Friday, February 5, 2016

How Effective Is Your Knee Brace?

Assortment of soft knee braces from the Holland Village Guardian
How many of you have seen runners run past with a knee sleeve/ brace on? That's what I always look out for! But that's me and that's what I always do, watching people move and see if there's anything wrong or different.

I've also seen so many of my patients walk in to our clinic with a self prescribed over the counter soft neoprene knee sleeve/ brace. Often, they are asked by the doctors they see to wear a brace.
Often prescribed by doctors
I always ask the patients why they have the sleeve/ brace on. Some will say the brace helps with their pain or it makes their knee feel less wobbly. They usually reply that they feel a little more secure with the sleeve / brace. Most, however are not sure if the sleeve/ brace works.

Let me explain what the differences are. Braces that are stiff and rigid are usually made from plastic, aluminium or carbon fibre. They usually restrict joint movement by physically pressing against the bones of the knee to provide firm external support.

My patient in his rigid knee brace 
While the rigid knee brace can help restrict or limit movement, there is a definite downside  to using them. Have a look at my patient who had a tibial plateau fracture and a partially torn anterior cruciate ligament (ACL).
Check out the rigid brace
See the difference in thigh girth?
Since knee movement is often limited and restricted, the load is often transmitted to the ankle, hip and lower back. Often I end up treating them for the back pain too.

The softer neoprene type sleeves usually will not be able to provide the same mechanical support as they are much softer and do not have any rigid structural support. Neoprene sleeves generally help the wearer by increasing proprioception (or joint position sense) much like the high cut shoes basketball players wear to give themselves more awareness of their ankles to prevent ankle sprains. It is believed that improved proprioception around a knee joint can help stability by improving balance.

However, a 2012 published study of people with knee arthritis found no significant improvements in balance with the use of a neoprene knee sleeve.

There is also very little evidence that knee supports worn prophylactically on healthy knees protect active people against knee injuries.

Granted, knee supports/ braces are usually less expensive or as invasive against knee operations to treat injuries or even arthritis so so people will try them before resorting to surgery.

Some specialized knee supports may help to take pressure off the knee joint while walking and especially during exercise. My patient (in the picture below) intends to use her brace when she goes back to wake boarding and skiing after her injury. Of course I added that proper rehabilitation is important too. Such braces may also be able to help patients with knee arthritis remain active and put off surgery at least for a while.
All ready for action
As explained above, rigid knee braces (but not sleeves) may help after some knee injuries. They are often prescribed by doctors after a patient suffers a torn medial or lateral collateral ligament (LCL). MCL's and LCL's tends to heal fairly well without surgery provided there is no further strain/ injury to the knee for the first 6-8 weeks after the initial injury.

Bracing can be effective when you know what injury you have and the structures involved as a brace can be matched effectively to your needs.
My MCL taping- "Much better than any brace" says my patient
I always prefer to tape compared to using a brace though. As I always say to my patients, I can customize the taping according to their needs and it always fits better than any brace they buy.

So don't just go and buy a sleeve/ brace.


Reference

Collins AT, Blackburn JT et al (2012). The Assessment Of Postural Control With Stochastic Resonance Electrical Stimulation And A Neoprene Knee Sleeve In The Osteoarthritic Knee. Arch Phys Med Rehab. 93(7): 1123.1128. DOI: 10.1016/j.apmr.2011.12.006.

*Big thank you's to all my patients who allowed me to take pictures or sent me pictures.

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