# Gait Training > Gait training in Physiotherapy: pre-gait preparation, parallel bar to walker progression, crutch gaits, weight-bearing orders, cane technique and crutch fitting. - Canonical URL: https://prepelephant.com/topics/allied/physiotherapy/gait-training - Exam / course: Allied Health · Subject: Physiotherapy - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Gait Training", PrepElephant, https://prepelephant.com/topics/allied/physiotherapy/gait-training ## Direct answer "Up with the good, down with the bad" — the stairs rule carries the logic of all gait training: the sound limb leads while climbing, the affected limb leads while descending, and the walking aid always travels with the affected limb. Training begins away from walking altogether — sitting balance, standing balance, weight-shifting and transfers — then progresses through parallel bars to a walker, crutches or a cane according to the surgeon's weight-bearing order and the patient's strength. An aid is fitted, never borrowed: axillary crutches sit two to three finger-widths below the armpit with elbows bent 20 to 30 degrees, because resting weight in the axilla compresses the radial nerve. ## What you must remember - Pre-gait prerequisites: adequate range and strength in hip and knee extensors and plantarflexors, sitting and standing balance, adequate cardiovascular reserve — the sequence runs bed mobility, sitting, standing, weight-shift, parallel bars, aid, independence. - Weight-bearing orders decoded: non-weight-bearing, touch-down or toe-touch (foot rests for balance only), partial weight-bearing (a set percentage), weight-bearing as tolerated, and full weight-bearing. - Axillary crutch fitting: pad about 5 cm below the axilla (two to three finger-widths), tip 10–15 cm lateral to the foot, elbows flexed 20–30 degrees; weight goes through the hands, not the armpits — axillary pressure causes radial nerve palsy and wrist drop. - Crutch gaits: four-point (right crutch, left foot, left crutch, right foot — always three points down, slowest, most stable), two-point (crutch and opposite foot advance together, near-normal rhythm), three-point (both crutches and the affected limb move together, then the sound limb — for non-weight-bearing orders), swing-to (feet swing up to the crutches) and swing-through (feet pass beyond them — fastest, needs strong arms and trunk, as in paraplegics with orthoses). - The cane is held in the hand opposite the affected limb and advances with it; it widens the base of support and reduces the load through the affected hip. - Walkers give maximum stability for frail or elderly patients; rollator frames suit those who cannot lift safely but brake reliably. - Safety kit: dry floor, firm footwear, gait belt, therapist positioned on the affected side and slightly behind. ## Gait training after total hip replacement Take a patient on day two after a right total hip replacement, posterior approach, weight-bearing as tolerated and three precautions: no hip flexion beyond 90 degrees, no adduction past midline, no internal rotation. Pre-gait work comes first — sitting edge-of-bed with the hip extended, standing with the frame in the bar, side-stepping weight onto the left leg, small right knee lifts within precaution limits. Parallel bars next: the sequence is taught as three words — lift the frame (or both crutches), step the affected right leg, step the left. The frame moves first, always, and never farther than arm's length; the patient counts aloud to stop the shuffle. Watch the right hip for any crossing of the midline, and place a pillow between the knees in bed. Progression to a rollator frame, then to a cane in the left hand within two to three weeks, always opposite the operated side. Stairs arrive before discharge because most Indian homes have them: with a rail on the left and cane in the right hand, ascend leading with the left (good) leg, descend leading with the right (bad) — "good goes to heaven, bad goes to heaven's gate first on the way down", or simply: up with the good, down with the bad. Sessions twice daily, ten minutes each, tolerated pain guiding speed, with Trendelenburg watching as the abductors recover. ## Where students slip The cane's side is the most wrongly answered fact in mobility training — opposite the affected limb, not beside it. Gait-pattern definitions get scrambled: three-point does not mean three limbs down but crutches-plus-affected-limb moving as one unit. Students forget that axillary pads must never touch the armpit, and they reverse the stairs rule under exam pressure. Weight-bearing order matching — touch-down allowing the toes to rest for balance only — also separates marks in scenario questions. ## Frequently asked questions ### In which hand is a cane held, and why? Opposite the affected limb; it widens the base of support and reduces force through the affected hip by shifting the line of loading. ### Which crutch gait suits a patient forbidden to bear weight on one limb? Three-point gait — both crutches and the affected limb advance together, then the sound limb steps through. ### How are axillary crutches fitted? With the pad 5 cm below the axilla, tip 10–15 cm lateral to the foot, and elbows in 20–30 degrees of flexion. ### What is the stairs rule with a cane? Up with the good, down with the bad — the sound limb leads ascending, the affected limb leads descending, cane always with the affected limb. ### What injury follows resting body weight on axillary crutch pads? Compression of the radial nerve in the axilla — crutch palsy with wrist drop.