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The effect of knee brace and knee sleeve on the proprioception of the knee in young non-professional healthy sportsmen
Abstract
Background:
Proprioception has been defined as the capacity to feel the position of a joint in space as sensed by the central nervous system. Prophylactic knee braces are supposed to help in knee injury prevention not just with a mechanical support of the joint but also improving proprioception. The main aim of this study was to determine the effects of a knee brace and a knee sleeve on knee proprioception. The secondary aim was to determine if different starting angles of the knee and different movement directions influence knee proprioception.
Methods:
We tested a group of twenty healthy male sport students without knee injuries. They were tested with the brace, with the sleeve and without support. The threshold of detection of passive knee movement with a starting knee angle of 30° and 60°, both in flexion and extension was determined.
Results:
We did not find any statistically significant change in the threshold of detection of passive knee movement wearing the brace or the sleeve compared to the unsupported condition (p=0.462, α=0.05). We found a significantly lower proprioceptive sensitivity starting at the more flexed knee angle (p=0.005, α=0.05) and moving in extension than in the other test situations (p=0.001, α=0.05).
Conclusion:
Movement direction and starting position appear to influence the threshold of detection of passive knee movement. The results of this study also suggest that knee supports do not influence either positively or negatively knee proprioception of uninjured active subjects.
... 65 Additionally, three studies utilized the threshold to detection of passive motion as a method for assessing joint proprioception. 64,71,72 Similarly, three other studies employed active movement extent discrimination apparatus. 54,69,70 Furthermore, one study evaluated proprioceptive accuracy by performing proprioceptive tracking and then calculating a score by computing the root mean square, 66 one computed tracking error percentage while using a visuomotor tracking task, 63 ...
... Bottoni et al. 64 6 ...
... Of the included studies, 14 studies had applied the CGs on the knee joint. 5,44,45,47,49,51,[64][65][66][71][72][73][74][75] Three studies used CG shorts, [67][68][69] whereas three studies used a below-knee CG, 41,53,54 with one specif-ically using compression socks covering the ankles. 54 Two studies reported using complete lower body CGs. ...
Compression garments (CGs) are commonly used in rehabilitation and sports contexts to enhance performance and speed up recovery. Despite the growing use of CGs in recent decades, there is no unanimous consensus on their overall influence on joint proprioception. In this current meta‐analysis, we aim to fill this knowledge gap by assessing the impact of CGs on joint proprioception. We conducted a literature search across seven databases and one registry. Ultimately, we included 27 studies with 671 participants. The meta‐analysis revealed that wearing CGs resulted in a significant reduction in absolute error during joint position sensing (Hedges’ g: −0.64, p = 0.006) as compared to no CGs. However, further analyses of variables such as constant error (p = 0.308), variable error (p = 0.541) during joint position sense tests, threshold to detect passive motion (p = 0.757), and active movement extent discrimination (p = 0.842) did not show a significant impact of CGs. The review also identified gaps in the reporting of certain outcomes, such as parameters of CGs, reporting of performance, individual‐reported outcomes, and lack of placebo comparators. Consequently, this review provides guidelines for future studies that may facilitate evidence‐based synthesis and ultimately contribute to a better understanding of the overall influence of CGs on joint proprioception.
... While some report improved joint position sense or detection of motion, in healthy individuals and in those with a pathology, 6,[13][14][15] others report no such effect. [16][17][18] In a recent systematic review and meta-analysis, Ghai et al. 19 concluded that joint stabilisers, including orthoses, have a positive effect on kinesthetic awareness at the ankle but neglible effects on postural stability. In contrast, the systematic review performed by Sugimoto et al., 20 focusing on orthotic use after ACL reconstructions, found insufficient evidence to support the statement that orthoses have a positive effect on joint position sense at the knee. ...
... The jointed orthosis condition exhibited poorer results when analysing combined data from all detection of passive motion tests and when the start position for the test was set at 70 moving into flexion. These results are in contrast with previous work which has reported either no effect, 16,17 or a positive effect 36,38 in detection of passive motion with the application of an orthotic device or tape. ...
... Given the observed results, it seems important to further investigate the association between pressure applied to the knee and proprioception by synchronizing pressure data with kinematic data. Bottoni et al. 16 reported no difference in detection of passive motion in 20 healthy individuals fitted with 1/ an elastic jointed orthosis and 2/ a knee sleeve. In this study, two starting angles of 60 and 30 were used in detection of passive motion tests. ...
Introduction
Conflicting evidence exists regarding the effects of knee orthoses on proprioception. One belief is that pressure applied by orthoses heightens kinesthetic awareness and that this affects balance. This study aimed to investigate the effects of two different orthosis designs on kinesthetic awareness and balance in healthy individuals.
Methods
Twenty individuals (13 women) participated in this case series study. Each was tested wearing 1/no orthosis, 2/soft elastic orthosis and 3/non-elastic jointed orthosis. Pressure under orthoses was recorded. Kinesthetic awareness was investigated by testing joint position sense and threshold to detection of passive motion. Balance was tested using a modified sensory organization test.
Results
Non-elastic jointed orthoses applied the greatest pressure to the knee. With non-elastic jointed orthoses, threshold to detection of passive motion was significantly poorer for pooled results ( p = 0.02) and when the start position of the knee was 70° (mean threshold = 0.6°, 0.6°, 0.7° for no-orthosis, elastic and jointed-orthoses; p = 0.03). No major differences were observed in JPS or balance and correlation between proprioception and balance was poor.
Conclusions
There may be a limit to the amount of pressure that should be applied to the knee joint by an orthosis. Exceeding this limit may compromise kinesthetic awareness.
... From the biomechanics aspect, the benefits of knee sleeves are not well established. Some researchers have suggested that the compression by knee sleeves stimulates the mechanoreceptors around the joints (Ramsey, Briem, Axe, & Synder-Mackler, 2011;Wilson, Mazahery, Koh, & Zhang, 2010), leading to improvement in proprioception and balance (Bottoni, Herten, Kofler, Hasler, & Nachbauer, 2013). However, there is little evidence to support this. ...
... Four studies assessed gait (Collins, Blackburn, Olcott, Yu, & Weinhold, 2011Giotis et al., 2011;Schween et al., 2015) ( Table 2); sixteen studies assessed balance and proprioception, of which, eight studies evaluated proprioception only (Asl, Kahrizi, Ebrahimi, & Faghihzadeh, 2008;Bottoni et al., 2013;Bottoni & Heinrich et al., 2014;Collins, Blackburn, Olcott, Dirschl, & Weinhold, 2009;Collins et al., 2010;Herrington, Simmonds, & Hatcher, 2005;; three studies focused on balance and functional performances (Birmingham et al., 2008;Bryk et al., 2011;Chuang et al., 2007;Collins et al., 2012); three studies assessed both balance and proprioception; one study evaluated functional tests and proprioception (Mortaza et al., 2012); and two studies assessed functional tests, proprioception, and balance together (Baltaci et al., 2011;Kwon et al., 2014). Nine studies examined healthy subjects (Baltaci et al., 2011;Bottoni et al., 2013;Bottoni & Heinrich et al., 2014;Collins et al., 2009;Herrington et al., 2005;Mortaza et al., 2012;; four studies examined individuals with symptomatic knee osteoarthritis (OA) (Bryk et al., 2011;Chuang et al., 2007;Collins et al., 2010Collins et al., , 2012; and three studies examined individuals with anterior cruciate ligament (ACL) reconstruction (Asl et al., 2008;Birmingham et al., 2008;Kwon et al., 2014). ...
