By: Jean Johnson for Knee1
Bracing has been around at least since the days of King Arthur when knights and warriors found that by encasing seriously injured limbs in rigid, hinged armor, they could still walk. According to David Finch, D.O., although medieval armor has given way to “Velcro and polymers, the function remains essentially the same.”
|Tips for bracing success:|
1. Keep your weight down to lessen pressure on joints.
2. Work with orthotics specialists to get your brace fitted correctly – even though it may take repeated trips to the office.
3. Listen to your physician about proper care and maintenance of the brace..
4. Insist on getting clear instructions you can understand about using your brace
Rehabilitation specialist, Molly Hoeflich, M.D., adds that it’s easier to brace the ankle than it is the knee. “An ankle-foot orthosis holds the foot up and is a relatively standard brace. Oftentimes as people gain strength in therapy, they wean themselves off the brace after a year or so. We especially see this in cases of stroke where patients have weakness in the muscles that hold the foot up,” Hoeflich said. “So the purpose of bracing is to help compensate for loss of muscle function.”
Finch puts it another way in keeping with his King Arthur theme. “In the war against disability, the world of bracing offers an arsenal.” He concurs with Hoeflich that ankle and foot bracing is especially effective for preventing further injury or re-injury, and enhances a patient’s ability to return to normal, or at least some, activity.
Factors that influence a patient’s candidacy for a lower extremity brace include prognosis, general overall health, weight, and age, with the elderly and children needing special consideration. Braces – the professionals are careful to point out do not take the place of adequate physical therapy programs, but rather are considered a way to augment mobility as patients work with therapists to regain strength and function of affected joints. Indeed, Finch emphasizes the importance of beginning physical therapy as soon as possible after an injury, even though in practice he admits it oftentimes does not happen.
Sixty-two-year-old Mack Lowell of Parks, Arizona wears a form-fitting ankle-foot brace on his left leg, a limb that remains paralyzed following a stroke. “The brace is comfortable enough, I guess,” said Lowell who has no feeling on his left side. “And it helps me walk such as I can. Now that I’m home, I really rely on it to get around.” The white polymer orthosis, or brace, that fits in Lowell’s shoe and extends up to mid-calf where it secures with a Velcro strap holds his foot in position. “It’s sort of a pain to put on, and someone has to help me. But without it, I probably would still be stuck in a nursing home.” Lowell shudders at the thought and smiles weakly at his inert leg cradled in its brace.
Patients like Lowell who are lean and not too old, writes Finch, are good candidates for braces, since patient compliance is always a factor. Not only does the fit have to be perfect for the brace to be effective, patients must perceive the orthosis as being manageable if they are to wear the device long enough to get benefit, emphasizes Finch.
Not all braces are polymer molds, of course, and for those concerned about appearance or greater comfort, exploring options can pay off. Elastic bandages or ankle sleeves are tried and true over-the-counter types of bracing that work for basic sprains or mild musculoskeletal conditions. There are also soft ankle braces that lace up, along with splint braces that prevent lateral motion and are easy to remove.
Hinged ankle braces are another choice that enable patients to roll down on the heel rather than hitting hard in a herky-jerky sort of fashion. Then there’s the walking boot, which in many cases has replaced the cast and is one of the most popular ways to stabilize an injured ankle.
So, those with lower extremity injuries confined to the foot and ankle have a wide array of options from which to choose. That’s good because those with knee problems don’t fare as well. Indeed, when it comes to bracing the knee, Hoeflich said, “if it’s a global muscle problem, you have to be pretty thoughtful. Knee braces are big, cumbersome and expensive. So if there’s any way you can try one out before you make a decision, we advise that. Generally speaking, if you brace about the knee, you are bracing in full extension, so when patients sit down, they have to unlock the hinge.”