Extended crutch use places significant and repetitive load on the wrists, elbows, and shoulders. This clinical overview outlines the biomechanical risks and evidence-based strategies to protect your upper limbs throughout recovery.
The Biomechanical Reality of Crutch Use
Forearm crutches are exceptional mobility aids but they require the upper extremities to perform work that the musculoskeletal system was not primarily designed for. During a standard three-point gait with bilateral forearm crutches, each upper limb bears a load equivalent to approximately 20–40% of body weight with every step. Over a day's walking, this represents thousands of repetitive loading cycles through the wrists, elbows, and shoulders.
For most short-term users (two to four weeks), the musculoskeletal system adapts without significant sequelae. For users requiring crutches for six weeks or more, the risk of secondary upper limb pathology increases substantially without appropriate precautions.
The Four Primary Risk Areas
Wrist Extensor Tendinopathy
Repetitive dorsiflexion loading during push-off phase. Particularly common when handle height is set too low, forcing excessive wrist extension to achieve ground clearance.
Rotator Cuff Impingement
Sustained shoulder elevation and repetitive overhead-adjacent loading can compress the supraspinatus tendon beneath the acromion, particularly in users with pre-existing shoulder pathology.
Cubital Tunnel Syndrome
Compression of the ulnar nerve at the medial elbow. Associated with prolonged elbow flexion under load or direct cuff pressure near the olecranon groove.
De Quervain's Tenosynovitis
Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons at the radial aspect of the wrist. Linked to repetitive thumb abduction and wrist loading during crutch use.
Prevention Strategies
1. Optimise Your Fitting
The single most effective preventive measure is correct fitting. Every millimeter of excess height translates into altered load distribution at every joint in the upper chain.
2. Use Ergonomic Handles
Standard cylindrical handles concentrate peak pressure across a narrow band of the palm overlying the carpal tunnel. Anatomic ergonomic handles are contoured to distribute load more evenly, reduce peak pressure at the hypothenar eminence, and allow a more neutral wrist position during load-bearing. For users anticipating more than four weeks of crutch dependency, ergonomic handles represent a clinically sound investment.
3. Manage Grip Tension
Anxiety-driven over-gripping is extremely common, particularly in new crutch users and those with fear of falling. Sustained isometric grip tension accelerates forearm extensor fatigue and contributes to wrist tendinopathy. Practice consciously relaxing your grip to a functional but non-white-knuckle level, and take seated rest breaks every 20–30 minutes during extended walking.
4. Pad the Cuff
The forearm cuff applies direct pressure to the soft tissue overlying the radial and ulnar aspects of the forearm. If the standard cuff padding becomes compressed or worn, replace it promptly. Additional cuff padding is available for users with sensitive skin, peripheral neuropathy, or thin subcutaneous tissue (common in older adults).
When to Seek Clinical Review
Mild muscle soreness in the first one to two weeks of crutch use is normal and expected. The following symptoms, however, warrant prompt assessment by a physiotherapist or your treating clinician:
- Persistent wrist or elbow pain that does not resolve with rest and overnight sleep
- Numbness, tingling, or burning sensation in any fingers
- Weakness in grip strength that develops after the first week of use
- Shoulder pain that radiates toward the neck or down the arm
- Skin breakdown, bruising, or oedema in the forearm under the cuff
Related at VidaStride: reduce hand pressure with an ergonomic replacement hand grip, protect the cuff area with replaceable forearm protection, and make sure your crutches are correctly fitted. Browse the full forearm crutch range.