The experts striving to improve anterior knee pain treatment

One in three patients of sports medicine clinics seek treatment for anterior knee pain1,2. The pain caused by this condition can prevent exercise or participation in sports, and can even lead to chronic disability and inability to work.

But a group of world experts is on a mission to improve the understanding and treatment of anterior knee pain. Along with knee brace manufacturers like DonJoy, their goal is to get people moving again.

What is anterior knee pain?

Anterior knee pain is another name for Patellofemoral Pain Syndrome (PFPS), a term used to refer to pain originating from the patellofemoral joint or its surrounding soft tissues. Due to the pain being felt in all parts of the knee, anterior knee pain is actually a misleading name, though its use remains popular.

This chronic condition usually worsens with activities such as running, squatting, and climbing stairs, as well as sitting. 

What is The Patellofemoral Foundation?

Founded in 2003 by Dr John Fulkerson, The Patellofemoral Foundation is a non-profit organization dedicated to improving the care of individuals with anterior knee problems through targeted education and research.

The author of many articles and books on patellofemoral pain, Dr Fulkerson is Professor of Orthopedic Surgery at Yale University. As well as sitting on the boards of a range of orthopedic associations, he has also been team doctor for the U.S. Olympic Ice Hockey team, the NHL Hartford Whalers, and the AHL Hartford Wolfpack.

Over the past two decades, The Patellofemoral Foundation has made progress in the understanding of anterior knee pain. Anatomic and clinical studies funded by it or carried out by its members have revealed previously unrecognized sources of pain leading to specific pain treatments around the front of the knee3.

During this time, technological advancements in radiology such as computerized tomography and MRI have also allowed greater understanding of the mechanical behavior of the patella.

The Patellofemoral Foundation

Yet despite this progress, much remains to be done to improve things for patients suffering from anterior knee pain. Among the objectives the foundation still seeks to achieve are to refine the indications for anterior knee pain management and surgery, improve bracing and non-operative measures, standardize operative approaches, and develop an educational network that reaches deep into the sports medicine and orthopedic communities.

One of the companies supporting the foundation in its efforts is Enovis. With its DonJoy brand offering a full range of patellofemoral knee braces, the orthopedics manufacturer has an important role to play in the conservative management of patients with anterior knee pain.

Tru-Pull® and the role of bracing in anterior knee pain treatment

A conservative aspect of anterior knee pain treatment is knee bracing. Wearing a patellofemoral knee brace can increase stability of the patella to reduce anterior knee pain4.

Developed in partnership with Dr Fulkerson, DonJoy’s Tru-Pull Advanced® knee brace is designed to place a dynamic pull on the patella during knee extension to improve alignment and reduce anterior pain.

Available in sleeve or hinged versions, the Tru-Pull Advanced provides support for patients with patellofemoral malalignment, subluxation, and dislocations.

Also available is the Tru-Pull Lite™, a shorter, more slimline version for enhanced comfort and ease of use. It is recommended for acute mild to moderate anterior knee pain, support for patella instability, lateral subluxation, and maltracking.

Tru-Pull Lite knee brace

DonJoy PateLax™ – flexible support for anterior knee pain

DonJoy PateLax™ is a new knitted elastic support that protects and supports the patella and is used to address overuse injuries such as anterior knee pain.

The brace offers targeted compression and a comfortable fit with its soft, breathable, elastic materials in a 3D-knit design.

DonJoy PateLax offers the following features:

  • Its anatomically contoured knee pad provides a massaging effect and helps improve proprioception by aiding stability and guidance of the patella
  • The patellar tendon pad with strap helps relieve tension at the tip of the patella and the tibial tuberosity (the bump on the top of the tibia where the patellar tendon connects)
  • Medial and lateral support of the knee are provided by a pair of flexible bilateral stays
  • Compression-reduced edges help provide a comfortable fit by diverting pressure at the ends of the support
  • Breathability, comfort, and freedom of movement are aided by stretch zones over the patella and the back of the knee
  • Non-slip silicone-coated bands help keep the brace in place

Stylish, modern, and easy to wash, DonJoy PateLax is a comfortable and convenient way for people to address anterior knee pain.

References

  1. Chesworth, B. M., Culham, E., Tata, G. E., & Peat, M. (1989). Validation of outcome measures in patients with patellofemoral syndrome. The Journal of orthopaedic and sports physical therapy, 10(8), 302–308.
  2. Boling, M., Padua, D., Marshall, S., Guskiewicz, K., Pyne, S., & Beutler, A. (2010). Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scandinavian journal of medicine & science in sports, 20(5), 725–730.
  3. Fulkerson J. P. (2002). Diagnosis and treatment of patients with patellofemoral pain. The American journal of sports medicine, 30(3), 447–456.
  4. Selfe, J., Thewlis, D., Hill, S., Whitaker, J., Sutton, C., & Richards, J. (2011). A clinical study of the biomechanics of step descent using different treatment modalities for patellofemoral pain. Gait & posture, 34(1), 92–96.

How wearing a soft brace can help jumper’s knee pain

One of the risks of regular participation in sports and physical activity is the potential for incurring overuse injuries such as jumper’s knee or Osgood-Schlatter disease. Painful conditions like these can be a barrier to further participation, but evidence shows that wearing a soft brace can help prevent or reduce knee pain,1,2 and a new elastic knee support from DonJoy could offer just the solution.

What is jumper’s knee?

The tendon which connects the kneecap (patella) to the shin bone (tibia) is called the patellar tendon. Inflammation of this tendon is called patellar tendonitis – more commonly known as “jumper’s knee.”

