SHOULD YOU WEAR A KNEE BRACE?

By: Mark Z. Jamantoc, PT

About the Author

It is not unusual to hear a diagnosis of Osteoarthritis on the knee. You may even hear your doctor say, “your knee is bone-on-bone now and that is why you are in pain." These patients would eventually get a referral to Physical Therapy in conjunction with perhaps, some type of NSAIDS (Non-steroidal Anti-inflammatory Drugs) or pain medication and/or a suggestion for a knee brace. But the question I always get in my clinic is: do braces really help?

This article will not replace education on correct exercise and form. It will also not include other forms of treatment for knee pain. I wanted to keep this article as short as possible for my patients and other busy clinicians so I mainly focused on specific studies and summarizing them with the intent of putting together a general idea whether or not knee braces actually work. In addition, I have included some information on whether or not wearing shoe orthotics such as Superfeet (which is what I recommend and carry in my clinic) would be helpful for knee pain.

To be honest, as I was looking online for research, there isn’t much out there for evidence and higher quality studies about this. On the latest issue of the Journal of Orthopedic and Sports Physical Therapy, Callaghan, Parkes and Felson examined the Effects of knee braces on quadriceps strength and inhibition in subjects with Osteoarthritis (4). This was a research study as a secondary analysis of a randomized controlled trial. The study had 108 participants who had at least 3 months of Patellofemoral pain and were randomized into 2 groups: those that wore a flexible knee support (brace) and a group with no knee support (no brace). The main concern of this study is not about preventing pain, however, but to see if wearing the knee brace had deleterious effects on the quadriceps muscle group strength. The results showed that it did not inhibit the strength of the quadriceps, which leads us to the first concept:

CONCEPT #1

Wearing a flexible knee brace does not inhibit quadriceps strength.

     
     The main concern for most clinicians and trainers out there is that wearing the brace might weaken the surrounding muscles. The potentially negative effects of the muscle can be measured by a maximum voluntary contration (MVC) and arthrogenous muscle inhibition (AMI). AMI uses supramaximal electrical stimulation (ES) to assess voluntary contraction. Also please note that to date, this is the first ever-published study on the effects of bracing on muscle inhibition (4). Other studies might start to surface in the future but to date, this may be the most useful tool for us in the clinic.

CONCEPT #2

Wearing a flexible knee brace may help improve pain in those with Osteoarthritis. 

     There is evidence that in patients with OA (Osteoarthritis) braces in the form of flexible knee braces does help improve knee pain. In a systematic review on the Efficacy of Knee Braces and Foot Orthoses in Conservative management of Osteoarthritis by Raja K and Dewan N (2) in a Pubmed published study, they concluded that knee braces and foot orthoses were, in fact, effective in decreasing pain, joint stiffness and drug dosage. Furthermore, they also improved proprioception and balance. In a 2010 study, Role of bracing in the management of Knee Osteoarthritis (3), the authors concluded that braces are recommended for treating Osteoarthritis but must be adapted to the symptomatic knee. This should be added in conjunction with conservative methods like exercises that your Physical Therapist prescribed as well as manual therapy.

CONCEPT #3
Foot orthoses may help improve knee pain and stiffness. 

     In a study done by Johnson and Gross in 2004 Effects of Foot Orthoses on Quality for individuals with Patellofemoral Pain Syndrome (1), they found statistically significant improvement in knee pain and stiffness 2 weeks following the start of foot orthotic intervention. 

     They further concluded that custom-fitted orthosis may improve patellofemoral pain symptoms in patients demonstrating excessive foot pronation. In a clinical commentary done by Gross and Foxworth in 2003 (5), they generally found that patients who have patellofemoral pain and who demonstrate excessive foot pronation benefit from foot orthoses that address directly the alignment problem that may be driving their foot pronation. These patients may have other problems related to this such as tightness of the Iliotibial band, tight quadriceps muscle group, tight hamstring muscle group, weakened external rotators, and tight tissues around the knee cap.

So what does this tell us? 

     If you were a trainer, how will you create a program to avoid knee pain for your clients? Based on these readings, and based on your assessment, you might be able to suggest a flexible knee brace that is over-the-counter and create an exercise routine centered on decreasing the valgus on the knee, proprioceptive and balance exercises (See USEFUL LINKS below), and a good flexibility regimen for major leg muscle groups like the quadriceps, hamstrings, and hip muscles. As a therapist, use your judgment and clinical decision-making skills in recommending the right brace for the client. Keep in mind that they may not actually need it. The brace may not be a one-size-fits-all resolve but I am hoping that knowing these studies will help you decide what’s best for your client.

Have plantar fasciitis? Click here to see my 5 quick ways to help it.

Useful links:

PROPRIOCEPTIVE EXERCISES FOR THE KNEE -YOUTUBE

GLUTE STRENGTHENING EXERCISE – THE RUNNINGMAN (YOUTUBE)

SINGLE LEG DEAD LIFT EXERCISE FOR RUNNERS -YOUTUBE

FLAT FOOT AND FOOT PRONATION

SUPERFEET SHOE INSOLES – the only insoles I carry in the clinic at this time.

EXAMPLE OF FLEXIBLE KNEE SLEEVE I USE IN THE CLINIC - call our clinic for information on ordering (541)-459-8459

FIND US ON

Reference:

1. J Orthop Sports Phys Ther 2004;34:440-448. Effects of Foot Orthoses on Quality for individuals with Patellofemoral Pain Syndrome

2. Am J Phys Med Rehabil. 2011 Mar;90(3):247-62. Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review.

3. Curr Opin Rheumatol. 2010 Mar;22(2):218-22. Role of Bracing in the Management of Knee osteoarthritis.

4. Journal of Orthopaedic & Sports Physical Therapy, 2015 Volume: 46 Issue: 1 Pages: 19–25  DOI:10.2519/jospt.2016.5093. Effects of knee braces on quadriceps strength and inhibition in subjects with Osteoarthritis

5. Journal of Orthopaedic & Sports Physical Therapy, 2003 Volume: 33 Issue:11Pages: 661–670 DOI:10.2519/jospt.2003.33.11.661 The Role of Foot Orthoses as an intervention for Patellofemoral pain