Crutches After Knee Surgery: Proper Use, Techniques, and Recovery Tips

How to use crutches after knee surgery?

Using crutches correctly after knee surgery is crucial for protecting the healing joint, managing pain, and facilitating safe, independent mobility as you recover. Proper technique ensures you bear weight through your hands and arms, not your armpits, and move with stability and confidence.

Why Crutches After Knee Surgery?

Following knee surgery, the joint and surrounding tissues require time to heal without undue stress. Crutches serve as a vital assistive device by:

• Protecting the Surgical Site: They offload the operated knee, preventing excessive weight-bearing that could disrupt sutures, grafts, or repaired structures.
• Reducing Pain: By minimizing stress on the joint, crutches help control post-operative pain and inflammation.
• Preventing Re-Injury: They provide stability and support, reducing the risk of falls or accidental movements that could compromise your recovery.
• Facilitating Early Mobility: Despite the need for protection, early, controlled movement is often beneficial for circulation and preventing stiffness. Crutches allow for this mobility while maintaining safety.

Selecting and Adjusting Your Crutches

Correct crutch fit is paramount for safety and comfort. Most commonly, axillary (underarm) crutches are prescribed post-knee surgery.

• Crutch Height:
  • Stand upright with your shoulders relaxed.
  • The top of the crutch pad should be 2-3 finger widths (approximately 1-1.5 inches) below your armpit. This ensures you bear weight through your hands, not your armpits, preventing nerve damage and discomfort.
• Handgrip Height:
  • Your elbows should have a slight bend of 20-30 degrees when you grasp the handgrips.
  • When standing, your wrist crease should align with the top of the handgrip. This allows for optimal leverage and weight bearing through your palms.

Proper Crutch Stance and Grip

Before initiating movement, establish a stable base.

• Tripod Stance: Position the crutches slightly forward and to the sides of your feet, forming a stable "tripod." This provides a wide base of support.
• Weight Distribution: Always remember to bear your weight through your hands and forearms, pressing down on the handgrips. Avoid leaning on your armpits.

Walking with Crutches: Non-Weight Bearing (NWB) Technique

This technique is used when absolutely no weight can be placed on the operated leg.

1. Advance Crutches: Move both crutches forward by about one foot, keeping them slightly wider than your shoulders for stability.
2. Bring Injured Leg Forward: Swing your operated leg forward, keeping it off the ground, so it is level with the crutches.
3. Swing Through with Uninjured Leg: Push down on the crutch handgrips and swing your uninjured leg through, landing it slightly in front of the crutches and your injured leg.
4. Repeat: Bring the crutches forward again and continue the sequence.
   • Maintain Balance: Keep your head up and look forward, not down at your feet.
   • Small Steps: Take short, controlled steps initially.

Walking with Crutches: Partial Weight Bearing (PWB) Technique

Your surgeon or physical therapist will advise when you can begin partial weight bearing. This technique allows for a controlled amount of weight on the operated leg.

1. Advance Crutches and Injured Leg: Move both crutches forward simultaneously with your operated leg. Allow your operated foot to touch the ground, applying only the prescribed amount of weight (e.g., "toe touch," "25% weight," "50% weight").
2. Step Through with Uninjured Leg: Push down on the crutch handgrips and step through with your uninjured leg, placing it slightly in front of the crutches and your operated leg.
3. Repeat: Bring the crutches and operated leg forward again and continue.
   • Listen to Your Body: If you feel increased pain, reduce the weight you are putting on the operated leg.
   • Use a Scale: Your physical therapist may use a bathroom scale to help you practice applying the correct amount of weight.

Navigating Stairs with Crutches

Stairs can be challenging but are manageable with proper technique. Remember the mnemonic: "Up with the good, down with the bad."

Going Up Stairs

1. Lead with Uninjured Leg: Place your uninjured leg onto the next step.
2. Push Up: Push down on your crutch handgrips and bring your operated leg and the crutches up to meet your uninjured leg on the same step.
3. Repeat: Continue this sequence, one step at a time.
   • Handrail Option: If a handrail is available, use it for added support. Hold the handrail with one hand and keep both crutches on the other side, or hold one crutch in each hand and use the handrail with one hand.

Going Down Stairs

1. Lead with Crutches and Injured Leg: Place your crutches and your operated leg down onto the step below.
2. Lower Uninjured Leg: Slowly lower your uninjured leg to meet the crutches and operated leg on the lower step.
3. Repeat: Continue this sequence, one step at a time.
   • Handrail Option: If using a handrail, hold it with one hand and keep both crutches on the other side.

Sitting Down and Standing Up with Crutches

Sitting Down

1. Back Up: Back up to the chair until the back of your uninjured leg touches the seat.
2. Position Crutches: Hold both crutches in one hand (the hand on the side of your operated leg, or your stronger hand).
3. Reach for Chair: Reach back with your free hand for the armrest or seat of the chair.
4. Lower Slowly: Slowly lower yourself onto the chair, keeping your operated leg extended forward if required (NWB).

Standing Up

1. Position Crutches: Hold both crutches in one hand, on the side of your operated leg.
2. Push Up: Push down on the armrest/seat with your free hand and on the crutch handgrips with the other hand.
3. Stand and Balance: Push up to a standing position, establishing your stable tripod stance before moving.

Common Mistakes to Avoid

• Leaning on Armpits: This can cause nerve damage (crutch paralysis) and significant discomfort. Always bear weight through your hands.
• Poor Posture: Slouching or looking down can affect your balance. Keep your head up and back straight.
• Rushing: Taking steps too quickly can lead to falls. Move deliberately and with control.
• Improper Crutch Adjustment: Crutches that are too high or too low compromise stability and can cause injury.
• Ignoring Pain: If you experience increased pain, stop, rest, and consult your healthcare provider.

When to Transition Off Crutches

The decision to transition off crutches is made in consultation with your surgeon and physical therapist. It depends on:

• Healing Progress: X-rays or other imaging may confirm bone healing.
• Pain Levels: Minimal to no pain with weight bearing.
• Strength and Balance: Sufficient quadriceps and hamstring strength, and the ability to maintain balance without assistance.
• Gait Pattern: A normalized walking pattern without limping.

Transitioning usually occurs gradually, often moving from two crutches to one, then to a cane, and finally to independent walking. Do not rush this process.

Important Considerations and Safety Tips

• Clear Pathways: Ensure your home environment is free of tripping hazards like rugs, cords, or clutter.
• Appropriate Footwear: Wear sturdy, non-slip shoes that fully support your feet. Avoid slippers or open-backed shoes.
• Hydration and Nutrition: Proper nutrition and hydration support healing.
• Listen to Your Body: Fatigue, pain, or swelling are signals to rest.
• Follow Professional Advice: Adhere strictly to your surgeon's and physical therapist's instructions regarding weight-bearing status, exercises, and activity restrictions.
• Carry Essentials: Use a small backpack or fanny pack to carry items, keeping your hands free for the crutches.

Conclusion

Mastering the use of crutches after knee surgery is a critical step in your recovery. By understanding the correct techniques for adjustment, walking, and navigating daily activities, you can protect your healing knee, minimize pain, and progress safely towards full mobility. Always prioritize safety, listen to your body, and follow the personalized guidance of your healthcare team.