If there’s one thing that causes confusion in orthopaedics, it’s braces.
Knee patients often wonder if they should wear one. So they do a quick search online, only to be hit by an avalanche of options. Type “knee brace” into Amazon and you get more than 80,000 results, ranging from 99p to £800. No wonder we feel bamboozled.
In truth, the choice is simpler than it looks. Braces fall into a few select categories. So we thought it would be useful to summarise them here.
First, though, a word of caution. We tend to advise against using a brace unless you really feel you need one. The reason for this is that they take over some of the natural functions of the ligaments and muscles. Doing this for too long can predispose those tissues to weakness or wasting – when what you really need is to be building them up.
If using a brace is the difference between functioning and not functioning, it may be worth considering. It’s just usually better to see them as a short-term, not a long-term, solution.
Strictly speaking not a brace, but used for its supportive qualities. Therapeutic tape is made from a sticky-backed elastic material that sits on the skin, providing ‘feedback’ from muscles and, possibly, aiding blood flow by lifting the dermis gently away from those muscles. Theoretically it might also help with proprioception, which is the body’s sense of balance and motion. Studies have offered mixed results, but some patients find the tape gives them more confidence as they move. If you do use therapeutic tape, it’s best to have it applied by a trained physiotherapist.
Material braces are often used after injury. They’re usually made of neoprene or a similar stretchy fabric, shaped like a sleeve that pulls tight over the joint. Some have straps running across the knee. The sleeves give a little general support and forming to the knee. They may also provide some compression – which could be useful if there’s swelling. There isn’t a lot of science to suggest they improve underlying conditions, but some patients appreciate the feeling of support they provide.
Hinged braces are used for side-to-side instability: for example, when a collateral ligament problem is causing weakness on one side of the knee. The hinge assists the joint by stopping excess sideways movement. Hinged braces come in two main types: a sleeve, which is relatively cheap, and a bulkier but firmer version with an external hinge, which offers more support but tends to be costlier.
ACL / PCL Braces
Knee instability can also be of the backwards-forwards kind. This is usually due to a problem with the cruciate ligaments. Depending on which one you injure, ACL or PCL braces provide targeted (often hinged) support to that part of the joint, either after injury or following surgical repair. People sometimes wear them to prevent re-injury on skiing trips; whether there’s enough evidence to support this is questionable. They can also be quite expensive.
Unloader braces are designed to move weight away from one part of the knee to another. This can be useful for problems like arthritis or deformity, where there might be more wear-and-tear in one particular part of the joint. Using this type of brace shifts the weight burden to the knee’s stronger side.
Cricket Pad Splints
This hefty brace is designed to immobilise the knee in acute situations. It’s usually deployed after an injury, when the joint is very swollen and we want to establish what’s going on and protect the area from being further damaged by movement. As mentioned, immobilisation causes stiffness and muscle wastage, so we aim to get patients out of these braces as soon as we can.
These braces usually come as a sleeve-type support with a circular hole above the kneecap, although there are solid versions too. The idea is to provide focused support to the kneecap (the patella) if a patient is experiencing problems in that part of the knee. It does this by pushing it gently into a more appropriate alignment – what we call patellar tracking.
In summary… The type of brace you use depends on what you’re hoping to achieve with one. Do you have an instability issue? Arthritis? A kneecap problem? Or are you just looking for a bit more support when you’re on the move? If you’re totally stumped about braces, you’re not alone! It’s always best to get some advice if you can. We’ve very happy to help if you need to speak to us.