A common misconception among folks with sore knees is that they should be able to locate and wear a knee brace that will immediately reduce their pain/discomfort. Of course, having no knee pain would be an ideal result from a brace, but not all knee braces are designed with pain relief at the forefront.
The primary functions of most of today’s knee braces are to provide support/stability to an unstable knee joint or to change the alignment of a particular less-than-ideally aligned component of the knee joint. Improved support and alignment can reduce the chance of future degenerative joint changes. AND – a potential bonus to wearing a knee brace is a reduction in pain.
Some knee braces are more likely than others to reduce knee pain. For example, a brace with a solid hinge designed and worn to support the medial knee joint (for a torn medial collateral ligament), may also end up reducing medial knee joint pain. Similarly, a brace that helps to change the position of an improperly tracking patella (knee cap) can also provide pain relief of the cartilage between the patella and the femur.
Most common types of knee braces:
Patellar tracking brace:
Usually, a sleeve created of neoprene or a similar stretchy fabric
Two common options:
A. one that changes the alignment of the patella by pulling it in a different direction (usually medially, for patellar femoral syndrome or patellar tendinitis)
B. one with a buttress/reinforcement to hold the patella in place (for a dislocating/subluxing patella)
- Provide support to the knee joint not provided by compromised ligaments
- Choices are off-the-shelf (OTS) or custom (more expensive but better fit ensured)
- Both OTS and custom can be constructed with a solid/hard shells or stays, increasing support by decreasing the potentially harmful movement that an unstable knee joint provides
- A less expensive OTS option is a soft shell (often neoprene) sleeve with metal hinges
- A wrap around style of OTS (versus a pull on sleeve) is often easier to get into position
- Typically, you get what you pay for!
- Often custom, but can be off-the-shelf
- The only ones worth considering have solid/hard shells to effectively change the alignment of the lateral or medial knee joint
- Designed to “unload” one side of the joint to decrease further degeneration (and potentially pain)
- Tight fitting sleeve to offer general compression but mild stability of the joint
- Can help diffuse swelling and increase confidence with mild support
- often has reduced compression over patella to avoid articular cartilage irritation
- The best ones offer medical grade (15-20 mmHg) compression and require a bit of effort to slip on
Since there are a variety of indications for a knee brace, health professionals need to have a solid understanding of the condition and symptoms of the individual requesting the brace. The more information identified, the better the chance of providing the safest and most effective knee brace possible.
For over 40 years we have all been routinely treating injuries with ice. Yet, surprisingly, there is no scientific evidence to support the use of ice for tissue healing and recovery. In fact, recent scientific research and clinical studies show that, not only is the application of ice ineffective in some cases, but it can also delay the healing of an injury.
A 2013 Journal of Strength and Conditioning Research article concludes that “these data suggest that topical cooling (icing), a commonly used clinical intervention, appears to not improve but rather delay recovery from eccentric exercise-induced muscle damage”.
Gabe Mirkin, the doctor who came up with the popular treatment acronym RICE in the late 1970s (rest, ice, compression, elevation) is backtracking and admits RICE was widely accepted without scientific validity.
According to Gary Reinl, the author of “Iced! The Illusionary Treatment Option”, icing does not reduce swelling or inflammation. The lymphatic system is responsible for eliminating the “waste” in the tissues caused by inflammation. It does this predominantly by muscle movement putting pressure on the one-way valves. Ice inhibits this muscle pump and therefore does not reduce swelling.
When tissues are damaged, more blood arrives at the injury site and with it, inflammatory cells such as leukocytes and macrophages. These cells rush to the damaged tissue to release proteins which clean up and heal the injured site. This build up of fluid, or swelling at the site should be considered a positive reaction. It allows the inflammatory process to progress, and prevents further injury (by increasing sensitivity to pain and restricting movement). Healing is delayed by anything that temporarily blocks blood flow to the injury site – like certain medications and ICE.
