Athletes with crutches and knee braces on track

Tips/TricksJune 27, 2024

Forearm Crutches vs. Underarm Crutches: What Nobody Tells You Before Surgery

If you've had surgery and you're about to be sent home with crutches, the hospital might give you a choice. More likely, they'll hand you one type without much explanation and wish you good luck. Either way, the question is going to come up: are underarm crutches better, or forearm crutches? Is there a right answer? There is. But it's not the one most people expect. The clinical evidence on this is actually pretty clear, and it points in a direction that might surprise you depending on what you've heard. Short-term users — people doing 6 weeks or less on crutches, learning from scratch — tend to do better with underarm (axillary) crutches. They move faster, use less energy, and find them more stable when they're new to this. But that advantage doesn't last. Once you cross the 3-month mark, or if you're going to be on crutches indefinitely, forearm crutches are the clinical and practical standard. The axillary model starts creating problems it wasn't designed for. And here's what neither type advertises: both cause real injury over time if you're on them long enough. The question isn't which one is perfect. It's which one fits your situation. Recovering from a specific surgery? Our companion guides go deeper: ACL Surgery Recovery, Hip Replacement Recovery, Knee Replacement Recovery, Meniscus Surgery Recovery, Foot & Ankle Surgery Recovery, Achilles Tendon Repair Recovery.

The Honest Answer to “Which Is Better?”

The research that most directly answers this question is a 2021 prospective cohort study by Yap and colleagues, published in the Malaysian Orthopaedic Journal. They compared naive crutch users (people with no prior crutch experience) on both axillary and forearm crutches over a 4-week period. The axillary group moved faster — 0.50 meters per second versus 0.44 meters per second — and rated their effort lower. For new users doing a 3-point non-weight-bearing gait, the standard post-surgical pattern, underarm crutches won. But the study also pointed to something important: the axillary advantage existed during early learning. As users became more skilled, the gap narrowed. The long-term literature tells a different story. The biggest determining factor here isn't which type is technically superior. It's how long you'll be on them. One thing most patients don't know going in: the reason forearm crutches are used by people with permanent mobility needs isn't because they look better. It's because axillary crutches cause nerve compression at the armpit when used for extended periods, and the cumulative hand and wrist loading of any conventional crutch, used day in and day out for months, can cause soft tissue injury in what starts as a perfectly healthy upper body.

The Two Types Explained (And When Each One Fits)

Underarm crutches (axillary crutches) are the ones most Americans picture. They have a padded top that goes under your armpit and a grip handle below. They've been around, largely unchanged, since the early 20th century. They're stable, easy to size roughly, and most people figure out a basic walking pattern in a few hours. Most hospitals and surgical centers stock them. Forearm crutches (also called Lofstrand or elbow crutches) have a cuff that wraps around your forearm and a grip handle lower down. They're the standard for people with long-term or permanent mobility needs in most of the world outside the U.S., where the axillary design still dominates for short-term post-surgical recovery. Here's how to think about which one fits your situation:

Short-term recovery (6 weeks or less)

Underarm crutches are the practical choice for most people. You'll learn faster, feel more stable initially, and use less energy. The risk of nerve injury from the axillary pad is low if your recovery is short and you use them correctly. The pad rests on your ribs, not your armpit. That distinction matters.

Medium-term recovery (6 weeks to 3 months)

This is the crossover zone. By 6 to 8 weeks, most patients have the motor skill to use either type effectively. The advantages of axillary crutches have mostly evaporated. If you're still uncomfortable on underarm crutches at this point — wrist pain, shoulder fatigue, the sensation that your hands are constantly overloaded — switching to forearm crutches is worth discussing with your PT.

Long-term recovery or permanent use (3 months or more)

Forearm crutches. The axillary design was never intended for extended use. Persistent axillary pad pressure causes brachial plexus compression, which can produce crutch palsy — weakness and numbness in the hand and wrist. It typically resolves in 8 to 12 weeks after you stop using the crutches, but occasionally doesn't. Energy expenditure on forearm crutches is roughly 20% lower than axillary over the same distance. The forearm cuff design also allows hands-free moments (you can briefly release the grip without dropping the crutch), which matters a lot when you're eight weeks in and need two hands to carry a cup of coffee.

The Rules That Matter Most

Fit matters more than type. A badly fitted underarm crutch set too high forces you into the axillary pressure zone every step. Set too low, you'll hunch and overload your wrists differently. With axillary crutches, the pad should be 1 to 2 inches below your armpit when you're standing straight, not jammed up into it. The grip should allow a slight bend in your elbow (roughly 15 to 30 degrees) when your arm is at your side. For forearm crutches, the cuff sits 1 to 2 inches below the elbow crease. The grip height follows the same elbow-bend rule. Getting this wrong is very common. Don't ignore wrist pain. Early wrist discomfort on crutches is normal — you're loading joints that aren't used to it. But persistent pain, or pain that worsens over weeks rather than improving, is a signal. Thenar muscle tenderness (the fleshy pad at the base of your thumb) or pain across the back of the wrist point to overuse injury. Ring and little finger numbness suggests ulnar nerve compression. Get it evaluated before it becomes a real problem. Never rest your weight on the axillary pad. This is the instruction that comes with every pair of underarm crutches and the one most patients ignore. The grip handles carry your weight. The pad is a guide, not a support. Leaning into the armpit pad transfers force directly to the brachial plexus. Do it long enough and you'll have crutch palsy. Plan for a learning curve with forearm crutches. If you get them and feel immediately unstable, that's normal. Forearm crutches require more neuromuscular coordination than axillary crutches, especially on stairs and uneven terrain. Most people reach comfort and efficiency within a week of consistent use. Don't give up after one hallway.

