How to use Crutches Safely after Surgery
We are upright, bipedal, locomotor systems as my anatomy professor said way back in my very first lecture. He also reinforced that we are designed to move and do not perform well when stationary.
When you have an upcoming surgery, it is good to check your walking ability and balance. It would be unrealistic to imagine after a new joint replacement or similar surgery that you will be off racing about like a two-year-old. In fact, you will most likely experience stiff and unused muscles and pain in other places such as ligaments and other joints. The wait for surgery can cause a loss of muscle mass and an overall reduction in fitness. This is a journey and while the main reason to have a joint replacement is for pain, I am sure you want to get going quickly and enjoy activities with friends and family.
At surgerycaoch.net the team recommends ways to help you to prepare your whole body for your new joint.
Let’s firstly check your walking ability.
- Stand upright and as you step forwards, try not to sway your torso from side to side. If you feel you are doing this, usually is it pain and weakness that makes offload away from the side of pain. Check in the mirror or window as you walk towards it. You can work on that prior to surgery with exercises to strengthen and stabilise your body, even lying down.
- Try to be balanced with stepping. This includes all directions front, sideways and backwards. If you feel unsteady, sometimes this is simply age-related change but often there is a loss of feedback from your joints and muscles (proprioception). This is because the joints are worn, and the muscles are compensating as best they can. You can practice stepping in all directions prior to your surgery to gain balance and control with changing direction. If this is difficult to understand, I can help.
- Arm swing even slightly while walking, encourages a natural rotation of your whole body. Sometimes when you are in pain you may find you walk with your arms close to your body, as perhaps it feels safer and more secure. What ends up happening is you tend to flex forward, lean over and lose more balance.
Walking poles that trampers and walkers use give your body a natural swing and rotation through your trunk and torso which is naturally balancing for your body and can spread the weight-bearing across all four limbs. Using walking poles is highly recommended if you want to keep active prior to surgery.
Preparing for using crutches.
If you are to have joint replacement surgery on your lower limb the chances are you will go home with crutches or similar. Crutches allow you to get up on your feet from day one post surgery. While you may use a frame with nurses and a physio present on the first day, getting upright is great for circulation, stopping you getting stiff, preventing pressure areas and of course your mental well-being.
If you haven’t used crutches before your operation, the physio’s at your hospital will teach you so don’t worry.
The right height of crutches is important:
When measuring the crutch handle height, place your arms relaxed by your sides, standing upright. Have another person measure two fingers above your wrist bone for the height of the crutch handle, this will be perfect. You want your shoulders to be relaxed and arms slightly bent.
Crutches need to have good stoppers on the base to avoid slipping on surfaces.
There are four levels of weight bearing your Surgeon will instruct you to do. This is based on the type and extent of your surgery. Check with your surgeon.
- Full weight bearing (FWB) is when you can fully load your new joint.
- Partial weight bearing (PWB) is defined as some weight bearing can go through your leg. Most literature defines this as 30% to 50% of a patient’s body weight.
- Touch weight bearing (TWB) means the foot or toes may touch the floor (such as to maintain balance), but no weight is taken by the affected limb. Imagine having a potato crisp underfoot that one is not to crush.
- Non weight bearing (NWB) means that no weight can be placed on the operated leg. This is the most restrictive of all weight-bearing limitations. Since you are not able to bear any weight on the leg, an assistive device, such as a walker, frame or mobility scooter where you kneel on a scooter with the affected leg and zoom around on the good leg.
Here are 5 Tips to ensure you are safe and balanced with crutches:
- Walk upright with your head up looking ahead, not at your feet. This will allow you to use your core muscles more effectively and allow your peripheral vision to scan for obstacles.
- Start with placing the crutches forward first then your affected leg and follow with other leg.
- I like to instruct with “Step up to the crutches (affected leg) then step through the crutches (good leg)”.
- Heel toe action encourages a normal walking action which may take a while to get the hang of. You may find you are walking flat footed for a day or so.
- Cadence or rhythm should be smooth and even after a few days of practice. Try counting as you stride out.
- Two times per day after you are home from hospital it is advisable to have two, ten minute walking sessions where you focus on the above techniques.
Stairs and steps
Many people are daunted by stairs on the first few attempts, so it is always advisable to have someone with you, below you when going both up and down stairs or steps.
The easiest way to negotiate stairs with crutches or sticks is to use this each step.
GAS – Give it the Gas going up (Good leg, Affected leg, sticks or crutches).
SAG – Sag going down (Sticks or crutches, affected leg, Good leg).
With a frame you will need to use a ramp.
With a bilateral (both legs) operation, you must decide which is the strongest and make this your good leg. Check with your rehab physio before you leave hospital.
Down to one Crutch?
Every surgeon has a guide to when they like you to go to one crutch which is usually around 14 days post operatively. Please follow this guidance.
The main thing to remember is to keep the crutch on the OPPOSITE side to your new joint replacement i.e. Right knee replacement, keep the Left crutch, this will off load your body weight off your new joint by approximately 1/8 of your body weight.
- The better prepared you are for your upcoming surgery – the quicker and easier you will come out the other side.
- Manage your expectations around your mobility and train up beforehand – seek advice as this can be activity in the pool, on an exercycle, walking with walking poles or a stick.
- Even on your bed or in a chair.
- Seek professional advice com is here to assist you, you can even book a 15 minute meeting over the phone to chat.
- Exercise with a buddy or to music and although you may be in pain, exercise is a great pain reliever, if done correctly.
- Always seek medical advice from your Doctor and surgeon if you have any concerns about this article.
Arthritis NZ is a great resource and recommends many ways to start, what to do, how to seek help. https://www.arthritis.org.nz/your-arthritis/living-well-with-arthritis/exercise-and-arthritis/
Outline: [How to prepare to use crutches for joint surgery]
Keyword MSV: [crutches walking surgery]
Author: [Carol Armitage]
Due Date: [20/04/2020]
Publish Date: [20/04/2020]
Buyer Persona: [Surgeon, Doctor, patient, joint replacement surgery, pre operation preparation post operative care]