Knee Bracing in Sports
As an athletic trainer, I have always felt two places prophylactic braces can’t help: 1. around the ankle or 2. in the locker. Needless to say, if the brace is not comfortable, doesn’t fit, or just doesn’t feel right, the athlete is not going to wear it. I think that is one of the beautiful parts of the new functional custom-fit knee braces. They provide superior protection against knee injury as thigh and tibial cuffs have snugger, firmer fits. Donjoy has even changed the profile of the upper thigh cuff making it sleeker and conformed to the anatomicaol features of the thigh. The hinges are lower profile making the brace much sleeker than designs of the 80’s and 90’s. Braces covered athletes’ knees more tightly and provided more protection for soft tissue.
Functional Brace Use
Functional knee braces provide restraining influence to control abnormal displacements of the knee and decrease anterior tibial translation without associated contraction of the musculature of the lower extremity. With the ACL-deficient patient, brace use resulted in fewer episodes of giving way and utilization of the brace gave perception of stability in the knee.
Unilateral vs. Bilateral Hinges
When deciding on style of brace to use, Liu reported brace designs incorporating bilateral hinges and rigid shells were more effective than unilaterally hinged designs in transmitting loads8.
In the 2000 edition of Biomechanics, I reported on the comparison of knee injuries from the 1997 University of South Carolina football season when players used traditional lateral braces, vs. the 1998 season when we made the shift to custom fit knee braces that are now common. While the scope of this study is limited, the results are nonetheless very revealing as the data illustrated a substantial drop in the number and severity of knee injuries incurred. The use of the newer custom fit braces resulted in a drastic reduction in the amount of time loss (performance) by athletes as well as a drop in economical impact (medical expenses for knee injuries) for our football program.
Further studies on the subject have since supported my early findings on the ability of custom knee braces to help athletes avoid injury and the coaching and athletic training community has responded by making the use of knee braces by athletes common. In 2003, we conducted a survey to quantify prophylactic brace usage among NCAA Div I and I-AA institutions and found that over two-thirds of the institutions responding reported embracing prophylactic brace principles for their offensive lineman in their football programs. With the cost of major knee surgery averaging around $26,000, the cost of a knee brace is minimal in comparison, never mind the loss of time and eligibility by the athlete and the possible drop in performance level a major knee injury can present. In 2004, 24 of the top 25 ranked NCAA Div I football teams mandated the use of knee braces to avoid injury. This rise in popularity has not happened by accident. As an athletic trainer, I believe the increased incidence of bracing has evolved both due to increased awareness and primarily due to the superior design and construction of the braces. With research from functional knee braces following anterior cruciate ligament reconstruction, we know how the braces can minimize force production on the ligaments and further apply these concepts to functional activities in rehabilitation and activity.
I think physician and health care team members need to totally understand the concepts of prophylactic bracing when making recommendations to coaches, athletes and parents relative to this subject. Why else would these teams utilize this technology if it did not work? As I watch college football each year, the players at Florida, Ohio State, Oklahoma, Georgia, South Carolina, Florida State, Notre Dame – to name a few – have embraced prophylactic braces principles, and effectively utilized this to protect their player’s knees. Today’s discussion of prophylactic bracing is totally different that the bracing concepts discussed in the 1980’s. Those braces worn in sport were lateral braces and simply diffused the forces following lateral valgus blows to athlete’s knees. Today, the braces are functional kneed braces with double upright hinges with biomechanical design to vector force away from knee ligaments.
I have had several athletes bring their brace in to me following a practice or game and the brace is bent beyond belief, and may even be fractured! The design dissipates forces effectively and these players walked away from injuries with mild sprains. This scenario often is a heralding activity for the athlete and further substantiates brace usage. I must say, it is a sickening feeling when you examine an athlete and realize that their medical collateral ligament tear and possible anterior cruciate ligament tears which were received from a clipping injury, would have been minimized and probably prevented with prophylactic brace use as the force would have been dissipated laterally, and the double upright hinge would have also resisted the force medially. Today, coaches, parents and athletes in high school sports are realizing that spending $350 on a standard knee brace, or even $600 for a custom brace, can be a wise investment in the effort to protect young athletes from significant knee injuries – injuries that not only can hamper a promising sports career, but also adversely affect a wide range of activities and lifestyle in later years. And to do their part in supporting this trend, manufacturers are making it easier and more affordable for high school coaches and parents to outfit their athletes in prophylactic knee braces with programs such as DJO Inc’s “Join The Club” program.
The Future of Knee Bracing
The bracing industry is constantly seeking newer technologies to apply to the bracing needs. Just look at how materials which are introduced rapidly make their enterance into the industry. Further, as newer and more efficient hinges and brace composite materials evolve they product is every improved. Donjoy’s new dampening hinge has been well received in the Sports Medicine community, and is now even being fabricated in a lower brace profile. Athletes seek sleek, clean designs that work. Remember the two places braces don’t work: in the locker and around the ankle!
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