To Knee Brace or Not, that is the question.

[Whoops]

I have the left knee of an 80 year old. It's the result of a stupid, low speed, get-off a couple of years ago. During rehab, I asked my OS about a prescription for knee braces. He said knee braces would not help me and they had the potential to do more harm than good. This guy is really good at what he does and I am greatful to him for fixing my seriously screwed up knee, but there is this nagging question in the back of my mind. If a knee brace won't help me, who will it help?

A lot of athletes, dirtbikers, skiers, etc.. wear knee braces so there must be some benefit. I have read threads on DirtRider.net where riders swear that a knee brace saved the day in a big get off. I've also read threads where doctors says a knee brace won't help. Why are so many doctors anti knee brace? Why should or shouldn't I be wearing a knee brace? :think:

Whoops

 

[MX-727]

I believe, and I may be way off base, that knee braces help prevent injury while riding dirt bikes. I think that the doctors are concerned that when a runner or skier wears a knee brace as a preventative measure, their knees actually become weaker due to the fact that the knee doesn't have as great a range of motion before the knee brace takes over and prevents movement and use of the muscles at those limits.

For our sport, our knees are seldom at those limits until something has gone terribly wrong, so I don't think that the same concerns over weakening of the associated muscles apply.

 

[crkid]

Could it just be the part of the knee you injured? There are quite a bit of muscles, tendons, ligaments, and a few bones around the knee right? Maybe it's something that a brace could not prevent, maybe it's even so sensitive that a brace would not keep from re-aggravating it. You might want to ask the doctor why.

This is just a suggestion, I am probably wayyy off, so feel from to call me out on it if you want.

 

[mark_england]

whoops
some surgeons just dont like knee braces, often stating that there knee ligament reconstruction is so strong it doesnt need a brace

 

[DougMXer]

Well if knee braces are so uneffective why is it that 95% of pro riders all wear them. It certainly ain't for show

 

[bizzow]

Look up studies on knee bracing and virtually all you find (that's valid and somwhat reliable) is some study done where it was found that in FOOTBALL (American football) offensive lineman may receive some benefit because it protects them when they are rolled up on from the side or behind. Other than that, there ain't much that proves braces are ineffective or effective.

There is a concern about the concept of stress-riser. If you brace the knee, and it would have normally taken the brunt of a stress that would have caused it to give way, then that stress will be redirected elsewhere. This COULD cause femurs and tibia/fibula breaks. So, what do y'all think? You want a chance at broken bones or ligament damage? I personally am going with the knee braces because I feel that a noncomplicated broken bone is much easier to deal with than a torn knee ligament and 6 months of recovery. I hope I don't have to deal with either problem.

I'll continue to wear the knee braces because, as a friend told me, you may be preventing injury from smaller traumatic stresses that could injure your knee as well. It doesn't have to be a spectacular event.

There is another concept involving micro-trauma where you... sorry, this is getting too long. I'll sum up micro trauma fast. You go skiing all day, the ligaments and support structures of the knee take a beating and are actually weaker at the end of the day due to the micro-trauma from a continuous beating. Blam! The knee buckles on the kiddie slope while you mug for the camera. A benign situation made worse because of the damage that occured throughout the day. The End.

 

[Okiewan]

I'll continue to wear the knee braces because, as a friend told me, you may be preventing injury from smaller traumatic stresses that could injure your knee as well. It doesn't have to be a spectacular event.

Well said. I too will take a broken bone over a knee <-- done that. As you said above, it's the smaller, "I can't believe I hurt my knee that way" injuries I feel protected from the most.

You'd think of all the hot-shot sports docs out there who take care of the Pro's, they'd all be told not to wear braces. That's obviously not the case.

