We often use the word crutch rather unkindly. A habit becomes “a crutch”; an easy solution is dismissed as “just a crutch.” The metaphor suggests weakness or dependence, and it is derived from an old English word crycce, which means “staff or support”. Yet the object from which it derives represents almost precisely the opposite. A crutch transfers weight, restores balance and allows a person to move when an injured or impaired limb cannot safely do so. In its simplest form it is an extra point of contact with the earth, a third foot fashioned by human ingenuity.
The Crutch as Support
Only a few medical devices are simultaneously so ancient, so mechanically simple and so immediately recognizable. Crutch is an assistive device, also seen in ancient Egyptian inscriptions, and has changed only a little in principle. It has evolved from a forked wooden staff to adjustable aluminum forearm supports. The history of the crutch runs alongside the histories of war, poliomyelitis, orthopedic surgery, rehabilitation and disability rights.
From a staff to medical appliance
The fundamental idea behind a crutch is ancient: extend the upper limb to the ground and transfer some of the load normally borne by the lower limb through the arms. For centuries, the solution was essentially wooden. For centuries this meant a stout wooden staff, eventually modified with a padded crosspiece beneath the armpit. It also acquired a crosspiece fitting beneath the arm and a handgrip partway down its shaft. This is the familiar axillary or underarm crutch.
Early wooden crutches had a fixed height. Industrialization gradually transformed this simple object. Rubber tips improved traction, adjustable fittings allowed devices to be matched more closely to the user’s height and aluminum and other lightweight materials reduced weight while permitting telescopic adjustment.
The traditional axillary crutch remains instantly recognizable. The name axillary is a misnomer. The user’s body weight should not simply hang from the armpits. Excessive axillary pressure can injure nerves and blood vessels. Properly fitted axillary crutches leave clearance beneath the axilla while the hands carry much of the transmitted load.
Axillary crutches remain useful today, particularly for temporary non-weight-bearing after trauma or surgery. Poor fitting or prolonged axillary pressure can cause neuro-vascular problems. This disadvantage becomes more apparent with prolonged use. These are bulky, require considerable upper-body energy and can cause hand, wrist, shoulder or axillary problems when incorrectly fitted or used.
The crutch enters the workplace: a symbol of Rehabilitation
War was an important, if tragic, stimulus to the development of rehabilitation. The enormous numbers of injured veterans following the First and Second World Wars encouraged governments to think beyond survival towards prosthetics, physiotherapy, vocational rehabilitation and return to employment.
A large number of veterans, who had to be employed into the society. Crutch became a symbol of mobility and rehabilitation. It was prominently shown on postage stamps and covers, now to depict ability rather than a disability.
While the language on the covers and stamps sounds uncomfortable today, but usage of terms to imply disability is historic, and has now changed. However, we need to note subtle shift, from disability to look at the person working.
A similar theme “Reclassement professionnel des paralysés” was used in a 1964 issue from France. The design is wonderfully specific: a wheelchair user works at a laboratory bench surrounded by scientific apparatus. Here the crutches leaning beside the workstation are important. They are present, but they are no longer the subject. The occupation is.
The advent of forearm crutches
A major conceptual change in design on this assistive technology was the development of the forearm or elbow crutch. In this the upper support moved from the axilla to a cuff around the forearm. It is frequently called a Lofstrand crutch, named after A. R. Lofstrand Jr, whose adjustable crutch designs were patented in 1955.
Forearm crutches have important advantages for many long-term users. They are less cumbersome than axillary crutches, allow greater freedom around the shoulder and can become highly maneuverable in experienced hands. They do, however, demand adequate hand and upper-limb strength, coordination and balance.
Modern crutches may incorporate ergonomic grips, articulated or shock-absorbing tips, spring mechanisms, specialized cuffs and lightweight alloys or composites. Yet the underlying mechanical principle remains astonishingly close to that of the ancient staff.
1981: One Year, Many Countries, a Changing Message
The year 1981 was proclaimed by the United Nations as the International Year of Disabled Persons. Postage stamps in this year had a logo of stylized human figure within a broken/open triangular form surrounded by olive branches. Some of the issues featured crutches, as a means of support and mobility.
Perhaps the most interesting development in the history of crutches has occurred around the crutch rather than within it. Older representations frequently present the crutch as a marker of impairment. Twentieth-century imagery increasingly associates it with rehabilitation.
In the 1981 postage stamp, crutch progressively moves out of the clinic. Its users appear in full public view, negotiating ramps, outdoors, playing football and beside a swimming pool and even among crowds.
Beyond the crutch: The social model
More recent stamps show a wide range of capability, beyond walking aids. The subject of these stamps is no longer simply mobility. It is participation.
The mechanical principle of a crutch has hardly changed: take weight from a vulnerable limb and redirect it safely to the ground. Yet meaning of that crutch changes enormously. It ranges from incapacity to mobility. A crutch is not a symbol of weakness. Sometimes it is simply a third foot—the piece of technology that allows the next step.
