And other ways to stay in shape when life throws you a curve or two…
Or three! I have spent parts of the last three winters on crutches and in a walking boot following bilateral foot, ankle, and knee surgeries. It was part of a three year plan to deal with bunions, severe arthritis, various past injuries, and significantly compromised ligaments and tendons. For obvious reasons, I chose to do these surgeries in winter time, so I would be sufficiently healed up to take on hiking, biking, and backpacking in the summer months. The last round included knee replacement in November and final foot and ankle surgeries in December. I am extremely happy to report that all surgeons involved believe that I am done with surgery for a good long while.
Over the three winters, I have learned a thing or two about how to stay active and in relatively decent shape, even while on crutches, in a walking boot, or some other mobility-assisting device. I wanted to share those here, in case you should find yourself in this position or are just curious about how far one can go on crutches or in a walking boot. It’s amazing what you can do with a little bit of determination, planning, and creativity!
Benefits of Crutching for Exercise
- Staying in shape. Crutching for exercise following surgery allows me to resume normal activities, including walking and working as a massage therapist, with much greater ease. Following each winter on crutches I have been able to do extensive hiking and backpacking trips in the summer, an accomplishment I partially attribute to my commitment to staying as active as possible while mobility restricted. I also lift upper body weights at the gym and do a program of floor exercises while I am on crutches, that, sadly, I don’t always maintain when I am not. But the discipline to do it during crutching times is there, as I am somewhat limited in what else I can do.
- An opportunity to work on balance. As we age, it becomes more and more crucial to maintain balance. Balance challenges go hand in hand with crutching, and I view this as an opportunity to actively work on improving my balance. Balance is a skill involving a brain body connection that is strengthened with practice. It’s a win/win here — balance improves, and I keep my brain healthy as well!
- Getting outside. There is a innate and fundamental need for me to be in the great outdoors. Often, it’s not enough for me to sit in it. I want to move in it and explore it to really experience it. Being able to do trails I love in an environment I relish simply feeds my soul like nothing else.
- Keeping the body moving! Each time I have long periods of sitting, I can really feel it in my body. For the first ten days to two weeks following surgery, I am usually and appropriately not doing much exercise. After that, the desire to move takes over, and, just in time, I am able to get out and about.
- Focussing on something other than the obvious! Having surgery or something else that interrupts a regular life and exercise routine can bring me or anyone else down. When I get out and about, the activity itself normalizes the experience, and I see myself as less impaired and more still in the game.. despite. It’s a huge psychological boost.
All that being said, I want to clarify that CRUTCHING FOR EXERCISE ISN’T FOR EVERYBODY! There are cautions, drawbacks, and potential side effects that can occur from using crutches for extended periods of time, both in terms of distance “walked”, and in terms of length of time you are on crutches. It’s a process of discerning if it’s is right for you and if the benefits outweigh any side effects. And it isn’t easy, physically, so crutching any distance should be eased in to very gradually, and evaluated regularly to see if it’s a good fit for you. It sure has saved my sanity!
How I got into Crutching for Exercise
It wasn’t planned. The first round of surgeries, in January 2015, was to be the longest time on crutches. Nine weeks of no weight bearing following ankle ligament repair, two fusions of the foot, and a new Anterior Cruciate Ligament (knee), all on the right side, sidelined me completely for a couple of weeks. Just after this, while talking about post-operative driving, someone said “I’ve heard some people drive with their left foot. I don’t know if I’d do it, but I guess some crazy folks do.” At that point, it entered my brain that maybe I could do that to get to our local lake, Lake Padden, and experiment with crutching part of it. At the time, I lived a mere two minutes away, and figured I could do the drive mostly on side roads, and thus decided to try it. I didn’t want to always have to depend on someone for rides, as I knew it was going to be a long haul on crutches. I desperately wanted to get out to enjoy the beauty and calmness of this 2.6 mile unpaved but gentle trail.
The first time was nerve racking in all ways. Especially the driving. An important note: I am NOT advocating driving with your left foot — and if you do, do it fully under your own responsibility and with great caution! As I did. The first time I went to Padden, after safely arriving at the parking lot, I only crutched a half mile and turned around and came back. It went well, and, while fatiguing, it wasn’t that bad. And day after day, I returned, each time going a little bit farther. Soon I could go all the way around. This was during a notoriously mild winter that was more like spring, so there was no ice and snow to deal with. I did a few other mostly flat trails that first winter, but generally stayed at Padden since it was close to home and very familiar and I felt safe doing it.
