A knee brace is a device that is worn around the knee joint to help provide support and/or alleviate pain/discomfort. Braces can vary considerably in their design from a simple elastic ‘one size fits all’ sleeve to custom made activity specific hinged mechanisms. There are a huge number of braces available but they can be separated into 3 identified categories:
Rehabilitation braces are designed to protect an injured area while waiting for healing to occur. They completely immobilize or restrict movement around the joint and as a result are larger and more cumbersome than other braces. Typically rehabilitation braces are prescribed by a health care professional according to the type of injury and degree of protection required.
Prophylactic braces are worn to prevent knee injuries from occurring. They are often worn in contact sports such as soccer although the available evidence is inconclusive as to exactly how effective they are at preventing injury.
A functional brace is worn to provide support to a knee that has been injured and as a result has some sort of structural or stability deficit. Functional braces can help to reduce pain and reduce risk of re-injury. The evidence suggests that while a functional brace takes time to get used to, they do not hinder performance. Most people considering a brace will be looking for a functional brace but the array of choice can be confusing.
The appropriate selection of a brace will depend entirely on the purpose for which it is intended. When choosing a brace there are several factors that you must consider:
• THE TYPE OF INJURY THAT YOU WANT TO PROTECT
• THE SPORT/FUNCTION THAT YOU WANT TO USE IT FOR
• THE AMOUNT OF MONEY THAT YOU WANT TO SPEND
Knee Braces by Type
Hinged braces are usually more robust than other types. They restrict lateral (side to side) movements and can also be used to limit the amount of flexion (bending) or extension (straightening) at the knee joint.
Neoprene is a thick stretchy material which will stretch in all four directions. It is a commonly used material in knee braces and is very versatile. Neoprene braces can come in the form of a simple sleeve, with added support around the knee cap, in a wrap around design for a more contoured fit, or with added lateral rigidity.
Elastic braces are made of stretchable fabrics and are generally considered to be very comfortable. They are typically only used for light support in very mild injuries.
Knee bands are usually much smaller than other braces and are typically used only for tendon and bursa problems. They wrap around the painful area to ‘offload’ stress through the injury. Knee bands are fairly uniform in their design a good range are available.
Knee Braces by Injury
Arthritic or degenerative conditions will benefit from a wrap style brace providing compression and support. If the patelofemoral joint is affected, a cutout brace which stabilizes the patella (kneecap) should be considered. For arthritis within the knee joint itself an ‘unloader’ brace should be considered.
Ligament injuries will benefit from a more dynamic, hinged brace. Collateral ligament (MCL or LCL) should be limited from any lateral (side to side) movement but still allowed to fully flex and extend. An ACL injury (either surgically repaired or non-surgically managed) can benefit from a similar sort of device but may further benefit from a knee extension constraint brace. A knee extension constraint brace is a type of hinged brace, it limits lateral movement, prevents twisting and reduces loading on the ACL. The DonJoy custom defiance brace is used for ACL injuries and is made to measure which helps with comfort and function.
Mild to moderate meniscus injuries can be helped by a compression/wrap around brace. A more significant injury or tear will require a hinged brace which limits twisting/turning type movements.
Once you have chosen the type of brace you need, it is also worth thinking about how long and what activity you are likely to need the brace for. If it is for short-term and light use only then a generic ‘off the shelf’ device is likely to be sufficient whereas if you are likely to need the brace for long term or heavy duty use (as is often the case with ACL injury or repair or activities which require a lot of impact/twisting & turning) then a more long lasting made to measure brace would be better.
Skiers in particular need to consider how the design of the brace will affect their activity. ACL tears are commonly associated with ski injuries. Assuming that a good recovery has been made, there is no reason why a full return to activity should not be made. However, most skiers will require bracing following repair and rehabilitation, especially high level aggressive skiers. Bracing manufacturers have designed braces specifically for this purpose. One example is the DonJoy Ski Armor.
An inappropriately chosen knee brace can cause more harm than good and the decision to use a brace should not be taken lightly. The most important factor in choosing a knee brace should be based on an accurate diagnosis of your injury. If you are in any doubt over this then you should seek advice from a registered health professional.