Features December, 2011 Issue

Bracing: R&R for Painful Joints

A joint brace can help an arthritic joint rest and recover—as long as you wear it when you need it and stop wearing it when you don’t.

Nearly 21 million Americans say that arthritis limits their usual activities in some way, and hundreds of thousands of people regularly use devices such as braces to help relieve arthritis-related pain and to improve function, according to the Arthritis Foundation.

Left to right: Semi-rigid knee brace shifts weight away from the most painful parts of the joint. Splinted brace relieves wrist pain from carpal tunnel syndrome. Strap-on ankle brace stabilizes a weak ankle joint. Counterforce elbow brace compresses forearm muscles, reducing strain on sore elbow tendons.

“If arthritic joints are painful, braces can offer support and allow you to do more without the same degree of pain,” says Susan Joy, MD, director of Women’s Sports Health at Cleveland Clinic. “Examples include walking or exercising with a knee sleeve or while wearing an ankle support, or typing with a wrist brace. The key is to use an appropriate brace if you need it, and stop wearing it when you don’t.”

Different Types, Different Reasons
A brace is basically a soft or rigid external device that is worn temporarily to help stabilize a compromised joint, provide support and pain relief, reduce the risk of further injury and aid recovery. Pre-made elastic and neoprene braces for joints such as the knee, elbow, wrist and shoulder are available over the counter in both drug and medical-supply stores. These braces come in a range of sizes, so you may have to buy and try different styles and sizes to find one that fits and works for you. Such braces provide some pain relief by compressing the muscles and ligaments around the joint; however, they should not be so tight that they affect joint motion or rotation.

Some semi-rigid braces are also available over the counter. Molded from lightweight plastic and other materials, these braces have built-in hinges and cushions and are often held in place with Velcro straps. These more rigid models can limit joint motion, so they should only be worn if you need to restrict the range of motion in your joint while going about daily activities.

Other braces are customized and fitted by a health care professional who specializes in such devices—for example, an orthotist or pedorthotist, an orthopedist, or a physical or occupational therapist. These braces generally are prescribed if you have incurred serious damage, often to a knee.
  
“Because braces can be used for different reasons, the type of brace you may need and the length of time you should use it can be highly variable,” cautions Dr. Joy. “That’s why it’s important to  ask your doctor specifically what brace to get and how to use it.”

The most commonly used braces are the following:

Knee brace: A one-piece elastic sleeve can provide compression around the joint and ease the pain of mild arthritis.  People with moderate or severe arthritis may benefit from a semi-rigid or custom-made brace that shifts weight away from the most painful parts of the joint.

Ankle brace: Many people start with a thin elastic sleeve; however, you may need more support, depending on the problem that is causing the pain, Dr. Joy says. See your doctor to be sure.

Elbow brace: Here too, the appropriate brace depends on the underlying problem, according to Dr. Joy. “Sleeves and tennis elbow straps are used for different problems,” she notes. Talk with your doctor to be sure you’re making the right choice.

Wrist brace: An elastic sleeve can help prevent pain from mild arthritis or repetitive use and reduce the chances of a wrist sprain. If you have carpal tunnel syndrome, which causes swelling of the tendons in the wrist, you may need a splint that keeps your wrist tilted slightly upward.

A Brace is Not Enough
“While a brace can help with pain, it is also important that you keep arthritic joints moving,” Dr. Joy emphasizes. “Balance the protection from the brace with stretching, regular exercise, and strengthening,” she advises. Your doctor or a physical therapist can provide a series of exercises that target your particular situation. Do the exercises as prescribed, use common sense (don’t overdo the exercises or put the affected joint at risk from a high-impact activity), and wear a brace only during the activities that require it for as long as it’s needed. Otherwise, wearing a brace may weaken the muscles and tendons around the joint, negating any steps you may be taking to stabilize the joint through exercise.