A Guide To Non-Weight Bearing

Being non-weight-bearing (NWB) after an injury or surgery can feel very overwhelming. NWB means keeping all weight off your affected leg or limb(s) with the help of crutches, a walker, or a wheelchair. It sounds simple on its face, but figuring out how to move, rest, and just live life without using one or both legs takes some adjustment. In this post, I’ll explain what non-weight bearing means, why it’s important, and share what has helped me along the way.

Reasons for non-weight-bearing restrictions

You could become non-weight bearingYou could become non-weight-bearing for a number of medical reasons that require you to keep all weight off a specific limb.

1. Fractures or broken bones: Severe fractures, particularly in the legs, ankles, or feet—like a pilon fracture—often require NWB status as part of the recovery process.
2. Surgery: Procedures like joint replacements, ligament repairs, or the insertion of screws, plates, or rods.
3. Tendon or ligament injuries: Tears or severe strains, such as an Achilles tendon rupture, often require immobilization and NWB.
4. Severe sprains or dislocations: Significant injuries to joints, such as the ankle or knee, might lead to NWB restrictions.
5. Arthritis or degenerative joint diseases: Advanced cases can lead to joint instability or severe pain, requiring temporary NWB.
6. Infections or wound healing: Conditions like osteomyelitis (bone infection) or open wounds may require NWB.
7. Bone or joint conditions: Diseases like avascular necrosis (loss of blood supply to the bone) or severe osteoporosis may require NWB.

Types of weight-bearing restrictions

Weight-bearing restrictions range from non-weight bearing (NWB), the most limiting, to partial weight bearing (PWB), which allows you to gradually reintroduce weight.

Non-weight bearing (NWB)

A non-weight bearing restriction means no weight can be put on your affected leg(s), not even to rest it on the floor. This restriction requires assistive devices like crutches or a wheelchair. During this stage of your recovery process, working on your upper body strength and mobility for your other healthy limbs can help make daily tasks easier. If you're like me, you'll find that by default, the rest of your body gets stronger and more functional since it needs to make up the work of your affected leg.

Toe-tough weight bearing (TTWB)

A toe-touch weight bearing restriction allows your toes to lightly touch the ground for balance, but they cannot support any weight. This stage still requires the use of crutches or a walker.

Some healthcare providers may recommend heel-touch weight bearing (HTWB), depending on the nature of your injury or surgery.

Partial weight bearing (PWB)

A partial weight bearing restriction means you can put a small amount of weight on the affected limb, often defined by a percentage of your body weight. Assistive devices will still be helpful during this phase.

Why NOT to resume weight too soon

Though it may be tempting to push yourself, resuming weight too soon can cause stress on the healing bone, joint, or surgical repair that could cause improper alignment of the healing area. Early weight bearing can also increase inflammation, disrupt newly formed scar tissue, or cause fractures or re-injuries at the surgical site. If you experience significant pain during the transition to a new weight-bearing stage, consult your healthcare provider.

Navigating daily activities non-weight-bearing

Adjusting to life while non-weight bearing is undoubtedly annoying, but you can still maintain some sense of independence with assistive devices and easy home modifications.

Strategies for daily living

• Modify your environment: Install grab bars in key areas like bathrooms, consider a shower bench for bathing, and remove tripping hazards like loose cords or throw rugs.
• Exercise safely: Keep working out your upper body and core to maintain strength and flexibility.

When I was early in my recovery process, I saw TikTokkers bragging about getting to the gym with their injured ankle and felt very discouraged. If this isn't for you, like it wasn't for me, try just keeping a set of small weights by the bed or doing chair yoga as you feel able to keep your body moving.

• Emotional support: Being NWB can make your world feel smaller than normal. Find ways to stay connected with people you care about and spend time on hobbies that can be done seated.

Assistive devices for mobility

• Crutches: Crutches are a classic choice to help transfer weight to your upper body. Keep your affected leg off the ground and rely on your hands, not your armpits, for support.
• Knee scooters: Knee scooters allow you to rest your knee on a knee pad while pushing yourself forward. They’re ideal for greater stability, using your hands when not in motion (whereas you need to juggle crutches), and resting the affected leg.
• iWalk Hands Free Crutch: This device is a hands-free alternative to traditional crutches or knee scooters. You strap it to your leg, allowing you to walk upright.

Transitioning to partial weight bearing

Before starting the transition to partial weight bearing, be sure you have your doctor's approval and clear instructions about how much weight (e.g., 25%-50% of your body weight) you can place on your injured leg.

Use a bathroom scale to practice applying the recommended amount of weight. For example, stand with both feet on the scale, supported by your assistive device, and gradually shift weight to your injured foot. Stop when it reaches the correct percentage. This helps you get a feel for how much weight is safe.

Continue using your assistive device(s) to support the remaining weight. Place the device slightly ahead of you, step forward with the affected leg, and allow it to bear partial weight while the assistive device and your healthy leg support the rest.

Focus on proper walking form. Keep your posture upright, with your shoulders back, looking straight ahead rather than down at your feet, if you can. Step heel-to-toe, rolling your weight smoothly from the heel to the ball of your foot. Try to keep your steps even and controlled.

Mild discomfort is normal, but sharp pain or swelling tells you you’re overdoing it. If this happens, reduce the weight you’re applying and allow your leg to rest.

Over time, slowly increase the amount of weight you place on the injured leg. Continue using the bathroom scale for accuracy, or practice placing more weight as your confidence grows.

Potential challenges of non-weight bearing

You'll need preparation and patience to get through your non-weight bearing period.

Physical challenges

• Mobility limitations: Talk to your healthcare provider to choose the best assistive device(s) for your needs.
• Home modifications: To prevent accidents, create a safe environment at home.
• Pain management: Work with your healthcare provider to figure out a pain management plan that may include physical therapy, over-the-counter medications, or other non-opioid strategies.

Emotional challenges

• Loss of independence: Limited mobility can leave you feeling helpless. Setting small milestones for yourself can really help; try to get out of the house a set number of times per week, challenge yourself with a (seated) workout class, or make a meal (even if it takes forever).
• Isolation and anxiety: Not participating in your usual activities can feel isolating. Getting out of the house with the help of friends or family or joining an online support group like Pilon Fractures Suck! can help.

Coping mechanisms

• Build a support system: Lean on family, friends, or caregivers for help with daily tasks and emotional support.
• Stay active within limits: Try safe, NWB-friendly activities like seated stretches or upper body strength exercises.
• Prioritize nutrition: Eat a balanced diet to encourage healing.

A note from Fracturely

Being non-weight-bearing can feel like such a hindrance—and it is—but with the right tools and mindset, you'll get through it. Follow the advice of your medical professionals, leverage assistive devices, and focus on small goals. Remember, recovery is a journey—take it one step (or roll) at a time, and don’t hesitate to lean on your support system when you need it.