Braces – An Overview
The simplest type of brace is a one-piece sleeve made of an elastic rubber – Neoprene that fits snugly around the knee area. Appropriate for use by patients with relatively mild Osteoarthritis, these sleeves, which are available over the counter at most pharmacies, compress the affected area, providing warmth and a moderate amount of support. Some patients, especially those who are comparatively active, may benefit from wearing one of these devices.
Sleeves may decrease pain, and a fair number of patients claim that to be the case, but we don’t really know why, since these devices don’t have any structural effect on the joint. Of greater value for patients with more advanced Osteoarthritis is an ‘Unloader Brace’ – a semi-rigid device made of molded plastic and foam, with reinforcing steel struts on each side to limit the knee joint’s lateral movement.
It is a custom-fit brace that is most often prescribed for people with arthritis in the medial compartment. When some people with arthritis in this part of the knee walk, you can actually see the knee wobble towards the inside. It is not dangerous, but this wobbling known as a ‘varus thrust’ can be painful. The unloader brace is designed to provide three points of pressure on the thigh bone, which forces the joint to bend away from the inside of the leg. In effect, it relieves pain by transferring pressure from the inner part of the knee to the outer part.
Although unloader braces are used primarily by patients who have Osteoarthritis in the medial compartment, a brace can also be designed to increase mobility and reduce pain stemming from cartilage destruction in the lateral compartment, allowing the patient to walk more rapidly and for greater distances.
In addition to easing moderate to severe pain, unloader braces are often prescribed as a temporary source of relief for patients with advanced cartilage damage, who will ultimately need to undergo joint-replacement surgery. Some patients can get along quite well for six to 18 months before the brace is no longer effective and they have need for surgery.
Unloader devices are unique in structure and differ significantly in purpose from other types of braces that are commonly found in pharmacies and sporting-goods stores. ‘Prophylactic braces’ are designed to prevent injury to an arm or knee. ‘Rehabilitative braces’ are designed to be worn by someone who has had a recent injury or surgery involving the ligaments in the knee joint. ‘Functional braces’ are designed to help control abnormal motion in an unstable knee. Unloader braces, for people whose knee instability is the result of cartilage loss, fall under the category of functional braces.
You will need a prescription from an orthopedic specialist in order to purchase an unloader brace and you will need to purchase it at a store that specializes in orthotic devices, where they will construct the brace so that it delivers the proper amount of force to the joint.
Obtaining maximum benefit from wearing an unloader brace will require a certain amount practice. The brace may not feel comfortable at first and it may take a week to a month for you to get used to how it feels on your leg. The more you wear the brace, the better it works. However, patients are urged not to neglect other important therapeutic measures, such as exercises to strengthen the muscles surrounding the knee. Also be wary of over-reliance. Wearing a brace all the time does not permit exercising and strengthening of the leg muscles.
The only drawback of an unloader brace is that it tends to be bulky, making it difficult for a patient to wear one, for example, under a pair of snug-fitting slacks. Furthermore, he adds, unloader braces tend to be relatively expensive. However, in the long term, it is a worthwhile investment for your health.