... Four studies assessed gait (Collins, Blackburn, Olcott, Yu, & Weinhold, 2011Giotis et al., 2011;Schween et al., 2015) ( Table 2); sixteen studies assessed balance and proprioception, of which, eight studies evaluated proprioception only (Asl, Kahrizi, Ebrahimi, & Faghihzadeh, 2008;Bottoni et al., 2013;Bottoni & Heinrich et al., 2014;Collins, Blackburn, Olcott, Dirschl, & Weinhold, 2009;Collins et al., 2010;Herrington, Simmonds, & Hatcher, 2005;; three studies focused on balance and functional performances (Birmingham et al., 2008;Bryk et al., 2011;Chuang et al., 2007;Collins et al., 2012); three studies assessed both balance and proprioception; one study evaluated functional tests and proprioception (Mortaza et al., 2012); and two studies assessed functional tests, proprioception, and balance together (Baltaci et al., 2011;Kwon et al., 2014). Nine studies examined healthy subjects (Baltaci et al., 2011;Bottoni et al., 2013;Bottoni & Heinrich et al., 2014;Collins et al., 2009;Herrington et al., 2005;Mortaza et al., 2012;; four studies examined individuals with symptomatic knee osteoarthritis (OA) (Bryk et al., 2011;Chuang et al., 2007;Collins et al., 2010Collins et al., , 2012; and three studies examined individuals with anterior cruciate ligament (ACL) reconstruction (Asl et al., 2008;Birmingham et al., 2008;Kwon et al., 2014). The sample size ranged from eight to 150 subjects. ...
Background
Knee sleeves are widely used for the symptomatic relief and subjective improvements of knee problems. To date, however, their biomechanical effects have not been well understood.
Objective
To determine whether knee sleeves can significantly improve the biomechanical variables for knee problems.
Method
Systematic literature search was conducted on four online databases - PubMed, Web of Science, ScienceDirect and Springer Link - to find peer‐reviewed and relevant scientific papers on knee sleeves published from January 2005 to January 2015. Study quality was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES).
Results
Twenty studies on knee sleeves usage identified from the search were included in the review because of their heterogeneous scope of coverage. Twelve studies found significant improvement in gait parameters (3) and functional parameters (9), while eight studies did not find any significant effects of knee sleeves usage.
Conclusion
Most improvements were observed in: proprioception for healthy knees, gait and balance for osteoarthritic knees, and functional improvement of injured knees. This review suggests that knee sleeves can effect functional improvements to knee problems. However, further work is needed to confirm this hypothesis, due to the lack of homogeneity and rigor of existing studies.
... Similarly, knee sleeves have been found to elicit immediate improvement in early and late stance KAM, increase walking speed after 6 weeks of sleeve use, and improve arthritic joints and tibial rotation of healthy joints [92,99,100]. Some studies assessed gait, balance, and proprioception with sleeve brace use and have reported functional improvements [92,93,[99][100][101][102][103][104]. Injury prevention effects are documented with neoprene knee sleeve use as well, demonstrating improvements in repositioning error in fatigued knee joints [87,89]; however, this effect is not demonstrated in non-fatigued knees. ...
... Sleeves with a patella cutout may restrict patellar mobility but may also help with patellar stabilization [82]. The thin metal bars, if present, may increase lateral reinforcement to improve stability [104]. Shortcomings in their effectiveness can also be attributed to the scarcity of literature and studies dedicated to evaluating their efficacy. ...
... Studies related to the proprioceptive effect of knee bandages/ sleeves have reported improved joint position sense that was later lost after removal, which may influence injury prevention [18,19]. However, the majority of studies on the effectiveness of knee braces have examined patients either while performing gait or other daily movements where the forces acting on knee joints were not considerably high [17,20,21]. The application of these findings in sports scenarios can be questionable, which does affect the reliability and effectiveness of sports knee braces and sleeves. ...
... The ACL loading estimated in this study did not exhibit any statistical differences in relation to wearing a brace or sleeve. However, studies that have examined the effectiveness of braces on the walking motion of patients with a knee injury reported improvements mostly in the biomechanical and proprioception aspects [17,20,21]. The current results may differ from previous research, given that the braces in previous studies were able to more effectively control the knee range of motion by attaching a type of steel hinge to the brace, whereas the sports braces and sleeves in the current study were made of textile and neoprene materials, and analyzed in drop jump tasks, which apply higher force on knee joints. ...
Background:
Knee braces are considered to be extremely useful tools in reducing the shear force of knee joints for non-contact anterior cruciate ligament (ACL) injury prevention. However, the effectiveness of sports knee braces and sleeves remains to be identified. Therefore, the purpose of this study was to evaluate the effectiveness of wearing commercialized sports knee braces and sleeves on knee kinematics, kinetics, and ACL force during drop jumps using musculoskeletal modeling analysis.
Methods:
Musculoskeletal modeling analysis was conducted on 19 male alpine skiers who performed drop jump motions from a 40-cm box under three conditions: without a brace/sleeve, with a brace, and while wearing a neoprene sleeve.
Results:
The physical performance (i.e., the center of mass of the jumping height) was not affected by the type of brace or sleeve. However, wearing a brace or sleeve during drop jump tasks reduced the knee joint's maximum flexion, abduction angles, and adduction moment. The knee joint shear force when wearing the brace or sleeve exhibited no statistical differences. Further, the ACL load estimated in this study did not exhibit any statistical differences in relation to wearing a brace or sleeve.
Conclusions:
The knee braces and sleeves reduced flexion and abduction movement, and adduction moment but did not reduce the knee joint shear force, internal rotation moment, or the ACL force. Therefore, if a sports knee brace that controls the knee joint's shear force and internal rotation moment is developed, it may aid in preventing ACL injuries.
... Likewise, incorporation of joint stabilizers (JS: brace, bandage, compression garment, taping and corsets) in modern clinical and sports settings as a rehabilitative, prophylactic and performance enhancement measure is primarily attributed to their beneficial capabilities of enhancing proprioception (Bottoni, Herten, Kofler, Hasler, & Nachbauer, 2013;Fu, Liu, & Fang, 2013). Several physiological mechanisms have been suggested for this effect (Birmingham et al., 1998;Herrington, Simmonds, & Hatcher, 2005). ...
