If you overstretch, overstress, strain, sprain, tear or rupture an anatomical structure in your body, the rehabilitation process can sometimes seem painful, overwhelming and daunting. Factors such as time off work for both rest and appointments and time away from competitive sport or training can feed into the negative conundrum of injuring oneself. Sometimes, it is challenging to know how to self manage your injury, leading to questions such as; do I use ice or heat?, do I rest it or move it?, should I go and get a scan?, should I use a brace? Rest assured, you are not on your own and this article chooses to answer one of those questions in particular; should I use a brace or not?
What are braces?
Braces can be used to both treat and prevent injury by providing enhanced stability to joints. They are generally made of synthetic materials and utilise velcro straps, elastic or stronger/thicker materials to both customise the fit or enhance the amount or stability given.
Conditions braces are typically used for;
- Fractures of the leg and foot
- Wrist sprains or overuse injuries
- Chronic ankle sprains
- ACL sprain or rupture of the knee – pre and post operatively
- MCL sprains of the knee
- SIJ instability
Pros of bracing
- Relieve pain by reducing the amount of stress on injured structures
- Limiting the movement available at a joint can allow healing to occur at a faster rate
- Cost effective
- Good availability
- Relatively easy to don/doff
- Braces can provide us with reasonable stability during both rehabilitation and return to sport/work – this can make both these processes faster and more pain free
Cons of bracing
- Braces do not replace a sound rehabilitation program set by your physiotherapist or exercise physiologist
- Aesthetically unappealing
- They do not replace muscle strength or synergy, nor the stability offered to joints by our own anatomical structures
- Wearing a brace too long can indeed make us over reliant on the synthetic structural support it gives us
- Wearing a brace too long can, in some cases, result in muscle atrophy, loss of proprioception and incorrect activation pattern of muscles both before and during movement
- By wearing a brace and decreasing the load on the injured area, you may indeed increase the load on another area of the body
What does the evidence say?
For the management of scoliosis, a review of available, low quality, evidence concluded that bracing did not change quality of life, back pain, psychological or cosmetic issues in the long term. However, all included papers consistently showed that bracing prevented curve progression.
For the management of knee injury, a small 2008 study showed there appeared to be no significant longer-term differences in clinical outcomes between patients who wore postoperative knee braces than those who did after ACL reconstructive surgery. Clinically, we see a reflection of this in current post-operative management of ACL rupture, with some orthopaedic surgeons choosing to use a knee brace during the rehabilitative period, and some choosing not to. Additionally, evidence was appraised for the use of braces to manage osteoarthritis, with the author of this article finding that evidence is inconclusive to support or negate the use of a brace. This was across the categories of pain, stiffness, function and quality of life in the treatment of patients with knee osteoarthritis.
For the management of ankle instability, there is moderate evidence (Grade B) to support the use of prophylactic ankle braces in adolescent athletes, particularly those who participate in football and basketball, to reduce the incidence of acute ankle injuries. A separate study, in 2012, concludes that using an ankle brace or ankle tape has no effect on proprioceptive (the ability to tell where our body is in space) acuity in participants with recurrent ankle sprain or who have functional ankle instability. Combining the knowledge of various studies allows us to acknowledge that whilst ankle braces provide structural stability which may prevent future sprains, they do not provide the proprioceptive element that our anatomical structures do.
For the management of shoulder instability, there is limited evidence regarding the comparative effectiveness of surgical vs. non-surgical treatment (slings, bracing and physiotherapy) for the management of traumatic anterior shoulder instability. There is a need for further evidence to devise whether shoulder braces are an optimal management strategy for providing stability to the shoulder and preventing future dislocation.
To ensure that your injury, ache or pain is managed in the best way possible, it is advised you seek an appointment with your GP or physiotherapist. During your appointment, they will be able to assess whether or not a brace is needed or appropriate for you. In the circumstance where a brace is required, your physiotherapist at Peak Physio may be able to supply you with one immediately or within a week time period.
- Duivenvoorden, T., Brouwer, R.W., van Raaij, T.M., Verhagen, A.P., Verhaar, J.A.N., Bierma-Zeinstra, S.M.A. (2015). Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database of systematic reviews. 3.
- Negrini, S., Minozzi, S., Bettany-Saltikov, J., Chockalingam, N., Grivas, T.B., Kotwicki, T., Maruyama. T., Romano, M., Zaina, F. (2015). Braces for idiopathic scoliosis in adolescents. Cochrane Database of systematic reviews. 6.
- Monk, A.P., Roberts, P.G., Logishetty, K., Price, A.J., Kulkarni, R., Rangan, A., Rees, J.L. (2015). Evidence in managing traumatic anterior shoulder instability: a scoping review [with consumer summary]. British Journal of Sports Medicine. 49 (5).
- Farwell, K.E., Powden, C.J., Powell, M.R., McCarty, C.W., Hoch, M.C. (2013). The effectiveness of prophylactic ankle braces in reducing the incidence of acute ankle injuries in adolescent athletes: a critically appraised topic. Journal of Sport Rehabilitation. 22 (2).
- Raymond. J., Nicholson, L.L., Hiller, C.E., Refshauge, K.M. (2012). The effect of ankle taping or bracing on proprioception in functional ankle stability: A systematic review and meta-analysis. Journal of Science and Medicine in Sport. 15 (5).
- Smith, T.O., Davies, L. (2008). A systematic review of bracing following reconstruction of the anterior cruciate ligament. Physiotherapy. 94 (1).