Information on Bracing

A brace is a device worn over an injured or painful joint. Their purpose is to provide protection to prevent injury, alleviate pain, or provide stability. Many ‘gimmick’ style sleeves (e.g., magnetic, copper, etc.) are sold on TV, however, there is currently no scientific data that supports their use. They will not be a focus of this information brochure.

There are 3 main types of braces:

1. Prophylactic Brace

A prophylactic brace is designed to prevent injuries from occurring in the first place. This type of brace is used often by athletes to provide extra support for the knee (1,2) and ankle (3-8).

Some studies suggest that a prophylactic knee brace prevents injuries(2), while others indicate that it does not (9,10). Likewise, it is unclear if prophylactic knee braces negatively impact athletic performance (1,11,12). This uncertainty guides researchers to lean towards not recommending its use. However, researchers noted that specific athletes, namely linebackers and tight-ends, do benefit from these braces more than other types of athletes (1). Consult your physician before making a choice for prophylactic knee braces.

Conversely, prophylactic ankle braces have countless resources supporting and advocating for their use (3-8). Additionally, they are less bulky than knee braces. Like knee braces, it is also unclear if ankle braces impact athlete performance (3,4,6). Despite this, some studies suggest that the proven benefits of the ankle brace outweigh the potential small impact on performance4. These braces restrict ankle motion ensuring that your foot is in a regular position before landing (5,6). Research advocates for the use of ankle braces as injuring your ankle once predisposes you to getting injured again, so it is important to prevent the initial ankle roll, as well as any further injuries (7,8).

2. Functional Brace

A functional brace is designed to increase stability in individuals with unstable joints. This type of brace is often used to conservatively treat a joint or ligament injury or after a surgery.

According to some sources, functional knee braces may reduce some ligamentous strain while weight-bearing (1). However, other research suggests that bracing after ACL reconstruction is not necessary or beneficial to the patient, and only adds to the cost13. In the long-term, there is no significant difference in functional outcome between using and not using a functional knee brace after surgery (1,14).

3. Patellofemoral Brace

A patellofemoral brace is designed to reduce pain in individuals with anterior knee pain, but its mechanism of action is not yet understood1,15,16. Very low-quality evidence has shown both positive15 and negative16 results about its efficacy. Ultimately support for the brace is inconclusive and more high-quality research is needed before anything can be concluded.

A sully brace is designed to stabilize, assist, or restrict movement in patients with shoulder instability17, especially for athletes who require to use their hands above their heads18. This brace does not prevent re-dislocation, but it does provide the user an increased sense of joint position and it serves as a reminder to keep the shoulder in appropriate positions17,19. The sully brace may help short-term, but re-dislocation rates are high, especially in young individuals18, meaning surgical management may need to be considered. Please consult your orthopaedic surgeon to discuss your shoulder instability.

4. Unloader Brace

An unloader brace is designed to help individuals with osteoarthritis of the knee or hip by applying an external force to improve your body alignment and reduce the amount of weight being applied on the osteoarthritic part of the joint1,20-23. Unloader braces can be a good option for individuals that cannot undergo an operation, such as a total knee or hip replacement, due to other medical conditions21.

Evidence suggests that knee unloader braces are most effective at improving medial knee pain from OA20-22, but inconclusive for stiffness and function20, 22-24. One noted downside of the knee unloader brace is a low compliance rate as it may be uncomfortable21-23.

Some evidence also suggests that hip unloader braces are effective at alleviating pain symptoms related to OA25,26. The two main models of hip unloaders available are the WISH type S form and Ossur hip unloader. The WISH brace consists of a part that wraps around your waist and attaches to the affected leg25, whereas the Ossur brace is a tight-fitting garment with elastic straps that tighten, a pelvic belt, and a pad26.

Overall, evidence supports the use of these unloader braces to help lessen OA pain.

Custom-fit versus generic-fit

Generic-fit knee braces are chosen based on which knee brace is closest to an individual’s measurements. Due to this the brace may not fit perfectly and may be more uncomfortable to use. On the other hand, custom-fit knee braces are unique to the individual purchasing it and may result in more comfort. One study comparing custom- vs generic-fit knee unloader braces indicated that both braces significantly improved pain, stiffness, and function, but the custom brace was more effective27.

Unfortunately, the cost of a custom brace is a lot more than generic braces.