... The findings obtained from the meta-analysis conducted on studies analyzing spine where a cumulative effect size of (0.19) and 95% CI (À0.06 to 0.45), and knee joint proprioception among participants affected by patellofemoral pain syndrome (À0.1) and 95% CI (À0.35 to 0.15), can be asserted towards the "overload mechanism" suggested by Cameron et al. (2008). Likewise, overload mechanism has been attributed by Chu et al. (2002), Callaghan et al. (2002), Bernhardt and Anderson (2005), and Bottoni et al. (2013) and Bottoni, Heinrich, Kofler, Hasler, and Nachbauer (2014) while reporting no significant enhancements amongst healthy participants, sports personnel and Cho et al. (2015), Birmingham et al. (2001), and Callaghan et al. (2008) while reporting significant enhancements amongst injured participants, in proprioception accuracy post JS application. ...
Objective
The current review and meta-analysis systematically investigated the effect of joint stabilizers on proprioception, postural stability, and neurological activity.
Methods
Systematic identification of published literature was performed on online databases; Scopus, PEDro, SportDiscus, and EMBASE, followed by a critical PEDro methodological quality appraisal. Data from the studies were extracted and summarised in a tabular format.
Results
Of 2954 records, 50 studies, involving 1443 participants met our inclusion criteria. In the included studies, 60% of studies reported significant enhancements (p<0.05), 19% of studies reported enhancements (p>0.05) and 21% of studies reported no effects of joint stabilizers on proprioception and/or postural stability. Meta-analysis of pooled studies demonstrated beneficial effects of joint stabilizers on the knee (95%CI: 0.35° to 0.61°) and ankle (at 10: 0.1° to 0.65°) joint proprioception, and negligible effects on postural stability (-0.28° to 0.19°).
Conclusion
The pooled evidence suggests that application of joint stabilizers enhances joint proprioception and stability by not merely altering the mechanical stability of the underlying musculoskeletal structures but by also causing subtle changes in cerebral hemodynamics and musculoskeletal activation. These findings support clinical implications of joint stabilizers as a prophylactic and rehabilitation measure in modern sports and rehabilitation settings.
... The knee is subjected to conditions; in which increased torque is placed upon the joint, proprioceptive acuity will increase [8] . Furthermore, as the knee gets closer to its end range of motion proprioceptive awareness will increase [9] . These factors may be important when examining knee proprioception across a variety of movements. ...
Background: Patellofemoral pain syndrome is a common, painful musculoskeletal condition that affects physically active young adults and adolescents. During assessment of joint position sense, the different positions of the knee may affect the internal structures of the knee differently. Therefore, examining the differences in the two positions between both males and females may shed light on the effect of muscle activation.
Aim of Study: To examine the differences between 20 and 60 angles of knee extension on knee joint position sense as well as to examine the differences in knee joint position sense between males and females in patient with patellofemoral pain syndrome.
Material and Methods: Thirty nine participants (11 men, 28 women) participated in this study. With a mean age of 18 to 35 years with mean age (24.25±3.40) years, mean weight (68.71±16.01) Kg, and mean height (164.07±10. 14) cm. All subjects were assessed by the same examiner via the Isokinetic Dynamometer Device (IKD) at angles 20º and 60º with angular velocity 2º/sec to determine which angle has more angular error.
Results: The results revealed that the 20 angle position had a significantly greater absolute reposition error than the 60 angle position (p=0.039). There was no significant differ-ence in joint position sense between males and females at angle 20 (p=0.829), and angle 60 (p=0.833).
Conclusion: The results indicate that there is a significant difference in knee joint position sense between position of 20 degrees of extension and 60 degrees of extension. Specif-ically, as the knee becomes more extended proprioceptive acuity was heightened. Therefore, future research is still needed to discern exactly whether the heightened propriocep-tive acuity comes from the differences in gravitational torque or the differences in the anatomical structures of the knee between the two positions.
... Some researchers believe that the compression exerted by knee sleeves stimulates the mechanoreceptors around the knee joint, leading to improvement in proprioception and balance. 16,17 Although knee sleeves are generally found to be beneficial for knee OA, it is unclear which type of sleeves confer the best clinical and biomechanical benefits. ...
Knee sleeves are often prescribed to alleviate pain in people with early knee osteoarthritis. However, the biomechanics underlying their pain-relieving effect are still not well understood. This pre–post study aims at evaluating and comparing the effects of two different types of knee sleeves on knee adduction moment. Patients with clinically diagnosed knee osteoarthritis were recruited from the University of Malaya Medical Centre and were randomly assigned to two test groups using (1) a simple knee sleeve and (2) a simple sleeve with patella cutout. Knee adduction moment was collected using the Vicon motion capture system with two Kistler force plates. Pain, stiffness and physical functions were recorded using the Western Ontario and McMaster Universities Osteoarthritis Index. All measurements were taken before, immediately after and at the completion of 6 weeks of application (primary time point). In total, 17 participants with early unilateral knee osteoarthritis (47.7 (9.7) years) completed the study. Overall results show significant reduction in pain, early stance and late stance knee adduction moment and increased walking speed after 6 weeks of both knee sleeves application. This study results suggest that knee sleeves can reduce knee adduction moments in early unilateral knee osteoarthritis by 14.0% and 12.1% using the simple sleeve and the sleeve with patella cutout, respectively, and can potentially delay disease progression. In addition, knee sleeve with patella cutout does not provide additional benefits when compared to the simple knee sleeve.
... The observations from this investigation concur with those of Bottoni et al. [37] yet disagree with the observations of Birmingham et al. [38], Herrington et al. [34], and Van Tiggelen et al. [39]. The lack of agreement between studies in general is due to the lack of standardization of testing protocols to quantify knee joint proprioception [33]. ...
Purpose
The aim of the current investigation was to investigate the effects of a prophylactic knee brace on knee joint kinetics and kinematics during single- and double-limb deceleration tasks.
Methods
Twenty female university first team-level netballers performed single- and double-limb deceleration tasks under two conditions (prophylactic knee brace/no-brace). Biomechanical data were captured using an eight-camera 3D motion capture system and a force platform. Participants also subjectively rated the comfort/stability properties of the brace, and their knee joint proprioception was examined with and without the knee brace using a weight-bearing joint position sense test.
Results
The results showed that during both single- and double-limb deceleration tasks, neither peak anterior cruciate ligament [brace: single = 1.30/double = 1.30 bodyweight (BW) and no-brace: single = 1.19/double = 1.29 BW] P = 0.51, patellofemoral (brace: single = 4.21/double = 4.93 BW and no-brace: single = 3.99/double = 4.63 BW) P = 0.20, nor patellar tendon (brace: single = 6.17/double = 6.49 BW and no-brace: single = 6.07/double = 6.14 BW) P = 0.49 kinetics were significantly affected as a function of wearing the knee brace. The findings also showed that the knee brace helped to increase participants’ perceived knee stability (P < 0.001), but there were no statistical improvements in weight-bearing knee proprioception (brace = 3.59 and no-brace = 2.94°) P = 0.44.
