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 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.