Do you suffer from knee pain due to arthritis? If so, you may have been recommended to try a knee support or knee brace to relieve your symptoms. But what if I told you that one of the most commonly recommended knee braces might not be the best option? A recent study suggests that it can be too cumbersome and even interfere with your quality of life.
So what are the best alternatives and which type of knee support will actually work for you?
In this video, I'll review the benefits and limitations of different knee supports, including neoprene knee sleeves, hinged knee braces, and unloader braces. We'll discuss the results of various clinical trials and real-world data, and I'll share my own recommendations based on my experience as a sports medicine physician.
Hey everyone, Dr Jeff Peng here. Knee bracing is advertised as a nonsurgical treatment option for individuals with symptomatic knee osteoarthritis. Studies continue to show mixed results, but in general, the existing evidence suggests that knee braces and supportive sleeves might provide some benefits.
Knee braces provide support and stability to the joint, helping to alleviate pressure and distribute weight more evenly. This can lead to not only a reduction in pain and discomfort, but also improved functional performance. This can be particularly helpful for people with knee osteoarthritis who struggle with mobility and daily activities.
Now, there are three main types of braces that are available to those with knee osteoarthritis. These include neoprene knee sleeves, hinged knee braces, and unloader braces.
Neoprene knee sleeves have a variety of benefits. They provide gentle compression which can help reduce swelling and inflammation in the knee joint. This can lead to decreased pain and increased range of motion. In addition, they can add some support to the knee which can help prevent injury or further damage. Knee sleeves are much less intrusive when compared to the other options and are much more versatile. They can be worn during a variety of physical activities including walking, running, cycling, weight lifting, and more.
Hinged knee braces have metal or plastic hinges on the sides of the brace that help to limit side to side movement of the knee. These provide more support than neoprene knee sleeves and are particularly useful in those who have instability of the knee. Hinged knee braces can potentially help correct alignment issues as well as reduce pain and improve function.
Knee unloader braces are designed to reduce pressure on a specific area of the knee joint and are commonly used to treat knee osteoarthritis. Knee unloader braces work by shifting the weight bearing load away from the affected area of the knee joint. They are typically designed with a hinge on one side of the brace that helps to apply a corrective force to the knee joint. This then reduces pain and improves function. Unloader braces can be modified and customized to the individual to provide comfort and support to each person’s knee.
This study looked at the efficacy of unloader braces when compared to placebo. The results showed that unloader braces led to better pain reduction throughout the day, as well as during physical activity at the one-year follow-up. However, it's worth noting that patients initially experienced worsened symptoms during the first six weeks of using the brace, indicating a significant adjustment period. Interestingly, no significant differences were found between the unloader and placebo braces at 12 and 24 weeks, with the benefits only being observed at the one-year mark.
The big problem with this study was that they had an incredibly high patient drop out rate of 44%. The primary reasons for this were mechanical issues related to the brace, including problems while working, sliding off, rubbing, feeling unstable, and being cumbersome. Notably, these findings are consistent with data from other studies.
For instance, this study found that only about 25% of patients continued to use an unloader brace regularly more than one year after fitting. The most common reasons for discontinuation were ill-fitting and uncomfortable braces, followed by inadequate symptom improvement. Other common reasons included skin irritation or swelling, difficulty wearing the brace with clothes for daily activities, and the brace being too heavy and bulky, making it difficult to put on and take off.
So this is a perfect example that although clinical trials can demonstrate the efficacy of an intervention or treatment, real-world data is more crucial. In my experience, many patients have found unloader braces to be inconvenient and counterproductive.
Ok so what about the other types of braces. Hinged knee braces and neoprene knee sleeves are more convenient and less intrusive for daily activities. Some small studies have shown that neoprene knee sleeves can help with gait and balance in people with knee osteoarthritis.
For example, this study compared pain and functional tests in people with knee osteoarthritis with and without a knee brace. They found that a simple elastic knee sleeve was highly effective at reducing pain and improving functional metrics.
Other small studies have looked at hinged knee braces with similar results. They can help with pain and function, although not to the extent that unloader braces can. However, a major limitation of these functional studies is that they are usually conducted in a controlled environment, where patients can withstand the bulkiness and weight of the brace to perform a few functional tests. These tests may show that unloader braces are effective, but when patients bring them home for everyday use, the bulky brace can become more of a hindrance than a help.
Alright so what do I recommend to my patients with knee arthritis? I actually DON’T recommend the unloader brace. In my experience, as well as based on real-world studies, unloader braces are often too cumbersome and actually interfere with quality of life. Additionally, they can be costly if not covered by insurance.
Instead, hinged knee braces are a reasonable middle ground and can be beneficial if you have knee instability or feel like your knee is giving out. It's important to note that knee braces, especially hinged knee braces and unloader braces, should not be worn 24/7 unless specifically instructed by a healthcare provider. Prolonged immobilization can be counterproductive, resulting in significant muscle atrophy.
Interestingly, some studies suggest a neoprene knee sleeve may be just as good for instability issues. For instance, this study compared a neoprene knee sleeve to a hinged knee brace for patellar dislocations. The findings showed no significant differences in dislocations, but the more restrictive hinged knee brace led to more quadriceps muscle atrophy, less range of motion, and worse functional outcomes at 6 months.
Personally, I am a fan of neoprene knee sleeves and often recommend them to my patients. They can be helpful for proprioception and provide a sense of stability, particularly during exercise and physical activity. Knee sleeves are also quite affordable and practical, making them easy to use. In addition, they can be useful for those experiencing acute osteoarthritis flare-ups, as they can reduce pain during daily activities.
And if you’re interested in learning about other non surgical treatments for knee osteoarthritis, check out this video here. Additionally, I highly recommend this video where I discuss the benefits of a specific supplement that has anti-inflammatory and pain-relieving effects, which may be comparable to taking prescription medications. Thanks for watching and see you next time.