Conclusions
The current investigation indicates that the utilization of prophylactic knee-bracing akin to the device used in the current study does not appear to reduce the biomechanical parameters linked to the aetiology of knee injuries during netball-specific deceleration movements.
... Tento koncept proprioceptívnej citlivosti je spojený so stabilitou a kontrolou kĺbu. Nedostatok proprioceptívnej citlivosti je spájaný s kĺbovou nestabilitou a následným výskytom zranení v oblasti kolena a členku (Bottoni, Herten, Kofler, Hasler, & Nachbauer, 2013;Han, Anson, Waddington, Adams, & Liu, 2015;Hrysomallis, 2007;Hertel, 2008). KP alebo KNTSL ovplyvňujú propriocepciu na základe doplnkového stimulu kožných receptorov a zvolenej kompresie. ...
Hlavným cieľom práce bolo priblížiť čitateľovi potencionálny efekt využívania kompresného oblečenia (KO) u bežcov. Čitateľovi práce chceme poskytnúť objektívny pohľad na využívanie kompresných podkolienok (KP) a návlekov na trojhlavom svale lýtka v športe. Uvedená práca nie je metaanalýzou, článok poskytuje základné informácie a uvádza čitateľa práce do problematiky využívania KO. V práci sa zameriavame na uvedenie vybraných parametrov, ktoré priamo, resp. nepriamo determinujú výkon a ovplyvňujú schopnosť podať opakovaný výkon. V odbornej literatúre sú v súčasnosti popisované dva účinky (zvýšenie žilného prietoku a redukcia svalových oscilácií), ktoré do výkonu výrazne zasahujú a môžu ho ovplyvňovať. Pri narastajúcej popularite využívania kompresie v rekreačnom a vrcholovom športe považujeme za kľúčové reálne posúdenie možných efektov. V tomto ohľade je súčasná odborná literatúra nejednotná. V prácach nachádzame výrazné potenciálne možné využitie KO, ktoré ovplyvňuje výkon i regeneráciu. Na druhej strane celá rada štúdií konštatuje žiadny alebo minimálny efekt na športový výkon a regeneráciu (hodnotené prevažne výkonové a biochemické parametre). Jednotlivé zistené dáta je však veľmi zložité porovnať, nakoľko prevažná väčšina prác neuvádza veľkosť pôsobiacej kompresie. V tomto bode chceme čitateľa práce upozorniť na základný problém, ktorý výrobca, resp. predajca KO častokrát neuvádza v informačnom popise produktu a to je práve veľkosť pôsobiacej kompresie. Preto považujeme za žiadúce ďalšie výskumné zámery smerovať do zistenia optimálneho tlaku pre výkon a regeneráciu. Uvedený zámer nám logicky nadväzuje na zistenie, že ak rozdielne kompresné tlaky vykazujú v sledovaných parametroch rozdielne výsledky, potom pravdepodobne bude existovať akýsi zlatý štandard voľby tlaku v závislosti od druhu vykonávanej pohybovej aktivity.
... The recommendation by Baltaci et al. [2], suggesting that prophylactic knee braces can be used for both healthy subjects and athletes to enhance proprioception, coordination, maximal force, and balance, is debatable. Bottoni and Baltaza showed that protective knee braces and neoprene knee sleeves did not influence knee performance in uninjured active subjects [4,11]. On ACL-reconstructed subjects, functional knee braces did not produce superior outcomes when compared with neoprene sleeves. ...
We report a case of a 47-year-old male handball player who sustained a direct trauma in competition of his right lateral knee against the hinges of a braced defensive player. The trauma resulted in a split fracture of the lateral tibial plateau. There is a high probability that the hinged brace might have caused or at least aggravated the injury and that the rules of handball should be more detailed on the topic of protective gear.
... However, clinical testing of the aforementioned proprioceptive devices has given controversial results. Some studies showed that proprioceptive acuity at the knee [10,11] or ankle [12,13] was not enhanced by the application of an external cutaneous stimulation, whereas other studies found a positive effect of such devices on knee [14,15] or ankle proprioception [16][17][18][19][20][21]. ...
Background:
Ankle movements can be partially encoded by cutaneous afferents. However, little is known about the central integration of these cutaneous signals, and whether individual differences exist in this integration. The aim of this study was to determine whether the effect of cutaneous stimulation at the ankle would differ depending on the participants' preferred sensory strategy appraised by relative proprioceptive weighting (RPw).
Methods:
Forty-seven active young individuals free of lower-limb injury stood on a force platform either barefoot or wearing a custom-designed bootee. Vibrations (60 Hz, 0.5 mm) were applied either to the peroneal tendons or to the lumbar paraspinal muscles.
Results:
The barefoot RPw was strongly negatively correlated to the absolute change in RPw measured in the bootee condition (r = -0.81, P < 0.001). Participants were then grouped depending on their barefoot RPw value. The RPw was significantly higher in the bootee condition than in the barefoot condition only for participants with low barefoot RPw.
Conclusions:
The external cutaneous stimulation given by the bootee increased the weight of ankle proprioceptive signals only for participants with low barefoot RPw. This result confirmed that optimization of the ankle proprioceptive signals provided by cutaneous afferent stimulation has a differential effect depending on the participants' preferred sensory strategy.
... It may be hypothesized that normal proprioception and static postural control of healthy subjects can hardly be improved by short-term application of a brace. This is consistent with previous research demonstrating that ankle and knee bracing did not influence either static balance (Kaminski and Perrin, 1996;Ozer et al., 2009) or knee proprioception (Bottoni et al., 2013;Kaminski and Perrin, 1996) in uninjured active subjects. Therefore, proprioception and static postural control could have been hardly affected to a different extent by the application of conventional vs. experimental orthosis in the current investigation. ...
The aim of this study was to compare muscle force control and proprioception between conventional and new-generation experimental orthoses. Sixteen healthy subjects participated in a single-blind controlled trial in which two different types of orthosis were applied to the dominant knee or ankle, while the following variables were evaluated: muscle force control (accuracy), joint position sense, kinesthesia, static balance as well as subjective outcomes. The use of experimental
orthoses resulted in better force accuracy during isometric knee extensions compared to conventional orthoses (P = 0.005). Moreover, the use of experimental orthoses resulted in better force accuracy during concentric (P = 0.010) and eccentric (P = 0.014) ankle plantar flexions and better knee joint kinesthesia in the flexed position (P = 0.004) compared to conventional orthoses. Subjective comfort (P < 0.001) and preference scores were higher with experimental orthoses compared to conventional ones. In conclusion, orthosis type affected static and dynamic muscle force control, kinesthesia, and perceived comfort in healthy subjects. New-generation experimental knee and ankle orthoses may thus be recommended for prophylactic joint bracing during physical activity and to improve the compliance for orthosis use, particularly in patients who require long-term bracing.