Jumper’s knee is an overuse injury often sustained from sporting activities involving repeated jumping on hard surfaces. The repetitive stress placed on the patella tendon from jumping and landing puts strain on the tendon which can leave it inflamed.

As well as causing swelling, jumper’s knee also causes pain below the patella, which can be felt more acutely when jumping, running, walking, or when bending and straightening the leg.

What is Osgood-Schlatter disease?

Another potential source of knee pain is Osgood-Schlatter disease. This condition causes painful swelling where the patella tendon connects to the top of the tibia. The most common sufferers of Osgood-Schlatter disease are young athletes – particularly boys aged 10-15 – who take part in sports or activities involving lots of running and/or jumping.

While they are still growing, the ends of children’s bones have not yet hardened, making them more susceptible to stress. Activities that put stress on the knee, such as running, bending, or squatting, can irritate these areas of cartilage and lead to painful swelling.

How to help jumper’s knee pain or Osgood-Schlatter disease

There are a number of ways to help prevent or reduce jumper’s knee pain or Osgood-Schlatter disease:

  • Follow the RICE protocol. REST the knee where possible. Apply an ICE pack to the knee for up to 30 minutes. Wear an elastic support on the knee for COMPRESSION. And use a pillow for ELEVATION to raise the foot and reduce swelling
  • Anti-inflammatories can help with the pain and swelling
  • Wear a soft brace. The support that soft braces provide can help to prevent jumpers’s knee, or aid recovery

Try DonJoy PateLax™ – flexible support for the patella

DonJoy PateLax™ is a new knitted elastic support designed to protect and support the patella, as well as provide relief at the patellar tendon insertion. It can be used to address overuse injuries such as jumper’s knee and Osgood-Schlatter disease.

Made from soft, breathable, elastic materials in a 3D-knit design, the brace offers a comfortable way to support the knee with targeted compression.

DonJoy PateLax offers the wearer a range of beneficial features:

  • An anatomically contoured knee pad aids stability and guidance of the patella, provides a massaging effect, and helps improve proprioception
  • A patellar tendon pad with strap helps relieve tension at the tip of the patella and the tibial tuberosity (the bump on the top of the tibia where the patellar tendon connects)
  • A pair of flexible bilateral stays help provide medial and lateral support to the knee
  • Compression-reduced edges help divert pressure at the ends of the support to provide a comfortable fit
  • Stretch zones over the patella and the back of the knee aid breathability, comfort, and freedom of movement
  • Non-slip silicone-coated bands help provide extra secure hold under stress
DonJoy PateLax elastic knitted knee brace

DonJoy PateLax is indicated for the following uses:

  • Support and compression following injury to the patellar tendon
  • Proprioceptive and neuromuscular stimulation through compression
  • Overuse injuries such as Osgood-Schlatter disease
  • Patellofemoral pain syndrome
  • Patellar tendinitis
  • Patellar maltracking

Easy to wash and with a stylish, modern design, DonJoy PateLax is a great option for people wanting to help prevent or protect their knees from painful overuse injuries.

References

  1. Sinclair JK, Selfe J, Taylor PJ, Shore HF, Richards JD. Influence of a knee brace intervention on perceived pain and patellofemoral loading in recreational athletes. Clin Biomech (Bristol, Avon). 2016 Aug;37:7-12.
  2. Phillips R, Choo S, Nuelle CW. Bracing for the Patellofemoral Joint. J Knee Surg. 2022 Feb;35(3):232-241.

DonJoy® LadyStrap – back relief, precisely for women

When it comes to choosing a back support, one of the most important considerations is finding the best fit possible. Male and female spines are fundamentally different in shape; the female spine features a greater curvature, a caudally located lordotic peak, and greater cranial peak height.1

Many back supports are designed for unisex use, meaning they aren’t always made to accommodate the natural differences in shape between men and women.

DonJoy® LadyStrap is made specifically for the female body. Fitted at the waist, with a more pronounced lumbar curvature, it’s shaped to fit a woman’s natural curves. This means women can now get the same support and targeted pain relief they expect from a DonJoy back support, but with improved comfort. And with a host of adjustable features, DonJoy LadyStrap helps provide even more precise back support.

DonJoy LadyStrap’s features

The support’s height-adjustable back pad provides additional support and compression in the back area, and can be placed at different heights to help target low back pain.

A pair of bilateral straps enables the wearer to adjust the level of compression to suit their needs; increased for activity and reduced for periods of relaxation.

Its four semi-rigid dorsal stays are curved for optimal anatomical fit and improved comfort.

The ergonomic front closure with finger loop allows for fast and simple application and adjustment. And lace fabrics create a feminine look.

These features are in addition to those that come as standard with DonJoy back supports. A lightweight, low-profile design helps make extended periods of wear

comfortable, ideal during the acute phase. Optimal thermoregulation allows air circulation under the support for enhanced breathability. And soft and comfortable materials help prevent skin irritation.

Intended use and indications

DonJoy LadyStrap is designed to provide support and stabilization of the lumbar spine and relief of low back pain. It is indicated for:

  • Acute lower back pain
  • Back pain prevention, return to activities
  • Back sprain
  • Muscular weakness
  • Lumbar disc diseases (conservative treatment)

Available in two heights and five sizes, DonJoy LadyStrap fits waists from 56 to 136 cm.

References

  1. Hay, O., Dar, G., Abbas, J., Stein, D., May, H., Masharawi, Y., Peled, N., & Hershkovitz, I. (2015). The Lumbar Lordosis in Males and Females, Revisited. PloS one, 10(8), e0133685.