 

[fragildan]

I was in 3rd gear doing a long setdown wheelie. started going over, went to tap rear brake, missed said brake with my toe and did a very slow flip. maybe 20 mph. thought to pullin clutch as i was going over and at least try to catch my bike. when my left toe hit 2" of my big shin bone shattered below my knee. bottom half of my knee was shattered. broke little bone in 3 places. This was a slow get off and I beleive I've tripped over curbs harder. I've had 4 surguries and 1 more possible. My dr. says my boots sent the force up as all the shattered stuff was at the top of my boot and above. The Dr. says braces would have done nothing to prevent any of it. he will not prescribe braces for me. he seems knowledgeable as he knows the names of most of the brace companies and has worked on other motocrossers. He says the pros wear them for the endorsment money, just like a jersey. I to thought braces would have helped. but I'm so confused I don't know what to think any more. I'd pay for braces myself if I knew they would help, but I haven't in person or on the web seen one dr. say they will help. I'm looking at 6-12 months recovery over what i consider a minor incedent. It's really a bummer, but I'm as confused as everyone else.

 

[Whoops]

Fragildan,

We are in the same boat regarding the brace question. I believe the guys that use them are convinced that braces offer protection, but I still have doubts. Nothing against those who have posted with their comments, but I'd like a professional opinon. I haven't heard any doctors, Orthopedic Surgeons to be specific, recommend braces.

Whoops

 

[Smit-Dog]

I go in to see my ortho doc (collarbone) next Monday and I'll see if she has an opinion either way regarding braces.

I've seen a lot of downhill skiers and guys who wake board wear them, only because they've already blown out an ACL. My thinking is, instead of waiting until after you've blown out your knee to wear a brace, wear them as a preventive device. Why do these guys wear them after a blown knee? Of course there are no guarentees, but if it will help out in even a few circumstances, then they are worth it.

- Bill

 

[vetwfo'er]

I have just recoved from a medial meniscus tear and medial coladeral strain. I asked the doc several times about a brace and he said testing shows no proof of reduced knee injury with a brace on. I went to this guy because he and his colleagues are the best in the area.

Looks like I'll be hitting the squat rack and doing lot's of leg extentions to strenghten my knee. Muscular support is key to injury prevention.

vetwfo'er

 

[MX-727]

Braces won't protect against breaks and as bizzow pointed out, may actually increase the chance of breaking a bone. They protect the knee against ligament damage. So, your doctor is probably right about fragildan's situation.

 

[Chili]

Originally posted by Smit-Dog
Why do these guys wear them after a blown knee? - Bill

Speaking from hockey related experience they wear them after a blown knee because the knee generally has an excessive amount of laxity in the joint after a ligament/tendon injury and the knee is more prone re-injury.

 

[Mattski]

If every body wore knee braces while playing sport alot of these surgeons would be out of a job, so its in 'their' best interests to say don't wear them, not yours!!
just my 2bob

 

[lightsts]

I bought a pair of Asterisks at the beginning of last season and didn't have on knee tweak all year. In previous years my knees where always on ice from one injury or the other. The things are worth there weight in gold. I think I would rather have a major bone broke instead of a disabling knee shred. The bone will heal, a blown out knee will never be right the rest of your life.

 

[JJmxr]

I don't know if this is acceptable to the Mods, but I found this link very informative. Click here

 

[mx547]

interesting reading.

 

[Jaybird]

This weekend I was riding at my practice area. I was feathering on a steep up-hill and the bike got a little squirrely when it opened up so I had to dab. I prolly should have been standing, but the transition from the bottom turn to the top turn was short, so I remained seated.
Anyway, when I dabbed with my left leg, I saved the crash but I jammed the leg. I think that my boot heel was partly to blame. I over-extended my knee and it hurt like heck immediately.
After loading up and a good think-back, I'm almost certain that without my Cells on, this would have been quite a bit more than it is.
The whatever running from my knee to the calf in the back, connecting to the whatchamacallit is in great pain, and if I stay seated too long I get all stoved up and it takes a few limps to get going. I'll take that over a leg that I can pull up over my head. Thank God for Vioxx.