Background
Knee orthoses have been extensively used as a nonsurgical approach to improving knee deficiencies. Currently, arthritic knee conditions remain the leading cause of disability, and this number is expected to increase. As the use of knee orthoses varies widely, so has their effectiveness which is still largely debatable. Here, we present the functions and effectiveness of the three most prominent knee orthotic models dedicated to supporting knee osteoarthritis—unloader, patellofemoral, and knee sleeves.Purpose/Research QuestionConsidering the depth and diversity of the many clinical studies and documented laboratory reports published to date, this literature review was created to educate the clinician, patient, and researcher on common knee orthoses used for the management of arthritic knee conditions. In doing so, we discuss their design, biomechanical effects, and clinical efficacy, as well as broader outcomes, limitations, and recommendations for use.Results/SynthesisThe knee orthoses discussed within the scope of this paper are dedicated to protecting the knee against strenuous compressive loads that may affect the patellofemoral and tibiofemoral joints of the knee. Since the knee has multiple axes of motion and articulating surfaces that experience different loads during functional activities, it can be implied that, to a large extent, knee brace designs can differ drastically. Unloader knee orthoses are designed to decrease tibiofemoral and patellofemoral joint pressures. Patellofemoral knee orthoses are designed to decrease strain on the patellofemoral and quadriceps tendons while stabilizing the patella. Knee sleeves are designed to stabilize movements, reduce pain in joints, and improve proprioception across the knee joint.Conclusion
Although patients often report benefits from wearing braces, these benefits have not been confirmed by clinicians and scientific investigators. Results from these three orthosis types show that clinical efficacy is still elusive due to the different methodologies used by researchers.Layman SummaryKnee orthoses also referred to as knee brace are commonly used for support and stability of the knee. Unloader knee braces are designed to relieve and support those suffering from knee osteoarthritis by improving physical impairment and reducing pain. Patellofemoral knee braces aim to help patients manage patellofemoral pain syndrome. Rehabilitative compression sleeves, also known as knee sleeves, are often used to assist patients suffering from knee pain and laxity. Important findings on the three knee braces discussed show discrepancies in results. Their effectiveness and validity are yet to be understood.
Knee orthoses have been extensively used as a conservative approach in protecting the knee against injury and treating knee deficiencies. In this review, we present three categories of knee orthotic models dedicated to supporting ligament tissues, stabilizing the knee, restricting abnormal displacement, and augmenting the knee joint. Prophylactic knee orthoses are the lateral knee guard worn by athletes taking part in contact sports to protect against valgus stresses on the MCL. Functional knee braces are a class of knee orthoses designed for corrective action after an injury has occurred, while rehabilitative knee braces are worn in postoperative recovery, to protect the healing ligaments and meniscus from any reinjury. The effectiveness of prophylactic knee braces on MCL injuries varies widely among users; more so, functional knee braces help athletes during both the early and late stages of postoperative recovery. Generally, knee braces are considered a potential cost saving approach in treating knee-related injuries, considering the ever-increasing healthcare cost associated with knee surgeries and rehabilitation programs.
Many clinical results and experimental studies published up-to-date on knee braces remain largely inconclusive on their clinical efficacy, nonetheless, making it challenging for clinicians to recommend their use to for patients. This review offers to discuss three types of knee orthoses, namely prophylactic, functional, and rehabilitative. In this review, we aim to provide a detailed account of different knee bracing solutions to educate the clinician, patient, and the researcher on common knee orthoses used for the management of ligament injuries and knee instabilities. In doing so, we discuss the most significant question regarding their clinical efficacy, duration of use, and whether postoperative functional bracing during rehabilitation is effective.
This reports indicated that discrepancies in the effectiveness and benefits of prophylactic knee brace have led to issues with its generalizability and recommendation about continuous use, which have remained unfavorable. Prophylactic braces can be presumed anecdotal with little to no scientific support, though their earlier use claims to decrease knee injuries. Theoretically, functional knee braces impart stability to the knee joint during rotation or when anteroposterior movement is a concern or the need for support after an ACL injury repair. Functional knee braces aim to correct valgus and varus misalignment—generally utilizing an external valgus force to reduce load on the medial compartment of the knee joint. A series of studies that investigated subjective and clinical assessments of ligamentous injuries in ACL-deficient subjects using functional knee braces showed mixed results. Rehabilitative knee braces are typically used to protect healing ligamentous grafts after ACL reconstruction, typically for no longer than few months due to their cumbersome nature. Rehabilitative braces are beneficial for their protective effect during the early stages of postoperative recovery through their restriction of range of motion.
Important findings on the three knee orthotic models indicated mixed results. The clinical efficacy as well as their validity are yet to be understood due to different approaches being employed by investigators.
Knee orthoses also known as knee braces are commonly used for knee support and stability. The types of knee braces discussed in this review aim to protect the medial collateral ligament and anterior cruciate ligament of the knee joint from adverse conditions. These categories of knee braces augment the knee against ligament injuries, meniscus tear, muscle laxity, and knee instability. Prophylactic knee braces are designed to protect the knee and are frequently worn by athletes involved in contact or high-impact sports that predisposed the knee to potential injuries.
Alpine Ski is an high energy sport where athletes reach high speeds. Their joints are undergone to several stresses that can lead to traumas of two types: generic and specific for joints. The first one are the injuries caused by high energy traumas and usually happen more often in Downhill (DH) and Super-Giant Slalom (SG). In Giant Slalom (GS) and Slalom (SL), the joint usually undergo a specific mechanism of injury due to an inappropriate movement.
The evaluation of multisegment coordination is important in gaining a better understanding of the gait and physical activities in humans. Therefore, this study aims to verify whether the use of knee sleeves affects the coordination of lower-limb segments during level walking and one-leg hopping. Eleven healthy male adults participated in this study. They were asked to walk 10 m on a level ground and perform one-leg hops with and without a knee sleeve. The segment angles and the response velocities of the thigh, shank, and foot were measured and calculated by using a motion analysis system. The phases between the segment angle and the velocity were then calculated. Moreover, the continuous relative phase (CRP) was calculated as the phase of the distal segment subtracted from the phase of the proximal segment and denoted as CRPTS (thigh–shank), CRPSF (shank–foot), and CRPTF (thigh–foot). The root mean square (RMS) values were used to evaluate the in-phase or out-of-phase states, while the standard deviation (SD) values were utilized to evaluate the variability in the stance and swing phases during level walking and in the preflight, flight, and landing phases during one-leg hopping. The walking velocity and the flight time improved when the knee sleeve was worn ( p < 0.05). The segment angles of the thigh and shank also changed when the knee sleeve was worn during level walking and one-leg hopping. The RMS values of CRPTS and CRPSF in the stance phase and the RMS values of CRPSF in the preflight and landing phases changed ( p < 0.05 in all cases). Moreover, the SD values of CRPTS in the landing phase and the SD values of CRPSF in the preflight and landing phases increased ( p < 0.05 in all cases). These results indicated that wearing a knee sleeve caused changes in segment kinematics and coordination.
