Knee Braces - Are they Detrimental?

[Kathy G]

Hi, everyone. I was wondering if any of you know whether knee braces are inherently bad for the knees and the muscles surrounding the knees.

When I was leaving the pool yesterday, the lifeguard told me the brace may end up causing more problems than it helps.   I really didn't want to hear that, because ever since I started wearing the brace (ACE Brand neoprene brace w/open patella), I have made significant progress in weight-bearing and walking, along with my water therapy regimen. The research I've done to this point has stated that long-term dependence may have negative consequences, but I do not plan on wearing the brace for much longer, and plus I remove it when I am not walking long distances or if I'm just sitting around or exercising.

Any feedback on your experiences would be sincerely appreciated!

[Bo]

Hi Kathy,

I have been wearing a breg extreme and a GII unloader for some time now and have found that I cannot walk without them. Also the muscles have deteriorated considerably. However I do swim regular and walk...although slowly.

I can only go by my own experiences but if you get the chance ditch the brace then do so. But again sometimes this just isn't an option. Also I have found that these braces afford me alot of protection from knocks to the knee.

I hope I have helped you at least a little.

Take care

Bo

[cm]

It really depends person to person.   If the brace is preventing further injury, then obviously you need to wear it.   I think it does weaken the knee - it's removing some of the external stresses and therefore your muscles aren't working as hard - so they won't be as strong.  

I think it's good to do as much "safe" activity as possible without the brace to build the muscles up.   My doctor has now prescribed a Donjoy brace for my most high-impact dangerous activities - DH mountain bike racing and riding my motorcycle off-road, and probably skiing.   My first OS was against braces if your knee was stable after rehab.   But now with my partial menisectomy my knee is not going to be as stable as the "good" one even once the muscles are back to full strength.  

So in your situation, I'd ask your doc and therapist how much you are able to do without your brace.   If you're only using it for a while, I wouldn't worry much, but it's always worth asking your doc's opinion.

-Connie

[Kathy G]

Thanks Bo and Connie for your advice, it has been helpful. In fact, I have been doing a lot more in the last two days without the brace - even going out without wearing it. I can tell the more I walk and exercise, the stronger the leg and knee muscles get. So I may find myself not using it any more.

Thanks again, and all the best to you both in your continued recovery!!  

[Ross]

Kathy, I'm inclined to the belief that the "soft" neoprene type "thermoskin braces are good for soaking up minor bumps.  The armourclad variety are definitely detrimental from my personal experience, mobility is the thing we all need and our knees are built out of muscle that has to be able to move.  Stop movement and muscles atrophy, end of story.  Move it or lose it!  

The heavy reinforced things have their place only where there is serious mechanical damage.  I have seen more folks recovery lengthened and made dependent upon a brace than I care to have.  The things are BAD news.

My recovery from a busted kneecap hasn't been really fast but, a couple of years ago, while they were fitting folks up with callipers and braces for busted femurs I was getting my knee rotation and quads happening.  I went back to work six weeks after a busted femur and pelvis, gotta be something in that!

[Kathy G]

Thanks, Ross for your response. I am pleased to report that I have gone about a week sans the brace, and it seems as if the more I use my leg, the stronger it seems to get, so I do not find myself feeling the need to wear it much any more. So maybe this well-meaning lifeguard did me some good after all!!

Thanks again to all of you, and all the best to each of you in your recovery!  

[ATsoccergirl]

There is really no precise research on this subject.  The neoprene knee braces are worthless, in my opinion, anyway.  I use them more for proprioception and for the athlete's peace of mind.  In terms of functional braces and unloaders, they actually change the biomechanics of the joint.  Unloaders change the alignment of the leg, while derotational braces force the leg to remain in a flexed postition longer thus preventing excessive motion of the screwhome mechanism.  Funtional braces can also prevent certain ROM, which in certain situations can be very beneficial to recovery and return to sports.  In terms of braces affecting muscle strenght, I don't believe that they do, but they can give that effect.  Due to the weight of the brace, the leg has to use more energy than in it's normally unbraced condition.  During activity the muscles will tend to tire out sooner providing an illusion that the muscles are weaker.  I try to return athletes without the use of a brace, sometimes it is necessary.  If they had any other significant ligament or mensical damage they will be put in a derotational brace for at most 6 months.  There are some athletes, however, when bracing is never really an option.  Goalkeepers are notoriously hard on braces, I had one whose ortho insisted on putting her in a brace after ACL recon.  She went through 6 or 7 braces during the season and numerous trips to the orthotist to have various repairs made.  We both agreed that she should ditch the brace for next season.  It really didn't hinder her performance at all, just all the diving on the ground can damage even the sturdiest brace.