 

[Smit-Dog]

I just saw my ortho for a follow up on a 7 week old collarbone break. I asked her opinion about knee braces, both as a preventative device, and post-injury. I also asked her about knee brace usage in the two sports I'm most interested in, riding dirt bikes and downhill skiing. This was her opinion:

1) The best prevention is conditioning and strengthening of the knee and leg muscles, along with honing your propreception (awareness of limb position in space). Basically exercise by doing things that put the knee in positions/situations where it may come under a lot of stress, and require the strength and flexability to prevent injury in a crash. Twist, jump, squat, bend, quickly switch position/direction, transfer weight, etc.

2) If you have never seriously injured your knee, wearing a brace while engaged in a sport (or even just exercising) will act as a crutch, and not allow your body to build the strength, flexability, and propreception necessary to help prevent a knee injury naturally. Wearing a brace all the time while engaging in a sport will actually make the whole knee area weaker and dampen your mind/body propreception.

3) After a knee injury, wearing a brace is good while the knee area is still weak, but don't depend on it as crutch. It will not allow you to build up the best prevention possible. See points #1 and #2 above.

I have never experienced a knee injury, but have friends who have (downhill skiing), and it sounds like it is a long and slow recovery/rehab period. I don't wear a brace currently.

Based on everything I've read, and on my ortho's opinion, my plan is to train the hell out of my knees and legs to make them as strong as possible. I have a ski machine (Skier's Edge) that I use to prepare for ski season, and this device is great for stressing / strengthening your quads and knees using a fast side-to-side, up and down motion against resistance (also an intense cardio workout). http://www.skiersedge.com if interested.

Since skiing uses a lot of leg and knee strength, I don't plan on wearing a knee brace for this sport. Between skiing and using the ski machine, this should make my knees strong and in good condition to help prevent injury.

Since riding dirt bikes doesn't really require a lot of leg or knee strength (at least not the kind of riding I do), but a crash, even a slow get-off, can really injure a knee, I do plan on buying a pair to wear while riding.

Just my thoughts...

- Bill

 

[JJmxr]

Personally I'm on the fence on the issue. It seems like all the Ortho's I talk to are of the opinion that they are of little help to a healthy Knee. There may or may not be alternitive motives to their opinions, but I doubt they would suggest something that goes against healing.

On the other hand many of you have stories that lead me to believe they work to some extent. As stated by many of you though, you believe a perticular incident would have been worse had you not been braced, but there is really no way to know if that would have been true.

I think the comparison to seatbelts, and helmets is apples to oranges because these devices have been proven to work, and we wouldn't be having this thread if the same were true for braces.

The bottom line for me is will I buy some? I think the answer has to be yes, and for reasons similar to why the pro's use them. I can't afford an injury, and if the braces are only effective a very small % of the time thats good enough for me. The pro's have so much riding on their health that they would be foolish not to use something that has even a chance to prevent an injury.

I am starting to believe that all braces are somewhat equal though. Similar to helmets where one Snell helmet offers about the same protection as another, I believe comfort and fit is where the differences (and cost) lie.

Of course I've been way off the course more than once.

 

[skmcbride]

Thought I would chime in. Interesting subject, for me anyway. I am a research fellow at a large teaching hospital with a background in rehabilitation medicine. I work with a variety of persons with injuries from sports. There has been quite a bit of research done in this area mostly involving post ACL repair. The main problem with the research, among others, is trying to duplicate forces that we encounter in sport and accurately measure what happens at the knee joint. They obviously don't want to subject a person to extreme forces or torques that could actually cause injury. There have been studies that have shown a reduction with a brace to a shear force when an external load is put on the knee both from an anterior and laterally direction (force applied to the tibia). Unfortunately, the loads are small and are applied gradually, not of high impulse like we would encounter to “blow-out” a knee.

