You've seen them. Those old-school underarm crutches that look like they belong in a 1950s hospital ward. They poke your armpits. They make your hands numb. Honestly, they’re kind of a nightmare if you have to use them for more than twenty minutes. If you’re dealing with a long-term injury or a permanent mobility issue, crutches with arm support—commonly known as forearm crutches or Lofstrand crutches—are basically the gold standard, though most people in the U.S. still default to the underarm kind out of habit.
It’s weird, right?
In Europe, you almost never see the underarm style. If someone breaks a leg in Berlin or London, they get forearm crutches immediately. There’s a reason for that. It isn't just a fashion choice. It’s about how your body actually moves and where the pressure goes. When you use crutches with arm support, you aren't jamming a wooden or aluminum post into the axillary nerve in your armpit. That nerve is a big deal. Compress it too long and you get "crutch paralysis," which is exactly as fun as it sounds.
The Physics of Staying Upright
Standard crutches rely on your torso to stabilize the poles. Forearm crutches rely on your arms.
The design is simple: a cuff that circles your forearm and a handgrip. Because the cuff stays on your arm even when you let go of the handle, you can actually use your hands to open a door or grab a coffee without the crutches clattering to the floor. That’s a massive lifestyle win.
But let’s talk about the weight distribution. When you’re using crutches with arm support, the weight is centered on your forearms rather than your wrists or armpits. This matters because the wrist is a relatively delicate joint. It’s a collection of small carpal bones. The forearm, however, is supported by the radius and ulna—thick, strong bones meant for leverage.
According to various physical therapy studies, including research often cited by the American Physical Therapy Association (APTA), forearm crutches encourage a more upright posture. You aren't "slumping" into the pads. You have to engage your core. It’s more work at first. You'll feel it in your triceps. But in the long run, your back will thank you.
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Why Does the U.S. Still Love Underarm Crutches?
It's mostly about the learning curve. Anyone can pick up underarm crutches and hobble away instantly. They require almost zero balance or upper body strength to start. Forearm crutches take practice. You have to coordinate your gait.
There's also the "swing-through" factor. If you’re non-weight-bearing, standard crutches feel very stable for big leaps. But that stability is a bit of an illusion. If you trip on a rug with underarm crutches, you're going down hard. With arm-support models, you have more agility to recover.
Real Talk: The Cuff Situation
Cuffs come in two main flavors: open and closed (or hinged).
Open cuffs are just a "U" shape. They’re easy to slip out of. If you fall, the crutch separates from you immediately, which can actually be safer because you won't get your arm tangled in the device as you hit the ground.
Closed cuffs, which are more popular in the UK and with brands like Lofstrand, have a hinge. They stay on your arm. If you’re a person who spends all day in these, you want the closed cuff. You can reach for a can of beans at the grocery store and the crutch just hangs there on your forearm like a piece of jewelry.
Does Brand Matter?
Sorta. You can buy a cheap pair of Medline forearm crutches for forty bucks. They’ll work. They’ll also click and rattle with every single step. That noise gets old fast.
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High-end options like SideStix or Indesmed use carbon fiber or high-grade aluminum. They use shock absorbers. If you have chronic pain or something like Ehlers-Danlos Syndrome (EDS), those shock absorbers aren't a luxury—they’re a necessity. Every time a crutch hits the pavement, a vibration travels up your arm. Multiply that by 5,000 steps a day. That’s a lot of micro-trauma to your elbow and shoulder joints.
Handling the Learning Curve
If you’re switching to crutches with arm support, don't expect to be a pro on day one. Your gait will change.
Most people start with a "two-point gait." You move the right crutch and the left foot together, then the left crutch and the right foot. It’s very natural. It mimics how we actually walk. If you can’t put any weight on one leg, you’re doing the "swing-to" or "swing-through" gait.
- Push your crutches forward about 12 inches.
- Grip the handles firmly.
- Use your triceps to lift your body.
- Swing your "good" leg through.
It feels athletic. It feels faster. But man, your palms are going to be sore for the first week. Get gloves. Weightlifting gloves or cycling gloves with gel palms are a lifesaver.
The Surprising Downside: Stairs
Stairs are the boss fight of mobility aids.
With standard crutches, you can tuck both under one arm and use the handrail. With crutches with arm support, it’s a bit trickier because the cuffs are attached to you. You have to decide: do you keep them both on and use the "step-to" method, or do you take one off?
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The rule is always: Up with the good, down with the bad. When going up, lead with your uninjured leg. When going down, lead with the crutches and the injured leg. It’s counter-intuitive until you do it. If you try to go down with your good leg first, you’re basically performing a one-legged pistol squat while leaning over a precipice. Don't do that.
Ergonomics and Nerve Damage
Let’s get technical for a second. The ulnar nerve runs right through the palm of your hand. If your grip on the crutch isn't ergonomic, you’ll start to feel "pins and needles" in your pinky and ring finger. This is a huge red flag.
Modern crutches with arm support often feature anatomical grips. These aren't just round tubes; they’re shaped to fit the palm. They spread the pressure across the thenar eminence (the meaty part of your thumb) rather than the center of the wrist. If you’re shopping for these, look for "offset" handles. They look a bit wonky, but they keep your wrist in a neutral position.
A Few Things People Forget
- Tips (Ferrules): The rubber bottom matters more than the crutch itself. Cheap tips are hard and slippery on wet tile. Look for "Tornado" tips or "Rain" tips. They have a wider base and a better grip. They’re like winter tires for your feet.
- Sizing: This is the biggest mistake. The handgrip should be at the level of your wrist crease when your arm is hanging down. If it's too high, your shoulders will be up by your ears. If it's too low, you'll be leaning over and destroying your lower back.
- Weight Capacity: Most standard aluminum models are rated for 250-300 lbs. If you’re a larger person, you must get bariatric-rated crutches. The flex in a standard crutch when it's over-taxed is terrifying.
Is It Worth the Switch?
Honestly, if you're going to be off your feet for more than two weeks, yes.
The mobility you gain is worth the initial frustration of learning a new balance point. You feel less like a "patient" and more like a person who just happens to be moving differently. Plus, they fit in the backseat of a car way easier than those giant underarm wooden things.
Practical Steps for Getting Started
If you're ready to make the jump to crutches with arm support, don't just wing it.
- Talk to a PT: Ask a physical therapist to check your height adjustment. Even an inch off can cause hip pain.
- Check your cuffs: Make sure the cuff is about 1 to 2 inches below your elbow. If it’s too high, it’ll pinch when you bend your arm.
- Buy extra tips: They wear out faster than you think, especially if you’re walking on asphalt or concrete. Once the tread is gone, they’re dangerous.
- Clear the floor: Remove area rugs in your house. Crutch tips catch on the edges of rugs constantly. It’s the number one cause of "crutch-related" falls in the home.
Switching your gear isn't just about healing a bone or a ligament; it's about maintaining your sanity while you do it. You shouldn't have to trade a leg injury for a shoulder injury. Get the right support, take it slow, and you'll find that moving around isn't nearly the chore it used to be.