The Knee Walker

knee walkerThe rolling knee walker (or knee scooter) is a fairly new addition to the durable medical equipment family. It is used on relatively) flat surfaces indoors or out, and up/down small curbs.

This is another device that doesn't fit into a category in order to easily try to classify it. It has a broader base of support than the canes, but it can potentially be used with one hand (I only recommend this for short distances, though, and indoors on flat surfaces. Especially if you have any balance problems.) It has wheels, like a walker; but the majority of support comes from your legs and trunk, not your legs and arms.

It's a bit of an "in-between" when it comes to walking aids.

The rolling knee walker takes the place of crutches, which can be difficult for those with hand problems (arthritis, prior surgeries, nerve impingement, weakness or pain), balance deficits, problems coordinating the use of crutches and/or maintaining the weight bearing ordered by the doctor. There are also people who just don't want to try or to use crutches.

It is designed for weight-bearing relief for those who have injuries to their foot, ankle or lower leg (below the level of the upper calf). These injuries include: fractures, wounds such as diabetic wounds/ulcers, torn Achilles' tendon, sprained or strained ankles, or surgery to the foot or ankle. It could also be used for partial or complete amputations of the foot while waiting for the wound to heal and fitting of a prosthesis.

In response to questions about using it after a total knee replacement, or with knee arthritis, please read this posting about total knee replacement and a knee scooter.

When using crutches, your arms are supporting your body weight; your arms and upper back are used for mobility, in place of the larger muscles of your legs. With the knee walker, you are using the wheels and those larger leg muscles to roll with. Using these larger muscles means less fatigue for your body.

It doesn't mean that you won't get tired, just that you will be able to do more and do it safely before you need to rest.

rolling knee walkerThere is quite a bit of variability in the design of rolling knee walkers, more than most walking aids. They are as variable as the manufacturers that make them.

The knee walker has a foam pad that the involved leg is supported on, with the ankle and foot allowed to rest without any weight on them. Having the foot up like this helps to minimize any swelling, also. The size of the pad for your knee varies from model to model, and the type of foam used on the pad is usually closed cell or memory foam.

The weights of the knee walker can be between from 15 to over 25 pounds. This is something to think about, not only for using it to get around but also if someone has to lift it up into a car trunk. Additionally, some fold up, while others don't; folding models make it a bit easier to get into a car.

The weight capacity is usually about 250 pounds, but bariatric models have weight capacities in the 400 pound range.

When using it, the weight of the body goes on the uninvolved ("good" or uninjured) foot and the knee of the involved ("bad" or injured) leg. Additional support comes from the handle bar (called a "tiller"), which allows the user to either steer or lift up the rolling knee scooter to change directions. Many also have hand brakes, similar to what you find on bicycles. The brakes are not meant to be the main method of slowing or stopping, as this is done with the uninvolved foot.

As mentioned before, some turn and some don't. This also means that the turning radius varies, and this is important if you are in a small room or one stuffed with furniture, animals or kids. In order to maneuver, even if it turns, you may need to lift it up to change directions. Or make 10-point turns.

The width of the wheel base (how far the wheels are apart, not only front and back but also from right to left) varies, with some models being from 30" to over 40" from front to back. Some have 3 wheels while others have 4. Wheel diameter may be 3" to 8", with most wheels fixed but some swivel.

For convenience, there may also be a basket or bag for carrying things, and to keep your hands free.

Adjustments for the user's height may be made by quick release levers, or taking a pin or a screw out of a hole and lengthening or shortening the tube. Some models adjust the seat height by changing the length of the wheel tubes.

What does all of this variability mean to you? This really depends on what different models you have to choose from where you are renting or buying it. In general, here are some qualities of these features to consider:

  • Foam pad: Since this is your knee rest, and where you will be bearing weight through, consider how long you will be using it at any one time. Closed foam will compress faster than memory foam, and will compress into a thinner foam. If you are putting a lot of weight on your knee for a long time, memory foam will be better at relieving the pressure on the bones of your knee.