ACL injuries often involve rotation force or torque at the knee joint. Studies using traction pins in the bones of the leg have shown no reduction in torques produced when wearing a brace. This makes sense when you look how braces attached to your leg and their limitation of stopping rotation. They work off a 3 contact point system to check front/back, side/side single plane motion. I, however, have not seen anything specifically related to the 2 braces often used by mx’ers and unlike; CTi and Asterisk.

I think as long as you are wearing a brace to supplement sound rehabilitation of your knee and good conditioning they could work well for some. I also think it would be unwise to wear braces as a substitute for the above and lull yourself into false security. Although no studies have been done on motorcycles, there have been many studies showing the increased energy cost, decreased speed and agility when wearing a knee brace. BTW, I can tell you that some of the companies that make these braces have been reluctant in the past to fund, support or donate braces for research unless they have exclusive rights to the results. Something to think about.

Many physicians and healthcare providers operate under what is termed “evidence based practice.” This is a good thing for the most part. Their prescription plans and treatment recommendations are base on sound literature taken in the context of how the study was conducted. This is critical for developing standards of care and for the insurance side of table. At this time, the use of knee braces to prevent cartilaginous injuries to the knee is lacking. This may never come, as mentioned earlier it is difficult to duplicate the forces that occur in an athletic competition in a consistent and systematic manner for a study. Cadaver studies also have many limitations. In addition, large-scale application studies are difficult to interpret or reproduce findings due to the huge numbers of uncontrolled factors.

I personally have nothing against knee bracing, if it works for you by all means use them. I do, however, feel that some of the companies and their sales reps that manufacture the braces often overstate the braces abilities in injury prevention and often misrepresent study findings to suit their marketing claims.

Good Luck, Keith.

 

[mx547]

i met with my ortho doc today. i asked him about the knee brace issue. he said that he does not recommend wearing knee braces for the purpose of injury prevention.

 

[mark_england]

smit ,
interestingly enough wearing a knee brace will increase propreception
[as will wearing a cheap neoprene or lycra sleave over the whole knee]

i deal with surgeons every day, and hear a veriety of diferent opinions,
believe me there not always correct.
(Ask anyone who had a lateral release of there patella especialy a child)
the most sensible thing is train your legs without knee braces and ride with them.
niether is good but id prefer to break my leg then damage my knee

 

[mark_england]

skmcbride
the study you refer to, ''anterior and laterally direction (force applied to the tibia''
If this is the study done in Vermont, then i understand what you say about the force applied to the tibia not being high , however its worth noting that they where at a level which provided significant discomfort to the patiant, it was also done on healthy ACL's {many people are riding with damaged ACL's}
in this study CTI's where included [as where many other braces] Surprizingly they didnt score that well when compared with other less well known braces.
if your interested i have a number of studies on the use of braces,
however im sure you are aware of many of them.
One which may be of interest is the propriaceptive effects of bracing.
this involved measuring the real time EMG of skiers, with braces then without.
Mark

 

[skmcbride]

Mark,
Your points are well taken and again I will state I am not against bracing. I am against misrepresentation of research and bogus marketing claims. I am aware of the study on skiers and many others that attempt to measure joint proprioception. The literature is full of studies on braces and proprioception. Interesting enough it appears a cheap neoprene brace will give the proprioceptive effect if that what you are looking for. Proprioceptive deficiency after knee injury and its relationship to stability is a whole other topic of debate, although its existence is undeniable. There have been several studies done using braces with acl deficient knees using traction pins to assess tibial translation on the femur in response to various forces and the findings have not been conclusive.

We are on the same page: There is no substitute for sound rehabilitation. Decide the cost to potential benefit of using a brace after you have rehabbed your knee. Be informed of what a brace can and can not do for you given your individual situation and make a choice.

Your argument, as well as many others, that you would rather break your leg than trash your knee goes against your previous statements using literature for support. It is theory, as I could suggest you could transfer forces to the hip joint from a knee brace and dislocate you hip. It has happened and so have broken femurs and tibias as well as broken bones with trashed knees. All with wearing a brace. These are the exceptions not a rule.

Good Luck, Keith