Crutches

My bet is on the cultural-economic QWERTY path. Crutches of the underarm type have been around for a very long time, and there’s already an industry grown up around them to manufacture and supply them. It may also stem from the stigma of polio. People with forearm crutches ‘appear’ to be more significantly afflicted, and hence it assumes a more permanent cast, as in ‘Gee, she looks like she’ll have that for a very long time’. There are forearm crutches used in the US, they are typically used for much more serious and lasting injuries, where the user is likely to use the crutches everyday. This is where their efficiency pays off. The dividends of this may not be obvious to someone with a fleeting injury that might last only weeks. It’s my bet that the costs are somewhat greater for the forearm crutch too. Therefore, like QWERTY, it grew up from being ‘good enough’ for a couple of centuries, and has not changed much except for material composition.

-because forearm crutches are for sissies?
-because I paid for a crutch damnit, so I want my money’s worth!
-because it requires some thought, and American hospitals don’t want to be liable for non-thinking American patients
-because with a ‘real’ crutch, you can grab it with both hands and beat an attacker over the head with it (assuming you can balance on one leg). With one of those forearm jobbies you’d probably thump yourself on the back of the head, thereby doing the attacker’s work for him

I think it’s a signalling mechanic.

Those giant, unwieldy underarm crutches are iconic – they’re what Americans envision when they hear the word “crutch”. Everyone who injures themselves gets issued a pair, so lurching around on them becomes a signal that you are recently injured and are likely to be fine in a few weeks.

Those efficient forearm crutches are used primarily by the long-term (or permanently) handicapped. Their presence signals that the user has a very serious and possibly permanent ailment or disfiguration, since they have gone to the trouble of procuring fancy, efficient crutches.

If someone comes into my coffee shop, clumsily maneuvering on big underarm crutches, I assume that he just twisted his ankle or broke his leg skiing – probably overdid it while pursuing an active lifestyle. If someone comes into my coffee shop defty wielding aluminum forearm crutches, I assume that they’ve got some serious problem (paraplegic? birth defect?) which triggers a serious of cultural constructs (handicapped = diseased = bad person = deserves shunning, careful – it might be catching!).

I’m not sure why there’s such a divide between Europe and the US in this regard. Are people’s attitudes and public policy towards the homeless markedly different between the two? (serious question)

Not crutches but hip joints.

according to one manufacturer of hip joints the UK uses old fashioned joints because they were pioneered in the UK. The originator struck a deal with a manufacturer which ensured a very good price in return for some degree of exclusivity, certainly including standard training for orthopaedic surgeons. Initially this did a lot for hip replacement in the UK but over time there has been substantial progress in hip joints and they leave the UK using a process that is less reliable and takes much longer to perform meaning more risk to the patient and fewer operations. A case of first is worst I suppose.

As for crutches, I imagine the price of forearm crutches would fall if they were used in the same quantities as underarm models. I wonder if there are multiple equilibria in the markets for crutches. I propose a geographical explanation. Just as with cars Americans drive clearly inferior but mauch larger models. Europe doesn’t have the wide open spaces that make gas guzzlers, SUVs and underarm crutches a viable option.

The underarm crutch is the saturday night special of prostheses. Poke! Whack! Trip!

I wonder if the forearm crutch is harder to learn and so problematical if you have a temporary injury?

In Australia, I think we go for underarms. It may also be that they have a larger range of adjustments when you borrow them from the hospital. Is there a nexus between forearm crutches and more modern casts for broken legs?

We use them because that’s all they offer us. Based on experience!

I’ve had to use crutches for extended periods several times in my life and have friends with permanent disabilities that require them, so I’ve got an actual answer.

Part of it is that, yes, forearm crutches are more expensive here. Part of it is that they’re also associated in many minds here with serious and generally permanent disabilities – for people with multiple dystrophy, say. One of the archetypal charitable fundraising images for the MD telethon, March of Dimes, and the like is of the kid with heavy corrective lenses, spinal or major limb deformation, and forearm crunches, gimping along.

It’s worth noting that the forearm crunch is generally superior, at least in my experience, but not in hugely clear-cut fashion. In particular it’s not an improvement if you’re coping with shoulder, upper chest, or upper arm damage; it can hurt like hell to brace yourself for the next step, depending on what’s messed up there. And since one of the classic pools of crutch users is the football player who may well have been injured by a bad tackle, there’s some reinforcement for underarm crutch use there.

So the forearm crutch goes under-used, for a combination of medical and cultural reasons.

Actually, things like the Standard Oil joke explanation are depressingly common in medical supply. That stuff is weird, and only when it gets really blatant (as in the recent bill forbidding the government to negotiate better rates on drugs) does the public ever notice it. But a recurring comment from literate friends of mine whose conditions require frequent care is that they just can’t read authors like Kafka anymore, because it’s too damn true.

I realize there is a bit of a flaw in my argument in that if the system doesn’t mind going for the more expensive treatment then that would mean they might as well give people the forearm crutch. I find the cultural argument somewhat convincing (stigma attached to forearm crutch vs underarm crutch), but still think that the cane/crutch question is relevant.

