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On the move _ with crutches

Each year about 2-million Americans suffer an injury or undergo surgery that hampers their mobility. When knees, ankles, feet, hips or legs are temporarily out of commission, they suddenly find themselves relying on crutches for ambulatory independence.

Unfortunately, learning how to manipulate them is a trial-and-error experience that often leaves users exhausted and frustrated. Unless they are enrolled in therapy for everyday skills, novice crutch-users are rarely taught more than the barest rudiments of the many techniques that can make temporary incapacitation safer and simpler.

Knowing in advance some of the tricks of the crutch trade can avoid wasted time and energy, enhance self-esteem, self-reliance and confidence and reduce the risk of a fall or injury.

It was this thought that prompted Sally R. Pryor, an emergency medical technician from Bedford Hills, N.Y., to write Getting Back on Your Feet (Chelsea Green Publishing, Post Mills, Ver., $16.95). The book's subtitle, How to Recover Mobility and Fitness After Injury or Surgery to Your Foot, Leg, Hip or Knee, merely suggests its comprehensive approach to easing the lives of the temporarily impaired.

Walking on crutches is hard work, all the harder if you do not use the most efficient techniques. Walking with crutches requires 30 percent and 70 percent more energy at a normal speed than you would use in walking fast on your own two feet. And once you become proficient at it, you could be working out at a rate that conditions your heart.

The main goal of using crutches is maintaining stability and balance. This is achieved by creating a tripod using the two crutches and your one good foot. At first, in walking you will want to place your crutches about 6 inches in front of your good foot and swing just to where they are.

After mastering this, the crutches can be placed about 10 inches in front, about 6 to 10 inches to the sides of your feet. Swing through so that the heel of the good foot lands 2 or more inches in front of the crutches.

In crossing streets and entering and leaving elevators, alertness and planning are crucial. You must be ready to start as soon as the light changes or the door opens. If you are doubtful about your ability to negotiate a move, ask for help.

Staircases can spell terror for the new crutch user. Although physically more demanding, going up is decidedly easier than coming down. The stair-climbing rule on crutches is "Up with the good foot, down with the bad."

To climb up stairs, place both crutches under the armpit of the arm farthest from the banister. Leaning forward and using the banister and paired crutches for support, raise your body enough to allow you to step up with the good foot.

As you become stronger and more agile, you may be able to climb stairs using only your crutches for support.

Coming down stairs, again place both crutches under the arm farthest from the banister. The toes of the good foot should extend slightly over the lip of the step.

Hold the banister at the level of the next step down and place the paired crutches on that step. Bending the good knee deeply and holding the injured leg out in front, step down, again placing the toes over the edge of the step. As with going up, you may eventually master a two-crutch technique going down stairs.

If someone is available to assist you, that person should walk behind you as you ascend the stairs and walk down backwards in front of you as you descend and be near enough and prepared to steady you if you lose your balance.

If the stairway seems too steep or slippery or you are afraid, too tired or too weak to ascend or descend safely, Ms. Pryor points out that the "bottom boogie" is a reasonable alternative: with your back to the stairs, lower yourself to a sitting position on the first step and use your arms to hitch yourself up or down one step at a time; remember to move the crutches along as you go.

As if it were not hard enough to get yourself around, you will need to carry things with you; for example, a purse, groceries, books or extra clothes. Two now-popular containers can be a great help: backpacks and fanny packs (belt pouches).

If you prefer a tote bag or shoulder bag, be sure the straps are long enough so that they can be placed over your head onto the far shoulder, and swing the bag around so that it rests on the back of the opposite hip.

For ordinary chores at home or at work, a cobbler's apron with large pockets in the skirt can help you carry tools, food, papers and a portable telephone. The current rage of "sports" water bottles and car cups fitted with lids and straws are terrific for carrying drinks on crutches.

If you get tired or winded while walking on crutches, rest awhile before trying to go on. Lean against a wall or place your bad leg over the bottom of the crutch on your good side and, with the other crutch at an angle for better balance, just relax.

To sit, try to choose a relatively high seat; it will be easier to get in and out. First make sure that the back of your good leg is touching the furniture you will sit on and that you are centered over it.

Place both crutches in the hand on your good side and, with your other hand holding onto the seat, lower yourself into a sitting position.

When getting into bed, you can use your good leg as a lever to help raise the bad leg onto the bed.

For bathing, Ms. Pryor recommends sponge baths while leaning sideways with the good leg against the sink cabinet. The kitchen sink is higher and deeper and often has a spray attachment that makes hair-washing easier.

If you prefer a hand-held shower in the tub, use a chair placed against the outside of the tub and a bathing stool inside and slide yourself from one to the other. Better yet, buy or rent a "transfer" stool that fits over the tub.

In your home and work area, remove all scatter rugs and objects that extend into walking areas that might catch your crutch or cause you to trip.

While in the bathroom, do not try to support your weight on objects like towel racks and wall-mounted soup dishes that were not meant for that purpose. If necessary, install a grab bar in the tub or shower or next to the toilet.

Grab bars are sold at hardware stores or medical-supply stores. Seats should have rubber tips on their legs and the tub should be fitted with a non-skid mat. Avoid glass containers. Use liquid soap in a pump dispenser or soap-on-a-rope attached to your arm.

In the kitchen, a small table or stool with wheels on the legs is handy for transferring hot or heavy objects.

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