    As far as the size of the pad goes, make sure that your knee fits on the center of the pad with room around all edges so that your knee will not slip off.

    The height of the knee pad may be adjusted by a quick release lever, a push button, or a nut and bolt. Some models adjust by changing the length of the wheel tubes, with adjustments made at each wheel.

  • The weight of the rolling knee walker depends upon the features of it (more features will add weight to the device) including the diameter and thickness of the frame and what it is made of. Most frames are made of anodized or aircraft aluminum. Parts such as the tiller (the steering part or the hand grips) may be stainless steel.

    The primary concern with weight is that added weight will require more strength and endurance to move with, and to allow someone to lift it in and out of a vehicle. If you are mostly staying at home, and not moving as much as if you were getting out and around, weight becomes less of a problem.

    The user's weight determines whether the knee walker is a standard (250 pound) capacity, or bariatric (up to 400 pound) capacity. A bariatric model will be heavier to lift, also, because the frame has a thicker diameter to accommodate for the increased weight being carried.

  • Turning, or not. Lifting up the rolling knee scooter requires much more balance than you might think. When you do this, most of your weight is supported on one foot only. Lifting it means that you are using much more energy, also. If your balance or endurance needs are greater, then the walker that turns is more beneficial for you. There are still circumstances in which you will have to lift it to turn it (think of a cramped bathroom, or having to turn around in a hallway at home), but planning ahead will help to reduce the number of times that you have to do this.

    If you are getting around mostly outdoors, or in areas where you are going longer distances without turning, the knee walker that doesn't turn may work for you. For example, if you are using it mostly for shopping (where the aisles are long, and the distance from parking lot to store is also long) it won't be needed for many turns.

    The tiller, or steering column, may fold down or collapse with release of a pin in order to make it more portable. The height of the tiller may be adjustable by pushing in a button to lengthen or shorten it, or by a quick-release lever or a nut and bolt.

  • Wheel base and wheels. A wider wheel base adds stability to the knee walker, but it can also compromise maneuverability because you need a bigger area to turn it in. A bariatric model will tend to have a larger wheel base compared to the standard knee walker to add more stability.

    3" wheels are for indoor or flat surface use, while 8" wheels provide more stability and roll smoother for outdoor use on more uneven surfaces. However, they aren't meant to go "off-roading" or anywhere that would be more of a challenge to keeping your balance.

    A 3-wheel device has 2 of the wheels on the front; the wheels are wider apart than on a 4-wheel knee scooter, up to 24" in width, which must be considered for turning in cramped areas.

    Some models adjust the height of the knee pad by adjusting the height of the wheel tube, meaning 4 separate adjustments.

  • Brakes: In my opinion, the brakes are used mostly once the walker has stopped, and you are moving on or off of it. This keeps it from shooting out from under you, for safety.

    When you are actually rolling along, the brakes add to your slowing ability but should not be relied on as the main method of slowing or stopping.

    Given all of the parts that can be different on a rolling knee walker, it's best to check with a durable medical equipment vendor to determine your exact needs.

How to Use a Knee Walker, Including Safety

Before you do anything, read through and understand the Owner's Manual. This is a good place to get acquainted with the various parts and controls, as well as precautions.

Maintain good posture with the rolling knee walker; for a start, this means keeping the hip on the involved/injured side straight, not flexed or bent. Keep your back straight, with your elbows slightly bent to absorb shock and to be relaxed for steering. Your hands should be about at stomach level. Keep your head up, looking out between 6' to 10' to steer away or around obstacles or problems.

To move it, you simply push with the uninvolved (good) foot, forwards or backwards. It is a motion similar to skating or skate boarding; with the good foot you push backwards in order to propel yourself forwards. Let the knee walker glide, and when you start to feel it slow down, push again. You make turns by lifting up the front wheels of the knee walker in small increments, or turn the tiller (if it has one) in the direction that you want to go.