Managing tennis elbow and golfer’s elbow pain with bracing

Epicondylitis is a condition many tennis players and golfers will be familiar with. The repetitive movements associated with these activities can lead to pain in the lateral and medial tendons attached to the elbow, resulting in the conditions known commonly as ‘tennis elbow’ and ‘golfer’s elbow.’1

Tennis elbow is the most common cause of elbow pain, with 1-3% of adults affected every year, and a higher incidence in those aged 40-60.2 If untreated, the condition can continue for an average of 6-24 months.3

One type of non-surgical treatment for epicondylitis is bracing, but how effective is it? This article looks at the clinical evidence for forearm orthoses, and introduces a new elbow brace from DonJoy®, EpiForce® Strong.

What is epicondylitis?

Epicondylitis is clinically defined as pain in the region of the epicondyle (a rounded protuberance at the end of a bone).1 The pain is often caused by inflammation or micro-tearing of the tendons that join the forearm muscles on the elbow.3

• Lateral epicondylitis: Pain in the tendons that attach on the outside of the elbow. Also known as tennis elbow

• Medial epicondylitis: Pain in the tendons that attach on the inside of the elbow. Also known as golfer’s elbow

Image credit: BruceBlaus, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

What causes epicondylitis?

The overuse aspect of epicondylitis is often caused by repetitive wrist extension with alternating supination/pronation, hence its association with tennis and golf.3

However, these injuries can also be caused by forceful or repetitive work tasks, such as those involving non-neutral positions of the upper extremities, use of heavy tools, and high physical strain.4 Obesity and smoking are also risk factors for medial epicondylitis.1

Treatment of epicondylitis

Epicondylitis is first treated non-operatively, with a reported success rate of 90% over 12 to 18 months.5 Surgery is usually only recommended when conservative management fails to relieve symptoms after 6 to 12 months.6

Types of non-surgical epicondylitis treatment include:

  • Counterforce bracing
  • NSAIDs
  • Physical therapy and activity modification
  • Corticosteroid injections
  • Shockwave therapy

These interventions are aimed at relieving tendon strain, reducing tendon irritation and inflammation, and allowing the tendons to heal.5

Elbow bracing for epicondylitis

Elbow counterforce bracing is prescribed in 77% of tennis elbow (lateral epicondylitis) cases in the USA.2 The most common type is a forearm orthosis, a band worn around the forearm to reduce loading on the extensor tendons of the elbow.

However, because the way in which these braces reduce pain and improve function in elbow epicondylitis is not well understood, it may be helpful to review a selection of clinical studies.7

Kroslak et al.’s 2019 clinical trial found that wearing Procare elbow braces reduced the level and frequency of pain for patients suffering lateral epicondylitis. They also helped reduce difficulties with picking up objects and twisting motions, lateral epicondyle tenderness, grip strength, and overall elbow function. Of the two braces used, the padded counterforce brace appeared to accelerate the recovery process and provide better pain relief.8

In their 2019 study, Barati et al. found that both an elbow band and an elbow sleeve were effective in improving proprioception, pain severity, and force production in the hand. However, better finger dexterity was achieved with the forearm band only.9

In their study comparing an elbow band to a wrist orthosis for treating epicondylitis, Akkurt et al. (2018) found both were effective. Pain, function, muscle strength, and quality of life were all improved.10

The results of Sadeghi-Demneh et al.’s 2013 study showed an elbow band and sleeve and a wrist brace all provided immediate improvement in lateral epicondylitis pain severity. Overall, the elbow band and sleeve were more effective.11

Heales et al.’s 2020 systematic review found that forearm orthoses can immediately reduce pain during contraction and improve pain-free grip strength, but not maximal grip strength, in individuals with lateral elbow tendinopathy.7

In conclusion, the literature presented here shows elbow bracing reduces frequency and level of pain, and improves function, pain-free grip strength, proprioception, and finger dexterity for patients with elbow epicondylitis.

Introducing EpiForce® Strong from DonJoy® – the easy way to elbow relief

When it comes to pain relief for the elbow, EpiForce Strong is the easy option.

Thanks to its removable pressure pad, DonJoy’s latest product offers a 2-in-1 bracing solution for tennis and golfer’s elbow. By simply moving the pad to the appropriate position, the brace can be used to help provide targeted pain relief for either lateral or medial epicondylitis.

Fitting is fast and simple and can be achieved with just one hand. Made from snap-fit material, the support wraps instantly around the arm and stays there while the patient clips the buckle into place. The single strap can then be adjusted easily to provide the suitable degree of compression; tighten the strap during activity, loosen it during periods of rest.  

Lightweight and low profile, the brace can be worn comfortably throughout the day. And with universal sizing for either arm, EpiForce Strong even takes the hassle out of ordering.

References

  1. Shiri, R., Viikari-Juntura, E., Varonen, H. and Heliövaara, M., 2006. Prevalence and determinants of lateral and medial epicondylitis: a population study. American journal of epidemiology, 164(11), pp.1065-1074.
  2. Sanders Jr, T.L., Maradit Kremers, H., Bryan, A.J., Ransom, J.E., Smith, J. and Morrey, B.F., 2015. The epidemiology and health care burden of tennis elbow: a population-based study. The American journal of sports medicine, 43(5), pp.1066-1071.
  3. Johnson, G.W., Cadwallader, K., Scheffel, S.B. and Epperly, T.D., 2007. Treatment of lateral epicondylitis. American family physician, 76(6), pp.843-848.
  4. Haahr, J.P. and Andersen, J.H., 2003. Physical and psychosocial risk factors for lateral epicondylitis: a population based case-referent study. Occupational and environmental medicine, 60(5), pp.322-329.
  5. Ahmed, A.F., Rayyan, R., Zikria, B.A. and Salameh, M., 2022. Lateral epicondylitis of the elbow: an up-to-date review of management. European Journal of Orthopaedic Surgery & Traumatology, pp.1-6.
  6. Calfee, R.P., Patel, A., DaSilva, M.F. and Akelman, E., 2008. Management of lateral epicondylitis: current concepts. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 16(1), pp.19-29.
  7. Heales, L.J., McClintock, S.R., Maynard, S., Lems, C.J., Rose, J.A., Hill, C., Kean, C.O. and Obst, S., 2020. Evaluating the immediate effect of forearm and wrist orthoses on pain and function in individuals with lateral elbow tendinopathy: a systematic review. Musculoskeletal Science and Practice, 47, p.102-147.
  8. Kroslak, M., Pirapakaran, K., & Murrell, G. (2019). Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. Journal of shoulder and elbow surgery, 28(2), 288–295.
  9. Barati, H., Zarezadeh, A., MacDermid, J. C., & Sadeghi-Demneh, E. (2019). The immediate sensorimotor effects of elbow orthoses in patients with lateral elbow tendinopathy: a prospective crossover study. Journal of shoulder and elbow surgery, 28(1), e10–e17.
  10. Akkurt, H. E., Kocabaş, H., Yılmaz, H., Eser, C., Şen, Z., Erol, K., G ksu, H., Karaca, G., & Baktık, S. (2018). Comparison of an epicondylitis bandage with a wrist orthosis in patients with lateral epicondylitis. Prosthetics and orthotics international, 42(6), 599–605.
  11. Sadeghi-Demneh, E., & Jafarian, F. (2013). The immediate effects of orthoses on pain in people with lateral epicondylalgia. Pain research and treatment, 2013, 353597.

How a back brace can help patients with osteoporosis

Osteoporosis is a progressive condition that weakens bones, making them fragile and more likely to break.

As a result of this loss of bone, many osteoporosis patients will also suffer spinal compression fractures, with 1.4 million new clinical vertebral fractures reported in the year 2000.1 Such fractures can have a serious impact on a person’s ability to maintain an active lifestyle, with pain and a loss of confidence presenting two formidable challenges to overcome.

One therapeutic option available to osteoporotic patients is semi-rigid back bracing. These kinds of medical orthoses are designed to alleviate the symptoms of vertebral osteoporosis and help patients stay active, but what evidence is there that these products work?

What causes osteoporosis?

Bone naturally becomes thinner as a person ages, but women are especially vulnerable to osteoporosis after the menopause because their ovaries no longer produce oestrogen hormones which help maintain bone mass. Around 200 million women worldwide are estimated to be affected by osteoporosis.2

Other causes of osteoporosis are:

  • Removal of the ovaries
  • A diet lacking sufficient calcium
  • Certain hormonal disorders
  • Prolonged use of corticosteroid drugs
  • Prolonged immobility

Osteoporosis is also more common in heavy smokers and drinkers.

What are the symptoms and signs of osteoporosis?

The first sign of osteoporosis is often a fracture caused by a fall that would not result in a fracture in a young adult. Typical sites for such fractures are the wrist and the top of the femur.

Another type of fracture that occurs in osteoporosis is a spontaneous fracture of one or several vertebrae, which causes the bones to crumble, leading to a progressive loss of height or to pain due to compression of a spinal nerve.

What are spinal compression fractures, and how are they treated?

Spinal compression fractures occur when the combined axial and bending loads on the spine exceed the strength of the vertebral body, resulting in the collapse of the vertebrae.

These fractures are associated with back pain and disability, loss of height, and kyphosis – a spinal disorder in which excessive curving of the spine results in an exaggerated forward rounding of the upper back.3,4,5

Spinal compression fractures involving the anterior elements of the spinal column are considered stable fractures and most patients remain neurologically intact.5,6

Once a diagnosis is confirmed, the first line of treatment is typically conservative pain management, usually involving some form of bracing or physiotherapy.5,6

Some patients who fail conservative treatment may require hospitalization, long term care, and surgical interventions such as percutaneous vertebroplasty and balloon kyphoplasty.5,6

How can bracing help osteoporosis patients?

Orthopedic back braces designed for the management of osteoporosis symptoms should perform some or all of the following functions:

  • Control pain by limiting motion7
  • Stabilize injured structures by immobilizing the spine7
  • Provide pressure to promote correction and prevent deformity7
  • Reduce pain and fatigue8
  • Promote function or participation8

Of the different types, semi-rigid back braces seem to be the most effective, with good clinical evidence supporting their use for osteoporotic patients.

In 2011, Jacobs et al. demonstrated that using a semi-rigid thoracolumbar orthosis seems to have a positive effect on gait and stability in patients suffering from an osteoporotic spinal compression fracture.9  

In the same year, a study by Pfeifer et al. showed that the use of a semi-rigid orthosis increases trunk muscle strength and therefore improves posture in patients with vertebral fractures caused by osteoporosis.10

In Dionyssiotis et al.’s 2015 study, they showed that semi-rigid orthoses could be an effective intervention for improving back pain and muscle strength in osteoporotic women.11

And Meccariello et al. (2017) demonstrated that a semi-rigid orthosis proved to be safe and effective in the treatment of thoracolumbar osteoporotic vertebral fracture, with better functional outcome and less complications compared to a standard rigid 3-point orthosis.12

Introducing DonJoy® Osteostrap – a new back brace for osteoporosis

With its innovative modular design, DonJoy® Osteostrap utilizes a set of adjustable features to aid active relief and postural correction of the thoracic spine.

The brace’s reverse shoulder straps, semi-rigid dorsal frame, and lumbar belt combine to provide patient-specific support and correction of kyphotic posture through active relief and stabilization of the spine. The brace is easy to self-fit, and its intuitive fixtures remain within easy reach for hassle-free adjustment.

Comprised of two separate sections, the brace allows 15 combinations of different lumbar belt and dorsal frame sizes to accommodate spine lengths from C7-S1, as well as waist circumferences from 56 – 130 cm.

Soft, elastic, breathable materials help provide a comfortable fit, allowing extended periods of wear and encouraging patient compliance. Also, the brace’s low-profile shape allows the wearer to maintain freedom of movement while remaining supportive.

User-friendly, comfortable, and available in a wide range of sizes, DonJoy Osteostrap offers patients suffering from osteoporosis and other debilitating back conditions the support they need to help live a normal, active life.

References

  1. Johnell, O., & Kanis, J. A. (2006). An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 17(12), 1726–1733.
  2. Reginster, J. Y., & Burlet, N. (2006). Osteoporosis: a still increasing prevalence. Bone, 38(2 Suppl 1), S4–S9.
  3. Mathis, J.M., Barr, J.D., Belkoff, S.M., Barr, M.S., Jensen, M.E. and Deramond, H., 2001. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. American journal of neuroradiology, 22(2), pp.373-381.
  4. Burge, R., Dawson-Hughes, B., Solomon, D.H., Wong, J.B., King, A. and Tosteson, A., 2007. Incidence and economic burden of osteoporosis‐related fractures in the United States, 2005–2025. Journal of bone and mineral research, 22(3), pp.465-475.
  5. Genant, H.K., Cooper, C., Poor, G., Reid, I., Ehrlich, G., Kanis, J., Nordin, B.C., Barrett-Connor, E., Black, D., Bonjour, J.P. and Dawson-Hughes, B., 1999. Interim report and recommendations of the World Health Organization task-force for osteoporosis. Osteoporosis international, 10(4), p.259.
  6. Kanis, J.A., 1999. The burden of osteoporosis. Journal of endocrinological investigation, 22(8), pp.583-588.
  7. Kato, T., Inose, H., Ichimura, S., Tokuhashi, Y., Nakamura, H., Hoshino, M., Togawa, D., Hirano, T., Haro, H., Ohba, T., Tsuji, T., Sato, K., Sasao, Y., Takahata, M., Otani, K., Momoshima, S., Tateishi, U., Tomita, M., Takemasa, R., Yuasa, M., … Okawa, A. (2019). Comparison of Rigid and Soft- Brace Treatments for Acute Osteoporotic Vertebral Compression Fracture: A Prospective, Randomized, Multicenter Study. Journal of clinical medicine, 8(2), 198.
  8. Newman, M., Lowe, C.M. and Barker, K., 2016. Spinal orthoses for vertebral osteoporosis and osteoporotic vertebral fracture: a systematic review. Archives of physical medicine and rehabilitation, 97(6), pp.1013-1025.
  9. Jacobs, E., Senden, R., McCrum, C., van Rhijn, L. W., Meijer, K., & Willems, P. C. (2019). Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture. Clinical interventions in aging, 14, 671–680.
  10. Pfeifer, M., Kohlwey, L., Begerow, B., & Minne, H. W. (2011). Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: a randomized trial. American journal of physical medicine & rehabilitation, 90(10), 805–815.
  11. Dionyssiotis, Y., Trovas, G., Thoma, S., Lyritis, G., & Papaioannou, N. (2015). Prospective study of spinal orthoses in women. Prosthetics and orthotics international, 39(6), 487–495.
  12. Meccariello, L., Muzii, V. F., Falzarano, G., Medici, A., Carta, S., Fortina, M., & Ferrata, P. (2017). Dynamic corset versus three-point brace in the treatment of osteoporotic compression fractures of the thoracic and lumbar spine: a prospective, comparative study. Aging clinical and experimental research, 29(3), 443–449.

How a soft brace can help maintain an active life

When asked for their reasons for avoiding exercise, patients often blame pain and a lack of confidence due to perceived joint instability.

Such barriers to activity can be the first steps on a downwards slope to more serious health conditions, which is why it is so important for these patients to maintain a healthy level of activity in their daily lives.

An easy, low-cost way to address the symptoms that prevent exercise is soft bracing. Soft braces are elastic and non-adhesive orthoses often used to reduce barriers to activity.1

Soft braces achieve this by:

•   Improving joint proprioception1,5

Proprioception is the body’s ability to sense its own location, movements, and actions. Soft braces supposedly act on sensory receptors in the skin that contribute to improvements in proprioception1,2,5

•   Reducing pain1,6

Tactile stimulation provided by a soft brace can cause neural inhibition leading to the reduction of pain signals1,2

•   Improving joint stability1,7

Mechanical effects are usually associated with soft bracing. However, it has been suggested that a reduction in joint instability may be the result of additional sensory input from the brace, leading to improvements in proprioception1,2

Why use a soft brace?

•   Ease of use

With mechanical bracing, despite improvements in patient reported outcomes, there is an unwillingness amongst patients to wear these braces for prolonged periods3,4

•   Low cost

Soft bracing is mostly designed for compression and is usually elasticated. Due to the lack of hinges and metallic material, they are usually significantly cheaper than mechanical alternatives

•   Improve patient compliance

Mechanical bracing is sometimes associated with poor compliance due to factors such as skin irritation, discomfort, bad fit, bulkiness, practicality, and social stigma5

Introducing elastic knitted supports from DonJoy®

DonJoy® began life in 1978 when two ex-professional American Football players cut up their old wetsuits to make knee supports, and the company has since gone on to become a major player in the field of orthopedic and sports medicine bracing.

Continuing its track record of delivering high quality, practical products for sports and everyday activities, DonJoy now introduces a new line of soft active supports to help prevent and recover from injuries.

Comprising ten options for the ankle, knee, elbow, and wrist, this range combines supportive yet adjustable features with lightweight, adaptable materials to help provide:

  • Prevention
  • Protection
  • Stabilization
  • Compression
  • Support
  • Proprioception

Each product’s knitted construction uses a multidirectional elastic fabric which helps provide effective and targeted compression and support. This elastic material is also soft and breathable for enhanced comfort, which is further provided by compression-reduced edges that help divert pressure at the ends of the support.

The range comprises:

  • 3 ankle supports
  • 5 knee supports
  • 1 elbow support
  • 1 wrist support

Attractive and ergonomic, these supports won’t compromise style or comfort, leaving patients feeling confident and free to continue an active lifestyle.

To learn more about DonJoy’s range of elastic knitted supports, visit djoglobal.eu

References

  1. Cudejko T, van der Esch M, van den Noort JC, Rijnhart JJ, van der Leeden M, Roorda LD, Lems W, Waddington G, Harlaar J, Dekker J, 2019. Decreased pain and improved dynamic knee instability mediate the beneficial effect of wearing a soft knee brace on activity limitations in patients with knee osteoarthritis. Arthritis care & research 71 (8), pp.1036 1043.
  2. Hassan BS, Mockett S, Doherty M. Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis . Ann Rheum Dis 2002;61:24 8.
  3. Cudejko T, van der Esch M, van der Leeden M, van den Noort JC, Roorda LD, Lems W, Twisk J, Steultjens M, Woodburn J, Harlaar J, Dekker J. The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis. Arthritis Res Ther. 2017 Dec 1;19(1):260.
  4. Beaudreuil J, Bendaya S, Faucher M, Coudeyre E, Ribinik P, Revel M, Rannou F. Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis. Joint Bone Spine. 2009 Dec;76(6):629-36.
  5. Kwaees, T.A., Richards, J., Rawlinson, G., Charalambous, C.P. and Chohan, A., 2019. Can the use of proprioceptive knee braces have implications in the management of osteoarthritic knees: An exploratory study. Prosthetics and orthotics international, 43(2), pp.140-147.
  6. Sinclair JK, Selfe J, Taylor PJ, Shore HF, Richards JD. Influence of a knee brace intervention on perceived pain and patellofemoral loading in recreational athletes. Clin Biomech (Bristol, Avon). 2016 Aug;37:7-12.
  7. Sinclair, JK, Vincent, H, Richards, JD. Effects of prophylactic knee bracing on knee joint kinetics and kinematics during netball specific movements. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine. 2018; 23, 93–98.

Does functional knee bracing cause muscle atrophy?

Functional bracing is a conservative treatment that involves the wearing of an orthotic brace in order to protect a joint and/or increase stability following an injury.1

Despite their widespread use, it is claimed that long-term use of these functional orthoses may also cause muscular atrophy and reduction in muscle strength.2 As a result, some physical therapists, athletic trainers, and health practitioners are reluctant to recommend functional braces due to a perception that they cause weakness in the surrounding muscle.3,4

While a complete review of the current literature would be necessary to find evidence of braces causing muscle atrophy, many recent studies demonstrate that rather than contributing to weaker muscles, bracing instead helps muscles to be more active.

What is muscle atrophy and how does it occur?

The term “muscle atrophy” refers to the loss of muscle tissue. Muscle atrophy occurs in response to a variety of stressors, including decreases in external loading and neural activation, which is often referred to as disuse.5 Disuse often occurs in clinical settings following limb immobilization and bed rest, resulting in significant loss of muscle mass and force production.

The extent of muscle atrophy under disuse conditions is variable and dependent on a variety of factors including age, the physiological function and fiber type composition of the muscle, and the degree of unloading and inactivity. Studies have shown that muscle volume can reduce by as much as 5.5% in just 7 days.6

How bracing can support the OA knee without making the muscles weaker

Knee osteoarthritis (OA) is a painful condition that can lead to a reduction in physical activity. Knee OA braces relieve pressure on the affected joint and help the patient stay mobile, but is there a risk of associated muscle loss?

Rather than finding evidence of knee OA bracing causing muscle atrophy, a number of studies instead showed that it actually helps improve muscle strength.

In a 1997 study by Matsuno et al., 17 of 20 subjects receiving brace treatment for severe medial knee OA showed improvement of symptoms and function while also increasing quadriceps strength.7

Girija et al. (2010), found that in a group of 28 subjects, after 4 weeks of wearing an OA knee brace and lateral wedge, there was an improvement in isokinetic concentric peak torque of quadriceps and hamstrings, reducing pain and functional status.8

OA bracing was shown to have neuromuscular retraining benefits for 10 patients who took part in Johnson et al.’s 2012 study.9

Hurley et al. (2012), found that increased brace use over a 6-month period does not result in muscle impairment, and even found evidence of significant improvement in hamstrings strength.10

In Larson et al.’s 2013 study, results showing increased weight acceptance and ability to be able to push off with more power suggest that the OA brace worn by the subjects, by redistributing the loading forces in the knee, aided the strengthening of muscles in the leg.11

And finally, Callaghan et al. (2016), showed a flexible patellofemoral knee support did not have an adverse effect on quadriceps maximum voluntary contraction in participants with patellofemoral joint (PFJ) OA, and also that it significantly improved arthrogenous muscle inhibition (AMI). This indicates that individuals with knee PFJ OA may consider using a flexible knee support without concern that this type of device will impair muscle strength or activation.12

How can bracing promote muscle activity in patients with patellofemoral pain or ACL injuries?

Proprioception is the body’s ability to sense its own location, movement, and actions. This ability can be impaired in patients with an anterior cruciate ligament (ACL) injury.

Research has shown that improving proprioception with bracing also improves neuromuscular control, dynamic stability, and muscle activation in patients with ACL injuries and in patellofemoral pain (PFP) patients.

In PFP patients, the vastus medialis, which is one of the four muscles that comprise the quadriceps, commonly displays atrophy.13

Sker et al. (2017), showed long-term wearing of patellar bracing increases electromyography activity of vastus medialis during mid-stance and late stance and preswing sub-phases of gait.14

Additionally, Kölle et al.’s 2020 study demonstrated that patellofemoral bracing results in an immediate decrease of pain, an earlier onset of vastus medialis and inverted vastus medialis/vastus lateralis ratio, and altered knee kinematics.15

In their 1997 study of skiers using functional knee braces following ACL injuries, Németh et al. found that skiing with a DonJoy Defiance brace caused increased proprioceptive input resulting in higher EMG activity level of the dynamic knee stabilizers and adapted motor patterns contributing to increased active knee stability.16

And Ramsey et al.’s 2003 results indicate joint stability may result from proprioceptive feedback rather than the mechanical stabilizing effect of the brace.17 None of these studies suggest evidence of ACL or patellofemoral bracing causing muscle atrophy, and instead show it helps the body’s ability to stabilize itself.

Conclusions

In summary, these studies conclude that functional bracing does not cause muscle atrophy. In fact, they show that muscles are more active with functional bracing, and more active muscles mean less atrophy.

Here are the key ways in which bracing helps muscles to be more active, and patients to lead more active lifestyles:

  • Less pain means more activity. By relieving pain, bracing helps patients to stay active.
  • Improved proprioception results in better movement patterns which in turn lead to more optimal muscle activation.
  • Improved knee stability can boost confidence to take part in physical activity.
  • Reduced AMI and less fear of movement results in an increase in muscle activity.

All of this evidence means practitioners should have no cause for concern when considering bracing for patients with knee injuries. Instead, they can be confident that functional bracing is an effective way to help their patients maintain an active lifestyle. To learn more about DonJoy’s range of functional knee bracing, visit djoglobal.eu

References

  1. Sinclair, J.K., Vincent, H. and Richards, J.D. (2017). Effects of prophylactic knee bracing on knee joint kinetics and kinematics during netball specific movements. Physical Therapy in Sport, 23, 93-98.
  2. Sato, N., Sekiguchi, M., Kikuchi, S., Shishido, H., Sato, K. and Konno, S. (2012). Effects of long-term corset wearing on chronic low back pain. Fukushima journal of medical science, 58(1), 60-65.
  3. Denton, J.M., Waldhelm, A., Hacke, J.D. and Gross, M.T. (2015). Clinician recommendations and perceptions of factors associated with ankle brace use. Sports health, 7(3), 267-269.
  4. Callaghan, M.J., Parkes, M.J. and Felson, D.T. (2016). The effect of knee braces on quadriceps strength and inhibition in subjects with patellofemoral osteoarthritis. journal of orthopaedic & sports physical therapy, 46(1), 19-25.
  5. Bodine, S.C. (2013). Disuse-induced muscle wasting. The international journal of biochemistry & cell biology, 45(10), 2200-2208.
  6. Kilroe, S.P., Fulford, J., Jackman, S.R., Van Loon, L.J. and Wall, B.T. (2019). Temporal muscle-specific disuse atrophy during one week of leg immobilization. Medicine and Science in Sports and Exercise.
  7. Matsuno, H., Kadowaki, K. M., & Tsuji, H. (1997). Generation II knee bracing for severe medial compartment osteoarthritis of the knee. Archives of physical medicine and rehabilitation, 78(7), 745–749.
  8. Girija, P., Eapen, C., Zulfeequer, & Kamath, S. (2010). Effect of knee support brace and lateral wedge in sole on isokinetic peak torque in osteoarthritis of the knee–a randomized clinical trial. Indian Journal of Physiotherapy and Occupational Therapy—An International Journal, 4, 25-28.
  9. Johnson, A. J., Starr, R., Kapadia, B. H., Bhave, A., & Mont, M. A. (2013). Gait and clinical improvements with a novel knee brace for knee OA. The journal of knee surgery, 26(3), 173–178.
  10. Hurley, S. T., Hatfield Murdock, G. L., Stanish, W. D., & Hubley-Kozey, C. L. (2012). Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength?. Archives of physical medicine and rehabilitation, 93(3), 496–502.
  11. Larsen, B. L., Jacofsky, M. C., Brown, J. A., & Jacofsky, D. J. (2013). Valgus bracing affords short-term treatment solution across walking and sit-to-stand activities. The Journal of arthroplasty, 28(5), 792–797.
  12. Callaghan, M. J., Parkes, M. J., & Felson, D. T. (2016). The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis. The Journal of orthopaedic and sports physical therapy, 46(1), 19–25.
  13. Callaghan, M. J., & Oldham, J. A. (2004). Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome?. British journal of sports medicine, 38(3), 295–299.
  14. Salarie Sker, F., Anbarian, M., Yazdani, A. H., Hesari, P., & Babaei-Ghazani, A. (2017). Patellar bracing affects sEMG activity of leg and thigh muscles during stance phase in patellofemoral pain syndrome. Gait & posture, 58, 7–12.
  15. Kölle, T., Alt, W., & Wagner, D. (2020). Immediate effects of an elastic patellar brace on pain, neuromuscular activity and knee kinematics in subjects with patellofemoral pain. Archives of orthopaedic and trauma surgery, 140(7), 905–912.
  16. Németh, G., Lamontagne, M., Tho, K. S., & Eriksson, E. (1997). Electromyographic activity in expert downhill skiers using functional knee braces after anterior cruciate ligament injuries. The American journal of sports medicine, 25(5), 635–641.
  17. Ramsey, D. K., Wretenberg, P. F., Lamontagne, M., & Németh, G. (2003). Electromyographic and biomechanic analysis of anterior cruciate ligament deficiency and functional knee bracing. Clinical biomechanics (Bristol, Avon), 18(1), 28–34.

How a Maternity Support Belt can Help Reduce Pregnancy Pain.

Pregnancy pain is a common experience for many women, but it can often have a negative impact on their work lives and quality of life. Remedies for pelvic pain and low back pain during pregnancy often focus on water exercise and physiotherapy, which are not always practical solutions, but a growing number of clinical studies also support the role maternity support belts can play in reducing this pain.

There are two common types of pain during pregnancy:

Pelvic girdle pain

Pelvic girdle pain is defined as pain in the symphysis and/or between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joint.

There are several causes for this, but they tend to stem from hormonal and mechanical changes in the body, as internal organs move and ligaments soften to make room for the birth of the baby. During pregnancy, an increase in the hormone relaxin can cause increased laxity of the ligaments of the pelvic girdle, with the resulting increase in range of movement in the pelvic joint causing pain.1

While typically mild to moderate, pelvic girdle pain is reported as the most common reason for pregnant women taking sick leave, with studies reporting a prevalence of 4%-76.4% in women during pregnancy

Low back pain

Often beginning in the second trimester, low back pain is defined as pain between the costal margins and the inferior gluteal folds, which may be associated with pain referred down to the leg. Usually accompanied by painful limitation of movement, low back pain often interferes with quality of life and daily living.

The cause of low back pain is related to additional stress placed on the back as a result of changes in the body during pregnancy. It is normal to gain 20-40 pounds in weight during pregnancy, and as the abdominal muscles stretch, they lose their ability to maintain posture, causing the lower back to support the increased weight of the torso. Increased axial loading results in increased spine compression, which leads to pain.

Low back pain is often considered “normal” in pregnancy, with studies reporting a prevalence of 50%- 71.3% in pregnant women.6 As with pelvic girdle pain, low back pain is another leading cause for pregnant women seeking sick leave.2

How a maternity support belt can help reduce pregnancy pain

A maternity belt is a supportive garment designed to be worn during pregnancy to provide support to the lumbar spine or pelvic regions, thereby helping to relieve pain.

The intended effects include:

  • Compressing the body to increase proprioception
  • Reducing mechanical loading of the localized weight
  • Stabilising the lumbar spine and pelvis
  • Stimulating the action of the muscles around the abdomen, spine and pelvic floor

A range of recent studies3,4,5 have demonstrated the effectiveness of maternity belts in reducing both pelvic girdle pain and low back pain, as well as providing improved stability and reducing the risk of falling during pregnancy.

Convenient, safe, low cost, and easily accessible for pregnant women, it is common for specialists to recommend maternity belts, especially alongside other therapies.

MyBabyStrap®

DonJoy’s MyBabyStrap® is a lumbar maternity belt designed to help reduce pain and discomfort during and after pregnancy. It is indicated for

  • Lower back pain
  • Pelvic pain
  • Sacroiliac pain
  • Postural instabilities
  • Discomfort due to stretching and expansion of the abdomen
  • Back support after birth

MyBabyStrap includes a number of features to help provide functional, easy-to-use support for pregnant women.

Thanks to itsmodular design, the support is easy to adjust, making it adaptable to all stages of pregnancy and also after birth. This includes an adjustable back pad and four rigid posterior stays to help provide extra support and compression in the lumbar area, and bilateral straps that can be tightened to help provide additional relief. It also comes with a removable elastic strap for lower abdominal support.

MyBabyStrap’s anatomical shapefollows the natural contours of a pregnant body for a comfortable fit, with no pressure on the abdomen. Its thin, soft, and breathable fabric and ergonomic front panel also help to provide comfort whether sitting or standing, while the design includes stylish details for a more fashionable and attractive appearance.

Finally, the belt is easy to fit, with a simple hook-loop closure that allows patients to quickly and simply adjust it to reach the desired level of comfort. It comes in one size that fits waist circumferences from 80 to 150 cm.


REFERENCES

1. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794-819.

2. Kristiansson P, Svärdsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine (Phila Pa 1976). 1996;21(6):702-709.

3. Kordi R, Abolhasani M, Rostami M, Hantoushzadeh S, Mansournia MA, Vasheghani-Farahani F. Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain; a randomized controlled trial. J Back Musculoskelet Rehabil. 2013;26(2):133-139.

4. Flack NA, Hay-Smith EJ, Stringer MD, Gray AR, Woodley SJ. Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain – a pilot randomized trial. BMC Pregnancy Childbirth. 2015;15:36.

5. Bertuit J, Van Lint CE, Rooze M, Feipel V. Pregnancy and pelvic girdle pain: Analysis of pelvic belt on pain. J Clin Nurs. 2018;27(1-2):e129-e137.

6. Kovacs FM, Garcia E, Royuela A, González L, Abraira V; Spanish Back Pain Research Network. Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish National Health Service. Spine (Phila Pa 1976). 2012;37(17):1516-1533.