[Kathy G]

Thanks, ATsoccergirl for your insights into the mechanics and usage of the brace - it has been very helpful information!!

[Linds]

I swear by my Breg PTO's , without them I would not be able to continue working. They have as of yet, not caused any muscle loss for me. I am having difficulties keeping muscle on my right leg, but that's due to the damage inside it..not the brace. Ross is right, that we need to move. However... if a brace helps you be more compfortable so that you move your leg through a more natural range of motion and don't gaurd it so much..it makes sense that it would be helpful.  When I have a bad day, if I am not wearing my PTO, I guard my leg like crazy, won't bend down, won't even bend my leg while walking. But with the PTO on I feel safe to do most anything I want. Sounds like  a benifit to me...what do you think?
Good luck,
Take care
Linds

[Bo]

Wow what a can of worms this subject has opened....

afraid I have to agree with Linds... I can't walk at all without one of my braces. I have tried so hard to keep the muscles but they don't want to know. Without a brace I can't put any weight through the knee at all...with the brace i can walk small distances although slowly but this is all freedom.

Again it is down to personal injury and if I could do without it and have my old life back then I would be the first to ditch it.

[jab105]

Alot of the bad that is associated with the brace is that you become so reliant on it that psychologically, you cant walk without it...not to mention that the squeeze on the muscles didn't help them grow (or something like that:))....

I wore that stupid thing for 9 weeks (which includes one week after I was able to start bending again), then I just got fed up...I started walking slowly without it (leaning on the hubby a lot), and refused to wear it at all any more, and the difference is huge, after about 2 weeks of not wearing it, I had full confidence back with walking...at 14 weeks after starting to bend it, I'm at about 99%, able to jog (not quite into sprinting yet:)), ride a bike....pretty much anything.......

I'd say get rid of it, asap...obviously, be careful, you dont want to hurt yourself, but I think it does more harm than good...

[jab105]

Alot of the bad that is associated with the brace is that you become so reliant on it that psychologically, you cant walk without it...not to mention that the squeeze on the muscles didn't help them grow (or something like that:))....

I wore that stupid thing for 9 weeks (which includes one week after I was able to start bending again), then I just got fed up...I started walking slowly without it (leaning on the hubby a lot), and refused to wear it at all any more, and the difference is huge, after about 2 weeks of not wearing it, I had full confidence back with walking...at 14 weeks after starting to bend it, I'm at about 99%, able to jog (not quite into sprinting yet:)), ride a bike....pretty much anything.......

I'd say get rid of it, asap...obviously, be careful, you dont want to hurt yourself, but I think it does more harm than good...

[ATsoccergirl]

I think were are now comparing different types of knee braces.  jab105, it seems like you are referring to a post-op knee brace (immobilizer, ROM/rehab brace).  There is solid research on the effectiveness of post-op braces.   They are used to stabilize the knee after injury or surgery.  The particular surgeon I work with puts them in a rehab brace after the injury, and then an immobilizer after surgery (ACL reconstruction).  With these type of braces, there will be some muscle atrophy, but again this is not caused by the brace.  This is caused by the inactivity of the muscles.  Or in the case of an ACL reconstruction, the loss of motor pathways.  Interestingly, atrophy can be retarded by exercising the other leg.  There appears to be some sort of intergration that occurs between the two extremities.  The body tries to make both limbs as equal as possible in terms of  muscle strenth and proprioceptive ability.  

[xj]

Soccergirl,

Wow, if I would have known that exercising my good leg would have prevented atrophy in my leg after I had my patella put back together, I would have been working hard on them. Particularly since I could not even do a leg lift for 6 weeks after the injury. I would be very interested on reading any references on this?

XJ

P.S. I am three months post-op and do not use any brace right now, but I am still on crutches.

[mabdegonian]

A lot depends on your injury/injuries and the type of brace you are talking about.  In my case I have to rely on the brace for stability.  On flat even terrain I can walk about carefully and do fairly well at work and home but there are certain obstacles I cannot handle safely without the aid of the brace to prevent further injury.  Any sort of slope or uneven terrain and coming down stairs are all very delicate operations.  With a lot of luck I will get my strength built back up and my knee will stabalize a bit but as it is right now I can feel the zing and slight pain of a miss step without significant reinjury because of my brace.

I doubt that I will be free of my brace unless I want to embrace further surgeries but in the mean time it gives me my life back.  I cant run, jump, jog or even walk across a park without discomfort but at least I can walk and shoot some baskets with my 10 year old son again.

Again I am not wearing a neoprene brace but a custom carbon fiber brace that provides significant loading, rotation protection, hyper extension protection, and stability.  If I could get rid of it and safely walk I would but right now that is not an option.

Dan