with an upper arm support. Later, A.R. Lofstrand Jr. developed the first crutches with a height-adjustable feature. Over time, the design of crutches has not changed much, and the classic design continues to be the most commonly used. [1]
There are several types of crutches:
Axillary crutches are used by placing the pad against the ribcage beneath the armpit and holding the grip, which is below and parallel to the pad. They are usually used to provide support for patients who have temporary restriction on ambulation. [3] With underarm crutches, sometimes a towel or some kind of soft cover is needed to prevent or reduce armpit injury. A condition known as crutch paralysis, or crutch palsy can arise from pressure on nerves in the armpit, or axilla. [4] [5] Specifically, "the brachial plexus in the axilla is often damaged from the pressure of a crutch...In these cases the radial is the nerve most frequently implicated; the ulnar nerve suffers next in frequency." [5]
An uncommon type of axillary crutches is the spring-loaded crutch. The underarm pad is a curved design that is open in the front with the grips for the hands shaped for maximum comfort and to reduce the prevalence of overuse injuries. [6] These crutches also contain a spring mechanism at the bottom. The idea behind this design is to allow the user to propel themselves further, resulting in quicker movement from place to place, though research has shown that the difference in speed is very small when comparing standard axillary crutches to spring-loaded crutches. [7]
A forearm crutch (also commonly known as an elbow crutch, Canadian crutch or "Lofstrand" crutch due to a brand by this name) has a cuff at the top that goes around the forearm. [1] It is used by inserting the arm into the cuff and holding the grip. The hinged cuff, most frequently made of plastic or metal, can be a half-circle or a full circle with a V-type opening in the front allowing the forearm to slip out in case of a fall.
Forearm crutches are the dominant type used in Europe, whether for short or long term use. Outside of Europe forearm crutches are more likely to be used by users with long-term disabilities, with axillary crutches more common for short-term use. [3]
These are less common and used by those with poor hand or grip strength due to arthritis, cerebral palsy, or other conditions. The forearm rests on a horizontal platform and is usually strapped in place with velcro-type straps that allow the platform or trough to release in case of a fall. The hand holds an angled grip which, in addition, should allow adjustment of length from trough to grip and side-to-side sway depending on the user's disability.
These non-traditional crutches are useful for users with an injury or disability affecting one lower leg only. They function by strapping the affected leg into a support frame that simultaneously holds the lower leg clear of the ground while transferring the load from the ground to the user's knee or thigh. This style of crutch has the advantage of not using the hands or arms while walking. A claimed benefit is that upper thigh atrophy is also reduced because the affected leg remains in use. Unlike other crutch designs these designs are unusable for pelvic, hip or thigh injuries and in some cases for knee injuries also. [1] [8]
Walking sticks or canes serve an identical purpose to crutches, but are held only in the hand and have a limited load bearing capability because of this.
When using one crutch, the crutch may be placed on the side of the unaffected leg or used to bear the load of the affected leg.
Those who can tolerate partial weight bearing on both legs usually use the four point gait. The sequence is right crutch, left leg, left crutch, right leg. This is the slowest of all gaits but also the safest in that three of the four points are in contact with the ground at any given time. [9]
Those who can tolerate partial weight bearing on both legs but require less support than a four-point gait usually use the two-point gait. The sequence is right crutch with left leg and then left crutch with right leg.
The three point gait is usually used by those who cannot bear weight on one leg. Both crutches are advanced while bearing weight on the unaffected leg. Then the unaffected leg is advanced while bearing weight on the crutches.
A person with a non-weight bearing injury generally performs a "swing-to" gait: lifting the affected leg, the user places both crutches in front of himself, and then swings his uninjured leg to meet the crutches. A similar "swing-through" gait is when both legs are advanced in front of the crutches rather than beside them.
When climbing up stairs, the unaffected leg is advanced first, then the affected leg and the crutches are advanced. When descending stairs, the crutches are advanced first and then the affected leg and the unaffected leg. [3]
The knee scooter and the wheelchair are possible alternatives for patients who cannot use or do not like crutches. These wheeled devices introduce an additional limitation, however, since most cannot negotiate stairs.
The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula. The thigh is between the hip and knee, while the calf (rear) and shin (front) are between the knee and foot.
In human anatomy, the arm refers to the upper limb in common usage, although academically the term specifically means the upper arm between the glenohumeral joint and the elbow joint. The distal part of the upper limb between the elbow and the radiocarpal joint is known as the forearm or "lower" arm, and the extremity beyond the wrist is the hand.
In orthopedics, weight-bearing is the amount of weight a patient puts on an injured body part. Generally, it refers to a leg, ankle or foot that has been fractured or upon which surgery has been performed, but the term can also be used to refer to resting on an arm or a wrist. In general, it is described as a percentage of the body weight, because each leg of a healthy person carries the full body weight when walking, in an alternating fashion.
The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.
An assistive cane is a walking stick used as a crutch or mobility aid. A cane can help redistribute weight from a lower leg that is weak or painful, improve stability by increasing the base of support, and provide tactile information about the ground to improve balance. In the US, ten percent of adults older than 65 years use a cane, and 4.6 percent use walkers.
Bicep curls are a group of weight training exercises in which a person bends their arm towards their body at the elbow in order to make their biceps stronger.
Equine conformation evaluates a horse's bone structure, musculature, and its body proportions in relation to each other. Undesirable conformation can limit the ability to perform a specific task. Although there are several faults with universal disadvantages, a horse's conformation is usually judged by what its intended use may be. Thus "form to function" is one of the first set of traits considered in judging conformation. A horse with poor form for a Grand Prix show jumper could have excellent conformation for a World Champion cutting horse, or to be a champion draft horse. Every horse has good and bad points of its conformation and many horses excel even with conformation faults.