Objective:
To report a method of evaluating 3-dimensional joint motion in dogs with a stifle orthosis.
Study design:
Experimental.
Animals:
Six healthy dogs.
Methods:
Three-dimensional pelvic limb joint motion was recorded with and without a stifle orthosis. Kinematic data were collected from dogs at a walk and trot for the hip, stifle, and tarsus prior to, and after application of, a stifle orthosis. Data were also obtained for the orthosis alone. Comparisons were made between the braced and unbraced limb, and between the braced limb and the orthosis alone. Complete waveforms, kinematic, and temporospatial variables were compared.
Results:
Gait waveforms differed between braced and unbraced limbs for all joints and planes of motion (P < .05), as well as between the braced stifles and the orthosis alone at both a walk and trot. However, joint ROM was inconsistently altered. The effect of bracing on stifle ROM was limited to a reduced extension at the end of stance. Adjacent joint ROM was affected by the stifle orthosis. Temporospatial variables were predominantly affected while walking.
Conclusions:
The restrictive motion of the stifle orthosis is not fully translated to the underlying joint, based on the limited differences between the motion of braced and unbraced stifles. This effect varies with plane of motion and phase of the gait cycle, with most changes in stifle motion being detected during the stance phase. The stifle orthosis had an equal or greater effect on the motion of adjacent joints, especially the tarsus.
Exoprostheses are devices that are secured to incomplete limbs to enable locomotion. By comparison, orthoses are devices externally applied to support or protect an injured body part. Orthoses also can be used to control, guide, protect, limit motion of, or immobilize an extremity, a joint, or a body segment. Exoprostheses and orthoses are a growing aspect of the physical rehabilitation of companion animals. They require precise design and fabrication. Patients and owners must be trained to use the devices. Exoprostheses and orthoses can have a profound beneficial impact on the mobility and the quality of life of companion animals.
Copyright © 2015 Elsevier Inc. All rights reserved.
Rehabilitation continues to evolve with the increased emphasis on patient management and proprioceptive training. Proprioception can be defined as a specialized variation of the sensory modality of touch that encompasses the sensation of joint movement (kinesthesia) and joint position (joint position sense). Numerous investigators have observed that afferent feedback to the brain and spinal pathways is mediated by skin, articular, and muscle mechanoreceptors. Examining the effects of ligamentous injury, surgical intervention, and proprioceptively mediated activities in the rehabilitation program provides an understanding of the complexity of this system responsible for motor control. It appears that this neuromuscular feedback mechanism becomes interrupted with injury and abnormalities, and approaches restoration after surgical intervention and rehabilitation. Rehabilitation programs should be designed to include a proprioceptive component that addresses the following three levels of motor control: spinal reflexes, cognitive programming, and brainstem activity. Such a program is highly recommended to promote dynamic joint and functional stability. Thus far, current knowledge regarding the basic science and clinical application of proprioception has led the profession of sports medicine one step closer to its ultimate goal of restoring function.
Several tests of human conscious knee proprioception have been described, but there is no consensus or reference standard established. Difficulties remain in the separation of information originating from muscles, tendons, and joints, and the tests cannot discriminate between loss of afferent signals or altered activity in the remaining receptors. There is convincing evidence from several descriptive studies that the afferent information is altered after a knee ligament injury and severely disturbed in some patients with anterior cruciate ligament (ACL) injuries. However, an inherent inferior proprioceptive ability may also exist in some individuals, which makes them vulnerable to injuries. The deficits in proprioception have mostly been studied and related to the consciously registered sense, whereas the extent of possible disturbances of the unconscious or reflectory mechanisms is largely unknown. The latter may, at least from a theoretical point of view, be predominantly contributing to the overall afferent regulation, and a possibility for major defects thus exists, since there is no knowledge of the quantified relation between the conscious and unconscious part. The clinical importance of the altered afferent information has not been evaluated properly, and the role of proprioception that contributes to function has yet to be investigated. A higher physiological sensitivity to detecting a passive joint motion closer to full extension has been found both experimentally and clinically, which may protect the joint due to the close proximity to the limit of joint motion. Proprioception has been found to have a relation to subjective knee function, and patients with symptomatic ACL deficiency seem to have larger deficits than asymptomatic individuals. Little is known about whether training can restore defects in sensory information or by which mechanisms possible compensatory pathways are established. In rehabilitation, each patient must, however, create muscle strength, alertness, and stiffness in harmony with the disturbed mechanics of the knee, which are present both after nonoperative treatment of the ACL and after a reconstruction of the ACL.
Braces are commonly used for the management of musculoskeletal injuries. With improvements in design and application, the knee brace has gained recognition by many as a treatment and prevention modality. However, there exist many different categories of knee braces, leading to confusion among many end users. The theoretical basis of the mechanism of action of the unloader, prophylactic, patellofemoral, and functional knee braces are explained in this review. This article also provides an update on the various knee braces in terms of the clinical efficacy and appropriate prescription recommendations.
The recent appreciation of the neural mechanism of articular structures has elicited considerable attention to the role of proprioception following joint injury. This is especially true following sport related injurit:s due to the role proprioception plays in performance of skilled movements and with reflex joint stabilization during running and throwing. Recent research in the area of proprioception has provided a basis for substantiating proprioceptive deficits with joint injury and the necessity for integrating specific activities into the rehabilitation program for the athlete. This paper will review these recent developments and provide additional information relative to the potential effect surgery has on enhancing this neurosensory mechanism. Although these recent developments provide a basis for understanding proprioception there is still a wealth of information that is not understood relative to this complex mechanism.
Proprioception and accompanying neuromuscular feedback mechanisms provide an important component for the establishment and maintenance of functional joint stability. Neuromuscular control and joint stabilisation is mediated primarily by the central nervous system. Multisite sensory input, originating from the somatosensory, visual and vestibular systems, is received and processed by the brain and spinal cord. The culmination of gathered and processed information results in conscious awareness of joint position and motion, unconscious joint stabilisation through protective spinal-mediated reflexes and the maintenance of posture and balance. Clinical research aimed at determining the effects of articular musculoskeletal injury, surgery and rehabilitation, on joint proprioception, neuromuscular control and balance has focused on the knee and ankle joints. Such studies have demonstrated alterations in proprioception subsequent to capsulo-ligamentous injury, partial restoration of proprioceptive acuity following ligamentous reconstruction, and have suggested beneficial proprioceptive changes resulting from comprehensive rehabilitation programmes.