We should not stand in the way of our body’s natural inflammatory response, which consists of a universally recognized 3 phase healing process. Inflammation is the first phase followed by the tissue repair and tissue remodeling phases. So if we stop inflammation, we are stopping the healing process. Essentially there cannot be healing without inflammation.
Ice can still be used for temporary pain reduction and local numbness – just be aware of its role in inflammation and swelling. Do your due diligence and then get on board with the huge industry-wide movement!
Our physiotherapists believe in keeping up to date with best practices and the most effective treatment strategies.
Runners, coaches, medical professionals, and now parents, are all realizing the benefits of allowing children to have proper natural foot motion. According to the experts, parents should think twice before putting their kids in a pair of “good sturdy shoes.” It seems that the smartest design that will ever be developed for injury free activity is the human foot itself. Our feet are sensory organs that allow us to interact with our environment and to develop natural movement patterns. Studies suggest that shoes can interfere with that development. “Balance, stride length and stride width are all influenced by our ability to sense the surface we are landing on. The more “stuff ” between the foot and the ground the less ability we have to sense the landing surface.” says Paul Langer, D.P.M., chair of the American Academy of Podiatric Sports Medicine’s Shoe Committee.
Rob Conenello, D.P.M., international lecturer on podiatric sports medicine, advises putting children in the “most minimal shoe possible, and adding support if necessary.”The level of minimal that is possible will vary with the child and may vary as the child ages.”
RECOMMENDATIONS FOR PARENTS: (Jonathan Beverly, Running Times Magazine, April 2010)
1) Encourage kids to go barefoot whenever possible: in the house, yard, parks, on the beach.
2) Buy the most minimal shoes appropriate for your child. Look for shoes that are flat, with low heels, little cushioning, flexible in all directions, light weight with lots of toe room. In early development, a child’s foot is widest across the toes.
3) Ensure all of your kids’ shoes are running-friendly. Kids don’t change into running shoes to run, they do it naturally throughout the day.
4) Add support only if necessary. Get an evaluation from a physiotherapist or podiatrist if your child shows signs of needing structural support.
5) Allow and encourage kids to run more like they do when they are very little: short bursts that end when fatigued, with a relaxed stride, at a variety of paces.
6) Encourage kids to participate in a wide variety of physical activities that build strength and flexibility.
7) Help kids stay at an appropriate weight through diet and activity.
Given what we’re learning about how minimal shoes can be beneficial to an adult’s running technique, efficiency and injury prevention, it makes sense that we should be starting our kids off on the right foot.
Sue Underhill is a registered physiotherapist and owner of Maximum Physiotherapy. She offers running assessments using video analysis and treadmill running and gives technique and footwear advice. To book a running assessment at Maximum call 705-444-3600.
When we have a sore muscle from physical activity, we assume the muscle must be tight and that we need to stretch it. Often though, especially if we’ve been participating in a repetitive activity/sport for many years, a sore muscle may indicate a relative weakness in the muscle.
To recover from a muscle strain or to prevent one altogether, it’s important to strengthen your muscles “eccentrically”.
An eccentric muscle contraction occurs as the muscle fibres lengthen. This happens when we do things such as lowering a weight by controlling it through a muscle’s full range of motion. Eccentric training, often referred to as “negatives”, focuses on slowing down the elongation of the muscle. This type of training allows for the greatest muscle forces at relatively low energy costs.
Many muscles cross two joints: hamstrings and hip flexors cross the hip and knee, the gastrocs cross the knee and ankle, and the long head of biceps crosses the shoulder and elbow. So to strengthen these particular muscles, we need to look at the position of both joints to make sure the muscle is being contracted throughout its full length. For example, to strengthen the bicep muscle eccentrically, lie on your back on a bench with your arm over the edge, and slowly lower a weight by extending the elbow and also extending the shoulder.
To get the biggest return on your investment, make sure to include eccentric strength training throughout a muscle’s full length.
Sue Underhill, Owner/Physiotherapist