Chart — Musculoskeletal
Assistive Device Comparison
Canes, walkers, and crutches each have a fitting standard, a movement sequence, and a signature wrong answer. This chart collects all of them — including every crutch gait and the stair rules — because device questions are NCLEX regulars and device errors are real-world falls.
Educational use only. Device selection and weight-bearing status are prescribed by the provider and physical therapist; nurses reinforce and verify safe technique. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Devices, Fitting & Movement Rules
| Device | Best For | Fitting Check | Movement Rule |
|---|---|---|---|
| Cane | Mild weakness or balance support on one side | Handle at the greater trochanter (wrist crease with arm relaxed); elbow flexed 15–30° | Hold on the STRONG side, opposite the affected leg (COAL: Cane Opposite Affected Leg). Sequence: cane forward → affected leg → strong leg |
| Standard walker | Significant weakness or balance impairment; partial weight-bearing | Handgrips at wrist crease; elbows flexed 15–30° | Lift (don't slide) the walker forward, then step the weaker leg in first, then the stronger. All four legs down before stepping — never use on stairs |
| Rolling (wheeled) walker | Patients who can't safely lift a walker; endurance limits | Same as standard walker | Push forward keeping all wheels in contact; brakes (if equipped) locked before transfers |
| Axillary crutches | Non- or partial weight-bearing on one leg | Crutch pads 2–3 finger-widths (about 2 in / 5 cm) below the axilla; handgrips so elbows flex 15–30°; tips about 6 in ahead and to the side | Weight on the HANDS, never the axillae — axillary pressure causes nerve damage (crutch palsy) |
Crutch Gaits
| Gait | Weight-Bearing | Pattern |
|---|---|---|
| Two-point | Partial, both legs | Right crutch + left foot together, then left crutch + right foot — mimics normal walking |
| Three-point | Non- or minimal weight-bearing on one leg | Both crutches + affected leg advance together, then the strong leg swings through — the classic post-injury gait |
| Four-point | Partial, both legs; maximal stability | Right crutch → left foot → left crutch → right foot; always three points on the ground |
| Swing-to | Both legs weak (e.g., paralysis, braces) | Both crutches forward, swing both legs up TO the crutch line |
| Swing-through | Both legs weak; strongest and fastest gait | Both crutches forward, swing both legs PAST the crutch line |
Stairs — One Rule to Remember
Up with the good, down with the bad. Going up: the strong leg leads, then the affected leg and crutches (or cane) follow. Coming down: crutches and the affected leg lead, the strong leg follows. With a handrail, crutches move to the outside hand and the rail does the rest. Walkers stay off stairs entirely.
NCLEX Pearls
- ✦Cane on the strong side, advancing with the weak leg — COAL. A cane on the affected side is the most common trap.
- ✦Crutch pads sit 2–3 finger-widths below the axilla; weight rides on the hands. Axillary pressure = brachial plexus injury.
- ✦Three-point gait belongs to the patient who cannot bear weight on one leg — the typical fracture scenario.
- ✦Up with the good, down with the bad — both directions get tested.
- ✦Walker: lift, place, step weak leg first — and never on stairs or escalators.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Orthopaedic Surgeons (AAOS) · National Association of Orthopaedic Nurses (NAON). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →