In managing musculoskeletal disorders, physicians often make decisions concerning the use of braces or splints. To prevent injury, bracing can be very helpful for serious injuries and persistent orthopedic problems. Braces and splints are design to alleviate physical conditions, decelerate disease progression, and decrease pain. They are use to immobilize joint and correct bone fracture, to unload a part of a joint and improve pain and function, and to eliminate range of movement in one or more direction. Though braces are of help, wide range of treatment should be explored and use if needed for they are not a substitute for any good rehabilitative program.
To determine whether to use a brace or splint, a precise diagnosis should be determined. Normally, splints are for short-term use. Over and continuous use of brace should be indicated. For the excessive use may cause chronic pain and stiffness of a joint or muscle weaknesses. However, unloader brace can help prevent the consistent pain due to osteoarthritis of the knee. Knee braces were develop to unload the medial part of patients with varus osteoarthritis, to treat anterior knee pain, and to immobilize the knee.
Unloader, or valgus, knee braces are consider as one of the treatment option for patients with knee osteoarthritis. These are design to apply an external valgus force to reduce the medial compartment load and decrease pain. An improved joint proprioception also plays a major role in decreasing knee pain. A radiographic diagnosis of unicompartmental osteoarthritis (medial compartment) and varus malalignment indicates the need to use of this kind of brace.
Few relative randomized controlled trial studies were done to publish the use and effectiveness of braces. One of this randomized controlled trial study by Cochrane systematic review, studied 119 patients with osteoarthritis with varus knee deformity to receive usual treatment, unloader knee brace, or neoprene sleeve to test the effectiveness of these therapies for better quality of life. Although the sleeve and the brace both reduced pain and improve function, the unloader brace is of greater benefit. Another study of six month randomized crossover trial of 12 patients with varus osteoarthritis using simple hinged brace or an unloader brace. Despite the small number of subjects and patients acted as their own controls, the study statistically and clinically proves the use of unloader compare to hinged brace is of greater advantage.
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Other knee braces include prophylactic braces designed to prevent or limit the severity of knee injuries. These braces commonly used by football players helps protect against medial collateral ligament injury. To provide stability to a ligament-deficient knee (e.g. in a patient with an anterior cruciate ligament tear before surgery) and for postsurgical repair functional knee braces are made. In addition, rehabilitative knee braces, postoperatively allows range of motion protected.
Recommendations for the right selection and use of these braces are highly variable, complex and often inconsistent, choice depends on trial and error experience and on patient’s convenience.