Four types of receptors have been described in the articular tissues of the knee joint in humans and animals. The first three types are encapsulated; the fourth is unencapsulated: type I, Ruffini endings; type II, Pacinian corpuscles; type III, Golgi tendon organs; and type IV, free nerve endings. Ruffini endings, Pacinian corpuscles, and free nerve endings are most prevalent in the fibrous joint capsule; Golgi tendon organs are most common in the collateral and cruciate ligaments and the menisci. In the anterior and posterior cruciate ligaments (ACL, PCL), receptors are concentrated at the tibial and femoral attachments of the ligaments. In the menisci, neural elements penetrate the horns and the outer and middle thirds of the body. Ruffini mechanoreceptors are believed to contribute mainly to maintenance of muscle tone, Pacinian corpuscles and Golgi tendon organs are stimulated during movement, and free nerve endings are nociceptors. Thus, receptors of the knee joint are able to produce a discriminating afferent inflow to the central nervous system (CNS), thereby contributing to the protection and function of the joint through the musculature.
It is estimated that knee injuries account for up to 60% of all sport injuries, with the anterior cruciate ligament (ACL) accounting for almost half of these knee injuries. These knee injuries can result in high healthcare costs, as an ACL injury is often associated with surgery, long and costly rehabilitation, differing degrees of impairment and potential long-term consequences such as osteoarthritis. The interest in ACL injury prevention has been extensive for the past decade. Over this period, many ACL (intrinsic and extrinsic) injury risk factors have been identified and investigated by numerous researchers. Although prevention programmes have shown potential in decreasing knee ligament injuries, several researchers have suggested that no conclusive evidence has been presented in reducing the rate and/or severity of ACL injuries during sporting competition. Knee braces have been available for the last 30 years and have been used to assist individuals with ACL-deficient and ACL-reconstructed knees. However, research is limited on the use of knee braces (prophylactic and functional) to potentially prevent knee ligament injury in the non-injured population. One possible explanation for the limited research could be that the use of these devices has raised concerns of decreased or impaired athletic performance. In summary, the review of subjective and some objective publications suggests that a functional knee brace may offer stability to an ACL-deficient knee joint; however, research is limited on the use of a knee brace for prophylactic use in non-injured athletes. The limited research could be a result of fear of performance hindrance that has led to poor knee brace compliance.
Proprioception was measured in the knees of 20 subjects with instability of the anterior cruciate ligament and compared with 17 age-matched control subjects. There was diminished position sense and threshold for movement detection in the injured patients compared with the control group. The proprioceptive deficit recorded from the injured knee showed a significant correlation with the hamstring/quadriceps power ratio recorded from the injured leg.
Elastic bandages are often used to treat musculoskeletal disorders, even though there is little scientific evidence currently to support this generalized practice. We tested the hypothesis that elastic bandages improve proprioception of the bandaged joint during their use, and that this benefit was more than temporary. The uninjured human knee was used as a model. Fifty-four volunteers (54 knees), aged 22 to 40 years, were asked to identify a prior set joint angle as their knee was passively extended. Each knee was tested without the elastic bandage, immediately after bandage application, after 1 hour of bandage wear, and finally after removal of the bandage. Results showed that elastic bandages significantly improved knee joint proprioception in the uninjured knee during the entire interval of their use (mean decrease in inaccuracy of 1.0 degree, equivalent to 25% improvement, P < 0.05), and that this benefit was lost when the bandage was removed. The magnitude of the improvement, or the potential beneficial effect of the bandage, was inversely related to the participant's inherent knee proprioceptive ability, which was demonstrated in the test group before the initial application of the bandage.
To examine the effects of a knee sleeve type brace on the proprioceptive ability of subjects with normal knees during a dynamic tracking task.
A 2 X 2 Latin square cross over design; in each Latin square, subjects were matched for age and gender.
An institution focused on clinical education.
Twenty subjects with no musculoskeletal or neurological conditions.
Each subject performed a tracking task on a Kin-Com dynamometer. Angle and force data from the Kin-Com and angle data from an electrogoniometer were sampled at 100Hz using a data acquisition program on a PC computer. The subjects were blindfolded and the limb attached to the Kin-Com was moved passively by the dynamometer. Subjects were instructed to follow the movement as closely as possible with the other limb (the tracking limb). Subject performed two trials, one without knee bracing and another that involved the application of a brace to the tracking limb.
The magnitude of the error in tracking was established by taking the difference of the active and passively moving limbs and calculating the root mean square (RMS) of the difference.
The findings showed that there was an improvement of 11% in tracking when subjects wore the knee brace (p < .05).
Alterations in proprioception as a result of bracing may be partly responsible for the improvement in knee injury statistics reported in some studies.
We studied a group of anterior cruciate ligament-deficient athletes to identify whether joint position and direction of joint motion have a significant effect on proprioception. Twenty-nine anterior cruciate ligament-deficient athletes were tested for their threshold to detect passive motion at both 15 degrees and 45 degrees moving into the directions of both flexion and extension. The single-legged hop test was used to identify function in the deficient limb. Results demonstrated statistically significant deficits in threshold to detect passive motion for the deficient limb at 15 degrees moving into extension. For the deficient limb, threshold to detect passive motion was significantly more sensitive moving into extension than flexion at a starting angle of 15 degrees; at a starting angle of 15 degrees moving into extension threshold was significantly more sensitive than at a starting angle of 45 degrees moving into extension. We conclude that in deficient limbs proprioception is significantly more sensitive in the end ranges of knee extension (15 degrees) and is significantly more sensitive moving into the direction of extension. To effectively restore reflex stabilization of the lower limb we recommend a rehabilitation program emphasizing performance-based, weightbearing, closed kinetic chain exercise for the muscle groups that act on the knee joint.
The primary objective of the present study was to compare the effect of a neoprene sleeve on knee joint position sense during a sitting open kinetic chain test and a supine closed kinetic chain test. Young (24 +/- 2 years old), healthy subjects (18 men and 18 women) performed knee joint angle replication tests during open kinetic chain knee extension (sitting) and closed kinetic chain leg press (supine with an axial load of 15% body weight) before and after application of a neoprene sleeve over the dominant knee. The improvement in ability to replicate joint angles after application of the sleeve (sleeve effect) was significantly less during the supine closed kinetic chain test (0.3 degree +/- 1.4 degrees) than during the sitting open kinetic chain test (1.2 degrees +/- 1.1 degrees). The sleeve effect was inversely related to subjects' performance without the sleeve during both the sitting open kinetic chain and supine closed kinetic chain tests, suggesting that some people may derive greater benefit from the sleeve than others. Although the sleeve effects were small, particularly during the supine closed kinetic chain test, 72% of subjects felt that the sleeve improved their overall test performance. Future research is needed to establish the functional relevance of the small sleeve effects observed and to identify the characteristics of people who might derive greatest benefit from sleeve use.
