Look in any medical supply catalog or down the aisles of the local pharmacy or sporting goods store and you will see dozens of different braces. Presumably, these products will allow you to function better with less pain. Braces are available for everything from your big toe to your neck and everything in between. In a series of articles, we will investigate the pros and cons of using braces for a few key areas including the lower back, knees and ankles. We will start with a brief description of the rationale for the use of braces in general.
First and foremost, braces are used to support soft tissues like muscles and ligaments. The construction of most braces uses neoprene (a stretchy rubber material) that can also act to keep local heat in the area. Neoprene braces are generally stretched to fit the desired area, which also provides compression. Compressive force to a joint can be of benefit for the reduction and prevention of localized swelling. Compression of a large muscle group (like the quadriceps on the front of the thigh) can actually help the muscle function slightly more efficiently. When a muscle contracts, or shortens, its job is to bring the bones closer together for movement. However, when it contracts a muscle also expands out to the side or widens. When mild compression is provided to the muscle, the brace gives the muscle something to push against for improved efficiency. This is also the rationale for athletes wearing compression shorts during sprinting activities like football and track and field. The limitations of these braces are that they can sometimes be hard to fit to some individuals. These braces are usually made in pre-fabricated styles and sizes. People who use these braces can not assume that the brace will provide significant support to joints and bones.
Braces are also used to provide skeletal support. This means that the brace helps keep two or more adjacent bones properly lined up. These types of braces tend to be made of nylon straps surrounding a hard material. Examples of these braces include knee braces to prevent ligament damage and wrist braces worn after a wrist fracture. Braces that serve this function usually need to incorporate hinges if they are designed to allow movement of a joint. These braces can be custom made with high-tech casting and molding methods or made as off-the-shelf pre-fabrications. The more of the brace that is made of hard materials (plastic, carbon fiber or other material), the greater the likelihood that the brace is custom-made.
One of the chief limitations of these braces, is that despite being custom-made, they are not entirely effective in their job of holding two bones in alignment. The reason for this seems to be due to the soft tissue movement that occurs. The brace is made to fit the outside of the body. Between the brace and the bones that are the target of the limitation lies skin, subcutaneous fat and muscles. All of these soft tissue layers allow the brace some “give” and movement. This limits the effects of the brace on the bones underneath the soft tissue layers. Other limitations of these braces can be the cost and the bulkiness of the brace itself while participating in desired activities. It would seem somewhat obvious that the more labor intensive and custom a brace is, the more expensive it is likely to be.
The descriptions of braces above are typical of the types of braces that individuals with common orthopedic injuries may be inclined to investigate. However, there is another function of orthopedic braces that exists for those with limited function. For those individuals with serious orthopedic dysfunctions that come with diagnoses like cerebral palsy or other neurological deficits, braces can play a crucial role in allowing the person to perform basic functions. The discussions in the specific articles on knee, ankle and lumbar braces will not focus on braces that are needed for body or limb support due to neurological or motor control deficits.