References

1. Chew, K. T., Lew, H. L., Date, E., & Fredericson, M. (2007). Current evidence and clinical applications of therapeutic knee braces. American journal of physical medicine & rehabilitation, 86(8), 678-686.
2. Sitler, M., Ryan, C. J., Hopkinson, L. W., Wheeler, L. J., Santomier, J., Kolb, L. R., & Polley, C. D. (1990). The efficacy of a prophylactic knee brace to reduce knee injuries in football: a prospective, randomized study at West Point. The American journal of sports medicine, 18(3), 310-315.
3. Bicici S, Karatas N, Baltaci G. Effect of athletic taping and kinesiotaping® on measurements of functional performance in basketball players with chronic inversion ankle sprains. International Journal of Sports Physical Therapy. 2012 Apr;7(2):154.
4. Cordova ML, Scott BD, Ingersoll CD, Leblanc MJ. Effects of ankle support on lower-extremity functional performance: a meta-analysis. Medicine & Science in Sports & Exercise. 2005 Apr 1;37(4):635-41.
5. DiStefano LJ, Padua DA, Brown CN, Guskiewicz KM. Lower extremity kinematics and ground reaction forces after prophylactic lace-up ankle bracing. Journal of athletic training. 2008 May;43(3):234-41.
6. Dizon JM, Reyes JJ. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. Journal of science and medicine in sport. 2010 May 1;13(3):309-17.
7. Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Brüggemann GP, Best R. Treatment of acute ankle ligament injuries: a systematic review. Archives of orthopaedic and trauma surgery. 2013 Aug 1;133(8):1129-41.
8. Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. British journal of sports medicine. 2010 Nov 1:bjsports76406.
9. Abernethy, L., & Bleakley, C. (2007). Strategies to prevent injury in adolescent sport: a systematic review. British journal of sports medicine, 41(10), 627-638.
10. Pietrosimone, B. G., Grindstaff, T. L., Linens, S. W., Uczekaj, E., & Hertel, J. (2008). A systematic review of prophylactic braces in the prevention of knee ligament injuries in collegiate football players. Journal of athletic training, 43(4), 409-415.
11. Baltaci G, Aktas G, Camci E, Oksuz S, Yildiz S, Kalaycioglu T. The effect of prophylactic knee bracing on performance: balance, proprioception, coordination, and muscular power. Knee Surgery, Sports Traumatology, Arthroscopy. 2011 Oct 1;19(10):1722-8.
12. Najibi, S., & Albright, J. P. (2005). The use of knee braces, part 1: prophylactic knee braces in contact sports. The American journal of sports medicine, 33(4), 602-611.
13. Kruse, L. M., Gray, B., & Wright, R. W. (2012). Rehabilitation after anterior cruciate ligament reconstruction: a systematic review. The Journal of bone and joint surgery. American volume, 94(19), 1737.
14. Harilainen, A., & Sandelin, J. (2006). Post‐operative use of knee brace in bone–tendon–bone patellar tendon anterior cruciate ligament reconstruction: 5‐year follow‐up results of a randomized prospective study. Scandinavian journal of medicine & science in sports, 16(1), 14-18.
15. Bolgla, L. A., & Boling, M. C. (2011). An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010. International journal of sports physical therapy, 6(2), 112.
16. Smith, T. O., Drew, B. T., Meek, T. H., & Clark, A. B. (2015). Knee orthoses for treating patellofemoral pain syndrome. The Cochrane Library.
17. Chu JC, Kane EJ, Arnold BL, Gansneder BM. The effect of a neoprene shoulder stabilizer on active joint-reposition sense in subjects with stable and unstable shoulders. Journal of athletic training. 2002 Apr;37(2):141.
18. Buss DD, Lynch GP, Meyer CP, Huber SM, Freehill MQ. Nonoperative management for in-season athletes with anterior shoulder instability. The American journal of sports medicine. 2004 Sep;32(6):1430-3.
19. Johnson R, Lehnert S, Moser B, Juenemann S. Shoulder instability. Primary Care: Clinics in Office Practice. 2004 Dec 1;31(4):867-86.
20. Duivenvoorden, T., Brouwer, R. W., van Raaij, T. M., Verhagen, A. P., Verhaar, J. A., & Bierma‐Zeinstra, S. (2015). Braces and orthoses for treating osteoarthritis of the knee. The Cochrane Library.
21. Gohal, C., Shanmugaraj, A., Tate, P., Horner, N. S., Bedi, A., Adili, A., & Khan, M. (2018). Effectiveness of Valgus Offloading Knee Braces in the Treatment of Medial Compartment Knee Osteoarthritis: A Systematic Review. Sports health, 1941738118763913.
22. Petersen, W., Ellermann, A., Zantop, T., Rembitzki, I. V., Semsch, H., Liebau, C., & Best, R. (2016). Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 42015026136). Archives of orthopaedic and trauma surgery, 136(5), 649-656.
23. Raja, K., & Dewan, N. (2011). Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review. American journal of physical medicine & rehabilitation, 90(3), 247-262.
24. Moyer, R. F., Birmingham, T. B., Bryant, D. M., Giffin, J. R., Marriott, K. A., & Leitch, K. M. (2015). Biomechanical effects of valgus knee bracing: a systematic review and meta-analysis. Osteoarthritis and cartilage, 23(2), 178-188.
25. Sato E, Sato T, Yamaji T, Watanabe H. Effect of the WISH-type hip brace on functional mobility in patients with osteoarthritis of the hip: evaluation using the Timed Up & Go Test. Prosthetics and orthotics international. 2012 Mar;36(1):25-32.
26. Nérot A, Nicholls M. Clinical study on the unloading effect of hip bracing on gait in patients with hip osteoarthritis. Prosthetics and orthotics international. 2017 Apr;41(2):127-33.
27. Draganich L, Reider B, Rimington T, Piotrowski G, Mallik K, Nasson S. The effectiveness of self-adjustable custom and off-the-shelf bracing in the treatment of varus gonarthrosis. JBJS. 2006 Dec 1;88(12):2645-52.
28. Cibulka MT, Bloom NJ, Enseki KR, MacDonald CW, Woehrle J, McDonough CM. Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2017: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jun;47(6):A1-37.