Sports Topics > Sports Bracing

Contributed by Ken Gavin, Certified Orthotist
Audubon Orthotic & Prosthetic Services

Introduction
Braces are externally applied devices designed to restrict motion. Forces are indirectly applied by contacting the soft tissue envelope of a joint such as the knee, ankle, foot, wrist or elbow. Modern sports bracing can be divided into two categories: prophylactic and functional. The biomechanical principle of prophylactic bracing is feedback to the athlete. This feedback reminds the athlete that they have an injury or unstable joint. The philosophy behind feedback is that the athlete will not over-exert and limit the occurrences of re-injury. The functional implications of bracing are to restrict excessive motion. Restricting motion is useful in the treatment of trauma, pain and instability, and to provide postoperative protection.

The earliest documented use of bracing for restricting motion and correcting deformities comes from the fifth Egyptian Dynasty (2750-2625 B.C.). The biomechanical principles of modern bracing can be traced to the devices used by Hippocrates and his successors. Today a wide variety of braces are available. These braces are often named for the company that designed the brace (e.g. Donjoy, Townsend, CTI) or by a description of the brace (e.g. ACL, MCL, ankle stabilizer).

A physician may prescribe a brace and, if medically necessary, most braces are a covered benefit with many health insurance plans. It is important for the prescribing physician, athlete, and parents to understand the biomechanical principles of brace usage and the degree and type of instability that is anticipated. Equally important is patient education in the donning, care, and precautions of the prescribed brace and close follow-up. A brace expert (orthotist) may be consulted for the best brace for a given instability or function. A brace may be an integral part of the rehabilitation goals and your physician shall decide if your athlete should wear a brace.

Advances in materials, science and engineering have revolutionized the bracing industry in recent years. Braces have become lighter weight, relatively comfortable, and durable. Graphite and titanium are now commonly used to fabricate braces. Innovative brace liners increase comfort and compliance. In spite of the advances in brace design, many braces remain unproven in an active athletic setting. Therefore, it is important to thoroughly evaluate a brace prior to its use.

The comfort and motion restricting properties of bracing vary widely. When choosing a brace for a given condition, the degree and direction of potential stability must be considered, along with the level of compliance that is required. Braces are expensive and many inhibit optimal performance. The external forces necessary to control motion vary from one athlete to another and from one joint to another. Forces used to control a joint are applied to the surrounding soft tissues of the knee or ankle/foot complex. Each athlete’s anatomy, flexibility and soft tissue envelope will vary, thus altering brace fit and efficacy. Therefore, a brace should be carefully matched to the patient’s anatomy. Ideally, the contact area should be maximized to lower contact pressures. Soft materials should be used at the sites of skin contact. When possible, breathable materials should be used to minimize perspiration beneath the brace. Patient compliance with brace wear is highly related to level of comfort experienced in the brace.

Skin breakdown due to elevated contact pressure beneath a brace remains a significant risk. Utilizing a properly fitted brace with breathable material beneath the brace and maintaining good skin hygiene can decrease the risk of skin breakdown. Frequent inspection of skin contact areas is mandatory when using a brace for all athletes.

Most athletes can be successfully fitted with modern, off-the-shelf braces which are available in a wide range of sizes to optimize fit. However, in some situations, custom fabrication of a brace is necessary to accommodate unusual anatomy. In noncompliant athletes or those requiring intimate control of joint motion, the coach or athletic trainer should be notified to assure compliance.

The physician, athlete, and parents must consider the negatives and positives of brace wear. The negatives and positives are reviewed later in the description of the most common braces. Although studies have documented the level of biomechanical benefit of most braces in normal subjects, the ability of braces to restrict motion in unstable joints and under athletic conditions in stable joints has not been well studied. A review of each commonly used brace may enlighten the athlete and parent about biomechanical and clinical features of the commonly used athletic braces and discuss the appropriate application of each.

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