We studied the effect that chronic anterior cruciate ligament disruption, functional bracing, and a neoprene sleeve have on knee proprioception by measuring the threshold to detection of passive knee motion in all three conditions. The threshold to detection of passive knee motion was worse in knees with chronic anterior cruciate ligament insufficiency when compared with uninjured knees. This difference was small, on average an additional 0.28 degree of flexion-extension rotation was required for the anterior cruciate ligament-deficient knee before the subject detected motion, and of questionable significance from a clinical and functional perspective. Wearing a functional brace or neoprene sleeve on the anterior cruciate ligament-deficient knee did not significantly change the threshold to detection of passive motion in comparison with the same knee without a brace, although improvements were observed. There was no relationship between the most common clinical means of characterizing altered biomechanics of the anterior cruciate ligament-deficient knee (that is, the magnitude of anterior-posterior knee laxity and the grade of pivot shift) and the threshold to detection of passive knee motion.
Objectives of this study were to examine the perceived sense of knee joint position during selected test situations, and to evaluate the proposed kinesthetic effect of a neoprene knee sleeve during these test situations.
Fifty-nine young healthy subjects (39 females and 20 males) attempted to replicate target knee joint angles using active and passive knee extension movements completed in sitting (nonaxially loaded) situations, and during active knee extension movements completed in supine while applying a load of 15% body weight through the long axis of the tibia (axially loaded). The criterion measure used was the absolute difference between target and reproduced angles, averaged over five attempts (Average absolute difference: AAD).
A three-way ANOVA (two genders by three test situations by two sleeve conditions), with repeated measures on the last two factors, indicated a significant main effect for test situation and sleeve condition (P < 0.05), but not for gender. There was also a significant test situation by sleeve condition interaction (P < 0.05). Post-hoc analysis indicated that the AAD score during the active nonaxially loaded test situation without the sleeve was significantly greater than AAD scores for all other tests (P < 0.01).
Pre-existing differences in knee joint kinesthesis observed during different contexts of limb movement must be recognized before various interventions, including the effect of knee supports, can be adequately interpreted. Because knee joint position sense was attenuated during voluntary active movement, and because this attenuation was ameliorated by the use of a sleeve, future studies evaluating the kinesthetic effects of knee bracing may benefit from using active movements. However, since the sleeve did not affect performance during the axially loaded test situation, future studies should also evaluate the relationship between tests of knee joint kinesthesis and other more functional tests of neuromuscular performance.
We evaluated the effects of prophylactic knee braces on athlete speed and agility, as well as brace tendency to migrate. Thirty college football players in full gear ran a 40-yard dash and a four-cone agility drill wearing braces on both knees or no brace (control). Braces included the DonJoy Legend, Breg Tradition, OMNI-AKS 101W, McDavid Knee Guard, and models 1 and 2 of the Air Armor Knee and Thigh Protection System. Brace migration and subjective measures were recorded after each trial. In the 40-yard dash, times using Air Armor 1 and OMNI did not differ significantly from control. Times with other braces were significantly slower. In the four-cone drill, only the Breg times were significantly slower than control. The Air Armor 1 and McDavid braces showed significantly less superior/inferior migration in the 40-yard dash than other braces. In the four-cone drill, the Air Armor 1 and 2 showed significantly less superior/inferior migration than other braces. These findings indicate that selected knee braces do not significantly reduce speed or agility. Braces showed a variable tendency to migrate, which could affect their protective function and athlete performance. This information will help athletes and coaches decide about knee-brace use during sports; studies are needed regarding whether braces protect against knee injury. This study does not constitute an endorsement of knee-brace use or efficacy.
Surrogate knee model biomechanical studies have indicated that off-the-shelf braces provide 20% to 30% greater resistance to a lateral blow when the knee is in full extension. Custom functional braces doubled the protective effects and proved effective with the knee in some flexion. Although functional performance studies are not consistent, preventive knee braces may slow straight-ahead sprint speed, cause early fatigue, and increase muscular relaxation pressures, energy expenditure, blood lactate levels, maximal torque output, oxygen consumption, and heart rate. Two epidemiologic studies have been performed. At West Point, a randomized control study of 71 injuries in 1396 cadets indicated knee brace effectiveness with a statistically higher rate of injury in the control group (3.4/1000 exposures) than in the braced group (1.5/1000 exposures), with the most significance for medial collateral ligament sprains in defensive players. The Big Ten Conference conducted a descriptive study of 100 medial collateral ligament sprains among 987 players in different positions, strings, and types of session. Brace-wear tendency varied directly with the unbraced player counterpart's risk of medial collateral ligament sprain, with the nonplayer linemen experiencing both the greatest risk of unbraced practice session injury (0.0801 injuries/1000 exposures) and the highest incidence of brace wear (85%). During practices, there was a nonsignificant but very consistent reduction in injury rate for braced players in every position and string. During games, there was also a reduced rate for linemen and the linebacker/tight end group. The study concluded that although the issue is not closed, preventive knee braces appear to offer some protection to the medial collateral ligament from a contact injury involving a valgus blow, but there may be negative effects on performance level, leg cramping, and fatigue symptoms.
Prophylactic knee braces are designed to prevent and reduce the severity of ligamentous injuries to the knee. Conflicting evidence is reported concerning their efficacy. The purpose of this study was to determine the effect of prophylactic knee bracing on the proprioceptive parameters of balance and joint position sense. Active and passive joint position sense were assessed using the Cybex II + Isokinetic Dynamometer (Cybex Division of Lumex, Inc, Ronkonkoma, NY). Sway index and center of balance were assessed using the Chattecx Dynamic Balance System (Chattanooga Group, Hixson, TN). Thirty-six male subjects were measured with and without prophylactic knee braces. Joint position sense was measured in degrees of error from four preselected target angles. Sway index and center of balance measures were recorded in centimeters under the following platform conditions: stable, plantar flexion/dorsiflexion, and inversion/eversion. Separate repeated measures ANOVAs were performed to determine if there were differences between the braced and unbraced conditions for center of balance, sway index, and joint position sense. Center of balance with the platform moving in a dorsi/plantar flexion direction was improved while wearing the knee braces. In addition, differences in both center of balance and sway were recorded across the three platform conditions with and without knee bracing. Bracing did not affect joint position sense. The results of this study suggest that prophylactic knee braces have very little impact on proprioceptive feedback mechanisms.
The use of knee braces
- S Najibi
- Albright
Najibi S, Albright JP. The use of knee braces, Part.
Rewiew of knee propri-oception and the relation of extremity function after an anterior cruciate ligament rupture
- Roberts T D Fridén
- E Ageberg
- M Waldén
- Zätterström
Fridén T, Roberts D, Ageberg E, Waldén M, Zätterström R. Rewiew of knee propri-oception and the relation of extremity function after an anterior cruciate ligament rupture. J Orthop Sports Phys Ther 2001;31(10):567–76.
Introduction to the sensorimotor system. Proprioception and neuromuscular control in joint stability
- S M Lephart
- B L Riemann
- F H Fu
Lephart SM, Riemann BL, Fu FH. Introduction to the sensorimotor system. Proprioception and neuromuscular control in joint stability, Human Kinetics; 2000.
p. xvii-xiv.