Crutch/Walker Training Instructions

Weight Bearing Status

Many patients who are injured or undergo surgery, have changes in weight bearing status, which will affect how
well they can walk and will limit what they are able to participate in. Normal walking, is known as full weight
bearing where there are no restrictions and an individual is free to fully weight bear on that extremity/body part.
As a patient progresses, their weight bearing status can change. It is important to clarify with the therapist in
charge when a patient thinks their weight bearing status has changed. If a patient is not following their weight
bearing precautions, it can significantly affect their progress and delay healing.

Some weight bearing restrictions will have a limit of a percentage of the patient’s body weight. Often times, a
scale is used to ensure the patient understands the concept.

Many of the weight bearing restrictions require the use of an assistive device in order to maintain the restriction.

Non-weight bearing Status (NWB)

• No weight placed on injured extremity
• Must keep injured leg off floor at all times

Toe-Touch Weight Bearing (TTWB) or Touch-Down Weight Bearing (TDWB)

• When you stand or walk, you may only touch the floor for balance
• Do not place any body weight on your leg
o Imagine there is an egg under your foot and you cannot crack it

Partial Weight Bearing (PWB)

• You may place ~50% of weight on extremity

Weight Bearing as Tolerated (WBAT)

• When you use the extremity, you may place as much weight as feels comfortable
• Let pain be your guide

Full Weight Bearing (FWB)

• You can place your full body weight on your extremity
 Walker/Crutch Recommendations

• Make sure when patients utilize a single assistive device, they use it on the unaffected side. Utilizing the
assistive device on the unaffected side, allows you to support the affected side when weight bearing
through the affected lower extremity. This also helps you to maintain a reciprocal gait pattern.
• Common Rule for stairs: “Up with the good, down with the bad”
o Every patient will have different preferences, so ultimately it will be their opinion, but this
method is successful with a lot of individuals.
• With crutches, your body weight should be on your hands, NEVER on the underarms
• Crutches should never be held even with the body; this can cause a loss in balance and it can put
pressure on the brachial plexus in the axillary region.

Crutches

Crutch Positioning
• When standing upright, the top of your crutch should be ~1-2 inches below your armpits.
• For the handgrips, place it so your elbow is flexed about 15 to 30 degrees—enough so you can fully
extend your elbow when you take a step.
• The total crutch length should equal the distance from your armpit to about 6” in front of the shoe.

Managing Chairs with Crutches

• Make sure the chair is stable and will not roll/slide; it must have arms and back support
• Stand with the backs of your legs touching the chair
• Place both crutches in one hand, grasping them by the handgrips
• Hold on to the crutches (on one side) and the chair arm (on the other side) for balance and stability while
lowering yourself to a seated position—or raising yourself from the chair if you’re getting up

Going up and down stairs with Bilateral Crutches

• Going up the stairs:
o Begin facing the stairs with the crutches under your arms; make sure to stand as close to the
bottom of the stairs as possible
o Step up onto the first step with the unaffected lower extremity; use the crutches for weight
bearing instructed. Then bring your surgical/affected lower extremity and your crutches up onto
the same step. Continue until you reach the top
 • Going down the stairs:
o Being at the top of the stairs with crutches under your arms.
o Place your crutches on the step below
o Place the affected side down onto the same step as your crutches, using your crutches for weight
bearing as instructed; then step down with your strong leg
o Continue until you reach the bottom

Walkers

Many individuals utilize walkers for added stability and balance. A walker increases an individual’s base of
support. The most common types of walkers that you will see are a standard walker, a front wheeled walker,
and a rollator.

Adjust your walker so that it fits the arms comfortably. Make sure to adjust correctly because it can reduce
stress on an individual’s shoulders and back.
• Elbows should bend comfortably an angle of ~15 degrees
• When standing inside the walker with your arms at your side, the top of the walker grip should align
with the crease inside the wrist

Standard Walker
This walker has four nonskid, rubber tipped legs for increased stability.
Front Wheeled Walker
This walker has wheels on the two front legs. This can increase the fluidity of walking, but the individual must
be able to control the movement of the walker.

Rollator
A rollator is a walker with four wheels and front breaks. This walker is ideal for individuals who do not rely on
leaning on the walker for balance and are able to demonstrate a more reciprocal gait pattern, but need some
increased stability. Patients who utilize a rollator must demonstrate the cognitive ability to safely utilize the
breaks on the rollator.

Knee Walker
The knee walker is similar to a foot-propelled scooter, but it has a platform for resting your knee. This is great
for athletes and individuals who have long distances to go and have the ability to coordinate and control the
walker.
Ambulating Up/Down the Stairs with a Walker
• Going up the stairs:
o Begin facing the stairs with the walker folded in one hand and the other hand resting on the
railing. Make sure to stand as close to the bottom of the stairs as possible.
o Put the front of the walker at the bottom of the next step, keeping the back of the walker on the
ground
o Bring the unaffected leg up, using the railing and walker for weight bearing as instructed, then
follow with the affected lower extremity

• Going down the stairs:

o Begin at the top of the stairs with the walker folded in one hand and the other hand resting on the
railing.
o Lower the front of the walker onto the step below; keeping the back in contact with the base of
the step above
o Bring your affected extremity down followed by the unaffected; utilize the railing and your
walker for weight bearing as indicated.