If you have to lift it to turn, this is usually easier done turning away from the leg that is planted on the ground/floor, in small parts of a circle so that you don't lose balance. If you have to turn towards the leg that is planted, the turn will be even smaller, to avoid running into your leg. This means that you will need to make more of these movements in order to get this turn done, than if you were turning away from the planted leg.

That's the simple part; but getting the technique down, like so many things in life, takes practice and learning through experience. Depending on the type of knee walker that you are using, you will need to learn how quickly you can safely propel it, and make turns. While using it, whether moving or stationary, there are several safety aspects to keep in mind:

  1. Always keep your knee on on the pad and your weight over the center of the knee scooter, to avoid loosing balance. Don't reach or stretch out from it to get something; move it and yourself closer to what you need.
  2. Watch your speed. Although many are equipped with hand brakes, these will not stop you as fast as you might need. Most of the braking will be done like Fred Flintstone, with your good foot.
  3. If you have to go up or down small curbs (this requires greater balance and planning, so it's not recommended) lean back as you slowly go down. Let the front wheels slowly go down the curb or step, apply the brakes to help hold you in place, step down with the good foot and slowly roll forward to bring the back wheels down.

    To go up a small curb (again, this requires greater balance and planning, so it's not recommended) lean forward (you want your weight to be heading in the direction that you are traveling) over the knee scooter, slowly lift the front wheel up the curb, move the knee scooter forward so that you have room to step up then apply the brakes so that it doesn't roll back to you, step up then roll the knee walker forward up and over the curb.

    If there is any question of you having balance problems, if you are tired or feel rushed do not do this; balancing on one foot while moving a 20+ pound object up or down a curb while trying to step up or down yourself is not something to be done without concern or thought. I've included these instructions only for suggestion, but it's up to you (and/or your doctor, physical therapist, family) to help you decide if this is something to be attempted.

  4. In order to go down a (slight) incline, lean back to control your forward speed, apply the brakes and take quick, short steps with your good foot in order to brace yourself from racing forward too quickly. This will help to control your speed and avoid accidents. Don't try to turn abruptly when going down an incline, as your weight will carry you forward while the knee walker turns away from you.

    To go up a slight incline, lean towards the front wheels for balance, push with your good foot and apply the brakes to avoid rolling backward when you are lifting up your good foot to push forward again. This is done with short, quick steps also, in order to keep moving forward and not roll back.

    As with going up/down a small curb, this shouldn't be done if you have balance problems or are tired or rushed. Focus on what you are doing, because this type of activity demands it. I've included these instructions only for suggestion, but it's up to you (and/or your doctor, physical therapist, family) to help you decide if this is something to be attempted.

  5. If you are going to stand with the support of the knee scooter (for example, standing at a kitchen counter), apply the brakes to keep it from rolling away from you. Most come with brakes that will lock, just for this purpose. Check with the Owner's Manual for this, and how to release the brakes when you are done.
  6. Don't carry anything except in the basket or bag that comes with it. Carrying more bags (for example, grocery bags) slung over the handle bars will make it harder to steer or lift, and could cause it to tip.
  7. Periodically check bolts or quick-release levers that keep the knee pad, wheels, and tiller in place. These can loosen with the vibration of rolling over irregular or uneven surfaces. Only check and adjust these when you are sitting on a chair, off of the knee scooter.

While using one of these myself recently, many people commented on how these would make getting around after total/partial knee replacement easier, or with an amputation above or below the knee. This I would have to disagree with from a professional standpoint for several reasons. The primary reason is that in a knee replacement or below-the-knee amputation, you want to regain as much straightening of the knee as possible to maximize function. If you use a rolling knee walker, the knee is kept bent, and makes it more difficult to stretch out into a straight position.

The other reason is putting weight on the knee itself, which is where an incision would go for a knee replacement or below-knee amputation surgery. This would also be the case after having a knee arthroscopy. In the case of these types of surgeries, I could not recommend using a knee walker.

But I've recently read about a seated scooter at this site which I could recommend for the above surgical conditions, if the person has sufficient balance to get on/off of it and can maintain their balance while moving.

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Updated April 26, 2012

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