Because.

This probably isn’t related, but in medical practice, a lot of things just vary regionally. For example, if you’re having open surgery to fix an abdominal aortic anuerysm, you’re more likely to have a retroperitoneal incision if you’re in California and a vertical incision if you’re in the Midwest (or mayber it’s the other way around).

kcindc – I realize that (but it’s fair for you to point it out since I didn’t comment on this in my note), nonetheless, costs seem extreme compared to what you pay for similar services elsewhere. So how do you explain that? Why aren’t insurance companies putting more pressure on hospitals not to charge $5/aspirin? (And are we conveniently forgetting about those who don’t have insurance to cover these crazy costs?)

For example, if you’re having open surgery to fix an abdominal aortic anuerysm, you’re more likely to have a retroperitoneal incision if you’re in California and a vertical incision if you’re in the Midwest (or mayber it’s the other way around).

I think it’s the other way round if you’re in the Southern Hemisphere?

It’s just because forearm crutches are used in Europe: they look French.

While forearm crutches more aesthetically pleasing (like, that’s a big requirement–?), are less unwieldly and probably easier to use, they have other consraints. I could use my hands while being propped up via underarms; not sure I could do the same using forearm crutches. And with both knees out of commission, I needed all the propping I could get.

I’ve never tried forearm crutches. I suppose I should. I don’t buy the notion that they are superor, though.

I’m an amputee, so I spend at least part of every day on crutches. As someone as already noted above, it’s possible to jam underarm crutches into your armpit and free up both hands. The first thing I do when I get out of bed in the morning is crutch over to the kitchen and make myself some coffee. With crutches fixed in my armpits, I am a stable tripod, and making coffee is no problem. I don’t see how I could do this with forearm crutches.

I also think getting up and down stairs would be harder with forearm crutches, though that may only be because I’ve never seen it done.

Why do most Americans prefer football to soccer?

Speak softly and carry a big crutch?

Postmodernist explanation: To state that more underarm crutches are used in Europe is to state a so-called “fact”. But, in fact, there are not facts, so there are no underarm crutches, and since underarm crutches are easier to use for womem and other oppressed people, their absence shows how oppessive our society is.

“It seems clear to me that the underarm kind is inferior in every important respect.”

Why? Is this based on personal observation or a recent study?

Axillary crutches bear a higher percentage of user weight and are more stable. They require less training and result in fewer instability injuries. Acute injuries require that the injured leg bears no weight at all. For long-term use, all sorts of ambulatory devices are available, taylored to individual strength and preference. Usually, chronic disabilities are varied in the limitation of limb use, that is, some weight bearing is often possible. The forearm cruthes are preferred in those situations.

Great explanations, though.

When I busted my ankle in America, my brother had a handy set of underarm crutches available. When I got back to the UK, I learned that they won’t give them to you here because they are afraid you’ll lean your full weight on them all the time and cut off the circulation to your arms.

My verdict: It’s much easier to balance with underarm crutches. So much so that I gave up on the sticks and rented a walker for the rest of the time I needed the assist.

None of these were any use to me on stairs, of course, which is a real pain given the design of your average London house.

The people I’ve seen with forearm crutches here in the US have been, as several people have noted, more likely to be encrutched for the long time if not permanently; they have also tended to be able to put at least some weight on their legs, as opposed to many of the people I see on underarm crutches (and as opposed to the person I recently WAS on underarm crutches) who are not putting any weight at all on the foot or leg in question. Is there a difference there? How easy is it to keep all your weight off one leg with forearm crutches?

(And while we’re discussing crutches, can I just say ow? I hate those things, although even a couple months after getting off them, I have more muscle definition in my arms than I ever did. But I’m not overweight and I’m in reasonably good shape — what do out-of-shape and/or fat people do when they have to be on crutches? I just don’t see how it’s possible.)

I broke my ankle last year and was on underarm crutches for six weeks and it beefed my arms and shoulders up quite a bit.
Perhaps americans like to beef up more?

Can anyone who remembers the 19th century think of canes as anything but a weapon? Consider Charles Sumner being clobbered over the head and left for dead.

I’ve used a cane myself once or twice. Back problems. Haven’t hit anyone. Yet.

Have you ever tried to cut down a branch off a tree and try to make a forearm crutch?

Americans have a history of carrying big sharp cutting knife things and makeing their own crutches from the nearest tree. It’s just a matter of finding a forked branch and a few cuts here and there and away you go on your genuine pioneer armpit crutch.

No tolerance for designer girlie-man forearms crutches.

I must agree with Jill. Underarm crutches got a feel in my mind of WWII movies. I’ve never seen underarm crutches being used IRL in Europe.
I myself have spent much of my youth on forearm crutches (due to several soccer injuries on foot and knee) and never experienced any problems with them. I even own my own pair because after a while I stopped bothering going to see a doc for another sprained ancle. I just brought out my crutches for a few weeks and stayed off my foot.

eszter – in america any non-old person who uses a cane is a pimp.