In subsequent winters, I branched out in my crutching. Both December 2015’s surgery and this past round were the on left foot and ankle, so driving was no issue. I gradually increased my repertoire of trails crutched to include: the Railroad Trail (in Bellingham, long, flat, and accesses Whatcom Falls Park); the Interurban Trail (also Bellingham, long and mostly flat); North Lake Whatcom Trailhead (just outside of Bellingham, 6 miles round trip, flat and right by the lake); Semiahmoo Spit (in Blaine, two miles round trip, paved, right on the water); Bellingham Marina and Zuanich Park (also short, paved, and on water); Padden horse trails (for variety, much more challenging with hills and mud!); Taylor dock into downtown (from Fairhaven in Bellingham, flat and partly paved); Lake Louse (1.3 miles around a small lake); and Stimpson Family Nature Trails (two loops, 4.4 miles total, with hills and pond and very beautiful). These last two I just added in this winter, as they are close to my current home in Sudden Valley.
A note about Scootering:
For the first and third winters, I rented a knee scooter. I experimented with using this for exercise as well. It is NOT my favorite, but I was able to use it some to give my under arms a break from crutching. Knee scooters only work well on paved and flat trails ( I hear there is a four-wheel version available, but I haven’t personally experienced it.) I have used the scooter at the Marina, at Semiahmoo, and on the paved portions of Taylor Dock and Boulevard park. But the best place to scooter I found is the local mall. I did that a lot the first winter, and some this winter since the cold, ice, and snow made scootering outside problematic. I will cover the hazards of crutching in ice and snow in the warnings section…but for those of you who live in Bellingham, you know this winter was much more wintery than the previous two. I chose for safety sake to do a fair amount of both crutching and scootering at the mall when the conditions were just plain too risky to go outside.
Tips on Crutching for Exercise
After three winters of experience, I have learned some valuable ways to make this form of exercise more doable…and definitely enjoyable! NOTE: I have only used underarm crutches, not forearm crutches. All of my suggestions apply to the former…if you have experience with the latter, I would love to hear from you!
- Make sure the crutches fit properly. The fit of crutches in important, regardless of whether or not you plan to use them for exercise or just getting around. The optimum fit is 1 to 1 1/2 inches of space under your armpit when you are standing straight up. The hand grips should be even with the top of your hips, with a slight bend at the elbows so that the weight transfer doesn’t take place on straight arms. I would recommend having a PT do a proper crutch fit.
- Vary it up. When I crutch any distance, I vary where the weight is taken. Sometimes I take it more under the arms, although there is much caution to be had with this (see warnings). Sometimes, I take it more in the forearms, wrists and hands. I can’t do either for an entire distance. Discerning how and when to vary up the portion of my upper body that is taking the brunt at any one time keeps me from overuse injuries associated with crutching.
- Start slowly. As mentioned, I started with 1/2 mile out and back. I would recommend even 1/4, just to see how your body tolerates the action. It takes awhile to build up the upper body strength necessary to crutch longer distances.
- Take breaks! I stop often when I am out on a longer crutch. On average, I will take a break every mile to give everything a rest — I elevate the foot to give it a break from hanging down, and spell the upper body from the crutching activity.
- Allow extra time. This goes without saying…but, when I first started crutching, I was astounded at how much longer it took me to do a path. Lake Padden for instance, normally a 40 – 45 minute walk, takes me about an hour on crutches. Over time, I got quite proficient at crutching quickly. But even then, it’s a slower pace than I can walk or hike. And I had to adjust my time frame accordingly.
- Wear appropriate clothing. A couple of things here. Some clothing creeps up with crutching, some does not. It’s a continual process of trail and error. Generally, the longer the coat or upper layers, the less they creep. Tucking in as much as possible helps too. The next to skin layer is important. I wear something that doesn’t chafe, as crutching does generate friction along the top of the ribs. And crutching generates more heat than walking, so be prepared with layers you can tie around you if necessary. I wear mittens, not gloves, and use hand warmers, as my hands get cold and I can’t ball them up easily for warmth.
- Keep your cast or boot clean and your foot inside warm. With a cast, I put a big fuzzy sock over my cast for some extra warmth, and added a garbage bag if it was raining. The boot is more cumbersome and difficult to cover, but I wear an extra sock underneath for warmth. Keeping the boot clean once I start weight bearing is a real project, and I will cover that more in the next post… Hiking in a Walking Boot.
- Use headphones if you don’t want to converse! My first winter on crutches, I frankly got tired of people commenting or asking questions when I was out crutching. I started listening to audio books with headphones. This habit kept my mind occupied and also limited the number of times I would have to stop for conversation. I still get comments when I crutch, but in my experience, people generally are less likely to want to talk if I have headphones in. If I am not on a time schedule and don’t mind interruptions, I don’t always wear headphones.
- Be conscious of where you are in your recovery process. Where and what distance I crutched always takes this into account. When not bearing any weight, I tend towards flat, wide, or at least very familiar trails. The risk goes up the more difficult the trail, and I don’t want to slip or fall and land on the bad foot. When I get to the point where I can bear some weight, I am willing to take on more challenging trails, which I will cover more in the next post. It’s worth noting that in my three years of crutching, I have only slipped once, and that was on a mossy sidewalk right by my car at Lake Padden.
