Braced for impact
ANYONE limping down the aisle at the local drug store has probably seen them: inexpensive elastic or neoprene knee braces beckoning -- promising relief for aching knees.
Simple knee sleeves are popping up with greater frequency on professional athletes and weekend warriors, who don them for pickup basketball, softball and football scrimmages in hopes of staving off pain and injury.
Although statistics aren’t available on how many people are using these sleeves, the number is probably high. An estimated 19 million Americans seek medical attention for aches and pains in their knees each year, and many, sports doctors say, will treat their bum knees with over-the-counter braces.
Although lacking the glamour of high-tech braces used for serious injury and rehabilitation, inexpensive sleeves have their place, says Dr. Marc Safran, chief of Sports Medicine at UC San Francisco. For people with sore or mildly injured knees, mild arthritis and even those recovering from a sprain or knee surgery, they serve three therapeutic functions.
They can reduce swelling and keep the knee warm, both of which reduce pain.
They can also improve the mechanics of the knee joint through what is known as proprioception -- the body’s ability to determine where the joint is in space and time due to signals from sensors in the muscles, skin and tendons. The brace reminds the brain that there are restrictions on that joint and to modify motion to reduce knee stress.
But don’t expect miracles from the sleeve. Although the brace may relieve pain and swelling so the wearer can be more active, it probably won’t cure an underlying injury, says Dr. Ali Motamedi, an orthopedic surgeon at Santa Monica-UCLA Medical Center.
And the jury is still out on whether knee sleeves reduce injuries -- with some national studies concluding that the sleeves offer protection from specific types of injury and other studies reporting they do not. Some researchers, for example, have concluded that simple knee braces offer some protection from side impact to the knee. But other studies suggest that this benefit may be offset by stresses placed on other parts of the knee.
That doesn’t stop athletes from liking knee braces, and many who routinely wear them report that the braces give a feeling of heightened stability. Studies to date haven’t borne this out.
Simple knee braces designed for minor knee pain (which are sometimes covered by health insurance plans) come in a number of styles. At the low end, no-frills elastic or neoprene sleeves start at about $10 and are available in many drugstores.
More sophisticated styles, usually made of neoprene or Lycra with Velcro fasteners, are available at pharmacies and medical supply stores. Some of these higher-end braces, which generally run from $30 to a few hundred dollars, wrap around the knee and have openings, reducing the chafing and kneecap pain sometimes associated with standard sleeve styles.
The better braces, says Safran, are made with anti-slip, breathable fabrics to reduce heat rash. They’re also more rigid, providing greater stability.
There’s no real science in selecting a simple over-the-counter knee brace. Usually they come in a limited number of sizes -- think small, medium and large -- and finding the right size might require trial and error. It’s important to choose a brace that isn’t too tight because an ill-fitting brace can cause tingling, numbness and can irritate the skin.
Because there are myriad conditions causing minor knee pain that might respond to other types of treatment, if the pain persists it’s a good idea to consult a physician.
For example, in some cases knee pain can be traced to muscle imbalances that put stress on the joint. “Someone who has built up quads without hamstrings can set themselves up for knee problems,” says Fabio Comana, an exercise physiologist with the American Council on Exercise. In this situation, an exercise regimen prescribed by an exercise physiologist or physical therapist may be more helpful in relieving pain than a brace.
A final word of caution: Anyone who has an acute knee injury and can’t walk on it or is experiencing severe restrictions of movement should get an evaluation from a healthcare professional, pronto.
“If the joint is really swollen and really painful,” says Safran, “don’t put on a brace and go out and play.”
Otherwise, you may end up with an orthopedic surgeon as your new best friend and a much more impressive brace -- the kind with lots of bells and whistles that sells for more like $1,000.