Setting Up Your Home Before Surgery

The right crutch type changes some of your home setup choices, but the fundamentals are the same. Stairs in your home: If you have stairs and no rail on one side, axillary crutches can be harder to manage. You can't easily use one crutch and one railing simultaneously with an axillary design. Forearm crutches can be held in one hand while the other grips a railing. If you're on axillary crutches and have stairs, practice the three-point stair technique with your PT before going home. Small spaces and narrow doorways: Both types require roughly the same lateral clearance. Forearm crutches are slightly more maneuverable in tight spaces because you have better grip control and can more easily adjust on the fly. Everything within reach: Plan to carry nothing in your hands while on crutches. A small backpack, a fanny pack, or crutch bag attachments are worth buying before surgery. Every kitchen item you'll need in the first two weeks should be between knee and chest height. Get a shower chair and a bathmat with grip. Floor hazards: Both types will catch on rugs, thresholds, and loose mats. Remove them before surgery or tape them flat. Your crutch tips should be replaced if they're worn smooth. A worn rubber tip on a wet bathroom floor is how most crutch falls happen.

Why Crutch Choice Matters More Than Most People Think

Here's what doesn't get discussed in the hospital discharge summary: conventional crutches of any design put extreme load on the hands and wrists. Biomechanical studies measuring peak hand-grip force during crutch gait report values exceeding occupational ergonomic safety thresholds. You're repeatedly generating forces at the wrist and hand that, in any other context, would be considered repetitive strain. For a 2-week recovery, that's fine. Your body can absorb it. For a 3-month recovery, you're looking at thousands of loading cycles daily on joints and soft tissue that weren't designed for it. The design problem with both conventional types is the same: all the load transfers through the grip. Your hand takes the hit every step. The In-Motion crutch was developed specifically to address this. The contoured arm platform distributes load across the forearm rather than concentrating it at the grip. The engineering behind it drew from 34 peer-reviewed studies on crutch biomechanics and upper-limb injury — research that identified exactly where conventional crutches fail the people who need them most. The result is a crutch that most patients find genuinely more comfortable over the long sessions, not just the first hour. See it at shopinmotion.com.

When to Call Your Surgeon

Armpit or arm numbness on underarm crutches. If you feel tingling, weakness, or numbness in your forearm, hand, or fingers, particularly in the ring and little finger, stop using the crutches and call. This is brachial plexus or ulnar nerve compression. It usually resolves, but the sooner you address it the better. Wrist or hand pain that isn't improving. Some wrist soreness in the first week is expected. Pain that worsens or doesn't improve by week 2 to 3 deserves attention. Don't white-knuckle through it. Fever over 101°F (38.3°C) or increasing redness, warmth, or swelling at the surgical site. Call your surgeon's office same day. Calf pain, tightness, or swelling, especially in one leg, combined with any shortness of breath or chest pain. Go to the emergency department. Don't wait to call the office. DVT and pulmonary embolism are serious risks in the weeks after orthopedic surgery. A fall. If you fall on crutches and feel anything at the surgical site, call before your next appointment.

The Bottom Line

Underarm crutches are the right choice for most short-term post-surgical recoveries in people who've never used crutches before. They're easier to learn, they're faster initially, and they're standard issue for good reason. If your recovery is 6 weeks or less, use them correctly and they'll serve you fine. If you're looking at 3 months or more, or you're 6 weeks in and still struggling, look hard at forearm crutches. The clinical world outside the U.S. figured this out decades ago. Forearm crutches are lighter, more efficient, and kinder to your upper body over the long haul. The crutch phase feels enormous when you're in it and much shorter in retrospect. A 12-week crutch recovery is genuinely hard. It's also 12 weeks in a recovery that typically spans a year or more. Getting the equipment right makes the rest of it easier.

Frequently Asked Questions

Can I switch from underarm to forearm crutches partway through recovery?

Yes, and for many patients it makes sense to. If your surgeon put you on axillary crutches for the first few weeks of non-weight-bearing and you're transitioning to partial weight-bearing, that's a natural time to evaluate a switch. Talk to your physical therapist. They can fit you for forearm crutches and teach you the gait adjustment in one session.

My hospital gave me underarm crutches. Does that mean forearm crutches aren't right for me?

Not necessarily. U.S. hospitals and surgical centers default to axillary crutches because they're inexpensive, available, and most patients go home with them for short recoveries. It's a supply-chain choice as much as a clinical one. Your PT is the better person to ask about what type fits your specific recovery length and mobility goals.

Are forearm crutches harder to use?

For most people, yes, at first. The learning curve is real. New users on forearm crutches move more slowly and feel less stable for the first several days compared to axillary crutches. By the end of the first week, most people have adapted. By week 3 to 4, the energy and comfort advantages of the forearm design usually become clear.

I keep hearing underarm crutches can cause nerve damage. How common is that?

Crutch palsy (brachial plexus compression from axillary crutch use) does occur, but it's relatively uncommon in short-term users who fit their crutches correctly and keep weight off the axillary pad. The risk increases significantly with long-term use, poor fit, and the habit of resting in the crutches. If you're on axillary crutches for more than 8 to 10 weeks, the risk is worth paying attention to.

Can I use forearm crutches if I'm non-weight-bearing?

Yes. Forearm crutches are fully compatible with non-weight-bearing, partial weight-bearing, and touch-down weight-bearing gaits. The gait pattern is slightly different from axillary crutches and takes more learning initially, but physically there's no reason they can't be used for any weight-bearing restriction.

What about platform crutches?

Platform crutches (which rest your forearm flat on a horizontal platform rather than gripping a handle) are used primarily for patients who can't grip a handle due to hand or wrist injury. They're not common in standard orthopedic recovery. If a standard crutch grip causes ongoing hand or wrist pain and switching between types hasn't helped, ask about a platform attachment or alternative mobility aid.