A leglock is a joint lock that is directed at joints of the leg such as the ankle, knee or hip joint. A leglock which is directed at joints in the foot is sometimes referred to as a foot lock and a lock at the hip as a hip lock. Leglocks are featured, with various levels of restrictions, in combat sports and martial arts such as Sambo, Brazilian Jiu-Jitsu, catch wrestling, mixed martial arts, Shootwrestling and submission wrestling, but are banned in some sports featuring joint locks such as judo. The technique has been seen across a wide range of different combat sports and is reportedly over 2,500 years old, having been seen in the lost art of Pankration in the original Olympic Games.
A standing frame is assistive technology that can be used by a person who relies on a wheelchair for mobility. A standing frame provides alternative positioning to sitting in a wheelchair by supporting the person in the standing position.
Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the deep fibular nerve, including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion). Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis and it can occur in one or both feet. In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground.
The pull-down exercise is a strength training exercise designed to develop the latissimus dorsi muscle. It performs the functions of downward rotation and depression of the scapulae combined with adduction and extension of the shoulder joint.
Spastic diplegia is a form of cerebral palsy (CP) that is a chronic neuromuscular condition of hypertonia and spasticity—manifested as an especially high and constant "tightness" or "stiffness"—in the muscles of the lower extremities of the human body, usually those of the legs, hips and pelvis. Doctor William John Little's first recorded encounter with cerebral palsy is reported to have been among children who displayed signs of spastic diplegia.
Pubic symphysis diastasis is the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture that measures radiologically more than 10 mm. Separation of the symphysis pubis is a rare pathology associated with childbirth and has an incidence of 1 in 300 to 1 in 30,000 births. It is usually noticed after delivery but can be observed up to six months postpartum. Risk factors associated with this injury include cephalopelvic disproportion, rapid second stage of labor, epidural anesthesia, severe abduction of the thighs during delivery, or previous trauma to the pelvis. Common signs and symptoms include symphyseal pain aggravated by weight-bearing and walking, a waddling gait, pubic tenderness, and a palpable interpubic gap. Treatment for pubic symphysis diastasis is largely conservative, with treatment modalities including pelvic bracing, bed rest, analgesia, physical therapy, and in some severe cases, surgery.
Gait training or gait rehabilitation is the act of learning how to walk, either as a child, or, more frequently, after sustaining an injury or disability. Normal human gait is a complex process, which happens due to co-ordinated movements of the whole of the body, requiring the whole of Central Nervous System - the brain and spinal cord, to function properly. Any disease process affecting the brain, spinal cord, peripheral nerves emerging from them supplying the muscles, or the muscles itself can cause deviations of gait. The process of relearning how to walk is generally facilitated by Physiatrists or Rehabilitation medicine (PM&R) consultants, physical therapists or physiotherapists, along with occupational therapists and other allied specialists. The most common cause for gait impairment is due to an injury of one or both legs. Gait training is not simply re-educating a patient on how to walk, but also includes an initial assessment of their gait cycle - Gait analysis, creation of a plan to address the problem, as well as teaching the patient on how to walk on different surfaces. Assistive devices and splints (orthosis) are often used in gait training, especially with those who have had surgery or an injury on their legs, but also with those who have balance or strength impairments as well.
A mobility aid is a device designed to assist walking or otherwise improve the mobility of people with a mobility impairment.
A high ankle sprain, also known as a syndesmotic ankle sprain (SAS), is a sprain of the syndesmotic ligaments that connect the tibia and fibula in the lower leg, thereby creating a mortise and tenon joint for the ankle. High ankle sprains are described as high because they are located above the ankle. They comprise approximately 15% of all ankle sprains. Unlike the common lateral ankle sprains, when ligaments around the ankle are injured through an inward twisting, high ankle sprains are caused when the lower leg and foot externally rotates.
A knee scooter or knee walker is a two-, three- or four-wheeled alternative to crutches or a traditional walker as an ambulation aid. It is known by many other names, including knee coaster, knee cruiser, knee caddy, orthopaedic scooter, or leg walker.
Orthotics is a medical specialty that focuses on the design and application of orthoses, sometimes known as braces or calipers. An orthosis is "an externally applied device used to influence the structural and functional characteristics of the neuromuscular and skeletal systems." Orthotists are professionals who specialize in designing these braces.
A gait trainer is a wheeled device that assists a person who is unable to walk independently to learn or relearn to walk safely and efficiently as part of gait training. Gait trainers are intended for children or adults with physical disabilities, to provide the opportunity to improve walking ability. A gait trainer offers both unweighting support and postural alignment to enable gait practice. It functions as a support walker and provides more assistance for balance and weight-bearing, than does a traditional rollator walker, or a walker with platform attachments. It also provides opportunities to stand and to bear weight in a safe, supported position.
Axillary dissection is a surgical procedure that incises the axilla, usually in order to identify, examine, or take out lymph nodes. The term "axilla" refers to the armpit or underarm section of the body. The axillary dissection procedure is commonly used in treating the underarm portion of women who are dealing with breast cancer. The lymph nodes located in the axilla area that are affected by breast cancer are called the guardian or sentinel lymph nodes. Lymph nodes are essential to the lymphatic/immune system due to their main function of filtering unrecognized particles and molecules. The idea of treating breast cancer with the axillary dissection procedure was introduced in the 18th century and was backed by German physician Lorenz Heister. There are certain criteria that make patients eligible candidates for this procedure. Patients tend to have three different levels of axillary lymph nodes; the level helps to determine whether or not the patient should undergo axillary dissection.
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