- Be aware of subtle nuances in terrain. Everything is different on crutches. Very small hills seem like mountains, and variations in the angle of the trail, as well as rocks and roots to navigate, all become much more important than when one is walking. I am always hyper-vigilant on trails because of my bad ankles (which now have both been reconstructed), crutches or no, but crutching does require a higher level of awareness of surroundings. I attribute my lack of slips or falls on trails to this keen awareness of terrain and conditions…crutches or no crutches.
Cautions about Crutching for Exercise
There are many things to be aware of should you choose to take this on.
- Watch out for numbness in your hands and fingers. Crutching can press on the Brachial Plexus, an area beginning on each side of the neck where nerve roots from the spinal cord split, extending into the underarm, and feeding each arm’s nerves. Sometimes with crutching, especially if too much weight is taken up under the arms, the radial nerve, after it leaves the brachial plexus and travels to the axilla (arm pit), gets impinged. This nerve travels all the way down the arm and into the hand, and impingement can result in significant numbness in the hands and digits and/or severe nerve pain in various areas (which may include the shoulder, scapula, and neck). This condition, Brachialplexopathy, can usually be alleviated by a proper crutch fit and periodically shifting weight to the forearms and hands from the underarms while crutching. I have had the most problem with numbness when I had nine weeks of no weight bearing. Once I could bear some weight with my foot, the problem reduced considerably. But numbness or any nerve pain that does not go away after crutching should not be ignored.
Chafing just below the underarm, above the ribs. This happens as a result of friction from the top handles of the crutches moving against the body. It has happened to me each and every year. I don’t let it stop me, but I do try to wear clothing that constrains the upper body less and moves well. I also use lotion to combat dryness from the rash that inevitably occurs. And, over time, the skin toughens up to more readily handle the pressure. For me, this irritation is a small price to pay for the ability to get outside, and I simply tolerate it.
- Other pain hazards: I also have struggled with pain in my elbows, from taking too much pressure on straight arms to get the pressure off my underarms. I have experienced soreness in the palms of my hands, which wearing gloves definitely helps alleviate (an advantage of crutching in winter!) I also experience pain in my hip flexor from holding my leg up, and similarly in the back of my knee of the affected leg. None of these problems persist once I am off crutches. But all are ones I monitor closely to make sure I can manage the discomfort and that pain doesn’t override the benefit of getting out.
- Watch out for ice, snow, and mud! Since my recent crutching experiences have been in winter, weather-related factors have been prevalent. In past years, It was mud. This year, it’s been mud, ice, and snow. I expanded out from the mall this year – once I felt confident about being in good physical shape – and into the residual ice and snow. It was very challenging and tedious, and I am sure people thought I was nuts. I crutched around Lake Padden when it was completely frozen over, and the trail had good amounts of ice. I avoided the ice if possible, crutching way up on the lawn to stay clear. Sometimes, I simply had to crutch very slowly over the ice. I wondered, who was crazier — me crutching around the frozen lake, or the throngs of people out on the lake, skating, biking, and sitting on lawn chairs in the middle? It was a trying experience, but it was worth it because I got to get out in the elements, even on crutches.
- Hills are hard — up and down. It takes a lot of energy to crutch up a hill, and going down is even more challenging. Going up, I tend to power into it and get it over with. Going down, I go much more carefully, as the chances of a crutch slipping out greatly increase with an assist from gravity.
Don’t go farther out than you can safely get back. If I am on an out and back trail, I need to remind myself that I still have to get back. I have made this mistake only twice. Once on the Interurban, I got out two miles, ignoring an increasing pain in one of my pectoral (chest) muscles. At the two mile mark, I knew I had to turn around. The two miles back were excruciatingly painful with a clearly strained pec muscle. I had to go very, very slowly and it was an uncomfortable and lasting injury that actually side-lined me from crutching for the remainder of that recovery. This year, I ambitiously and swiftly crutched three miles to Whatcom Falls Park, feeling great, but the three miles back were all I could manage.
- Take your phone in case you do get stuck or need help. I have never had to call for help, but I have come close and I am always prepared.
Overall, use common sense!
Like everything in life, crutching for exercise is a balancing act. I do it because the pros definitely outweigh the cons. It is not easy, and it takes much more focus and concentration and energy than simply walking. Each winter facing surgery I have asked myself, will I do it again? The answer is always yes. I hope and believe the surgical marathon is over and I know I have earned that” surgical holiday” my foot guy always talks about! But I also know I have a secret weapon to combat surgical weariness should I need to go that route again.
The next post will be on Transitioning into and Hiking with a Post-Surgical Boot…even more fun but with it’s own set of challenges.