Is the height measurement on crutches always correct?

[Trixyp]

There is a height measurement already on most crutches.

A friend of mine recently hurt his leg and went to the ER. An EMT gave him crutches and a straight leg knee brace. The EMT set the height to 5'11, his height (His self proclaimed height, nobody measured him)

On the first day, he was walking with the crutches so under his arms had all the weight, but his arms were still at the correct angle. He complained it was hurting under his arm, so I told him they were too tall. I said he needs to make them shorter, and he said no they're measured for his height. I told him they need to be 2-3 inches under his arm, and he said he would move them later.

Point being, I was taught that the crutches should be 2-3 inches below the armpit, NOT TOUCHING, while the arms should also have a 30 degree bend (And I have a very un happy nursing school story for why I remember this haha)

However, on him, his crutches still touch under his arm when he is standing normally, so he has self adjusted the handles so now, they do not touch his armpit. This causes his arms to be at no angle. They are straight. He has to lift his shoulders up to walk with out them touching his arm pit, while leaning forward and curving over his upper back, causing bad posture. He also walks with them about 8 inches away from his feet. I have told him they are too tall for him, but he gets angry and starts saying it was measured for his height, and he only has to adjust the handles and it will adjust it to either touch or not touch his armpit (However this will clearly require him to hold his shoulders up or down obviously)

So when he walks, he lifts his shoulders so they dont touch the crutch, and has the handle positioned to his arms are straight.

Can you picture this clearly?

He has zero medical training and says he would rather listen to the EMT (Most likely because he is so incredibly stubborn that it makes him ignorant..For example, he is so adamant on being correct, I told him I would show him why he is using them incorrectly and he snapped back with "NO you can't". Then he just ended it with I would rather listen to the EMT. He was complaining of hand and wrist pain, but said it isn't because of the crutches.

I just am curious on what is the right answer here. Is the height measurement always correct? I was taught it was just a reference point so you're not way off when measuring for crutches, and the crutches should be 2-3 inches under the arm, elbows slightly bent, and crutches wide enough apart to let your hips pass through. However I have also read that you set the crutches to the height, and then offers no further explanation or anything about it. Which one is correct.

[Altra, BSN, RN]

The height measurement isn't the only parameter - everyone is proportioned differently (long legs/short torso, etc.). This is where the adjustments of the handles come into play.

Having said that ... as long as your friend is using his crutches steadily ... I would let this go. It's not up to you to "fix" what is most likely a temporary problem that will resolve as soon as his injury heals.

[Trixyp]

Perhaps I should clarify my question.

My question is if the height measurement on axillary crutches has always ended up being correct for your patient on the pre-set "height" printed on the crutches in your experience, or if you have had to change them to something different than the patients charted measured height. As in, If the patient is 5'7, have the crutches you have measured for patients always been perfect when set at the 5'7 measurment printed on the crutches, OR have you ever had to place them at 5'6 measuremnt, etc.

[Altra, BSN, RN]

No, it's not always perfect, for the reason I gave above -- body proportions. If I line up 5 people who are all the same height head-to-floor ... their axillae and other body landmarks are not all going to be at the same height.

Sometimes the fix is to adjust the "height" ... and sometimes it's to adjust the handles ... and sometimes it's both.

[Trixyp]

Thankyou!

[jadelpn, LPN, EMT-B]

The 30 degree angle of the arms is so that all the weight is in those handles, and none under the arm. Most people will instinctively put the crutches up under the armpit, as it is "easier" to move this way--no matter how much you tell someone that it is not in their best interest to lean on the crutches from the armpit. They should be 2-3 inches under the arm, but the patient should not stoop over either--and the crutches should not be far out in front of the person--

The handles are the most important thing, as that is where the weight focus should be. So when standing straight, and hands on handles if the crutch is still touching up under the arm, THEN they are at the wrong, too high, height.

Most adults guess at their actual height. Which, depending on the shoe, can be off as much as a couple of inches. So to start at the stated height and adjust is common.

So as a pp suggested, it may not be a height issue, rather a handle issue, as someone's arm should not be straight to the handle--there is no momentum that way to crutch walk, and instincively one doesn't use their hands and lower arms.

[VickyRN, MSN, DNP, RN]

Good information here: Crutch Walking

[Esme12, ASN, BSN, RN]

crutch measuring....

Underarm (axilla) crutches are commonly used following an acute, short‑term injury and may be recommended for those who are only able to bear weight on one leg. Forearm (or elbow) crutches may not be quite as stable with a full load and are commonly recommended in situations of long‑term use for those who can bear weight on both legs, but who require the additional support.

When using crutches, weight should be taken through the hands via the hand pads. For underarm crutches, the top pad of the crutch should be pressed against the side of the chest wall (approximately 5cm under the armpit). It is important that the crutches are not positioned high against the armpit as this can cause damage to nerves and blood vessels located close to the skin and can also affect posture, balance and stability. Crutches should be positioned slightly to the side and forward of the body for a stable base of support.

To set the correct height of underarm crutches, place the top axilla pad approximately 5cm (2–3 finger widths) under the armpit and extend the crutch to a point on the ground approximately 15cm out from the side of the foot. In this position the handgrip should then be adjusted to sit approximately at the height of the wrist crease. This should allow for around 15–30 degrees of bend at the elbow.

.http://library.osfhealthcare.org/PatientEd/Rehabpdf/Physical Therapy/crutch.pdf

[Anna Flaxis, BSN, RN]

No, I have not found them to be terribly accurate.