Sunday, October 13, 2013

Joint Mobility & Stability: To Brace or Not To Brace

In all aspects of physical activity there is the risk of injury. There are many methods of treatment for injuries, from icing to stem to ultra sound. A common practice when treating injured joints is to brace the joint. The function of the brace is to act as an artificial muscle and stabilize the joint. This method can be very beneficial when dealing with an injured stability joint, such as the knee or elbow, because it relieves stress and allows the joint time to heal. However, this method can be detrimental when dealing with a mobility joint such as the wrist or ankle. As you may or may not know, the body’s joints form a chain of mobile and stable joints, one following the other as demonstrated in the illustration below.
When a mobile joint, which is designed to have a wide range of motion, is stabilized by a brace and that range of motion is decreased, it forces the next joint down the chain to compensate for that missing range of motion and the stress is transferred to the next joint. When1
a mobile ankle is stabilized by a brace it forces the stable knee to mobilize in order to compensate, greatly increasing the risk of injuring the knee.
A common mistake made by general practitioners, sport coaches, and athletic trainers is to brace a joint too quickly instead of strengthening the area. If a brace must be used, for instance if an athlete is in their competitive season and has no time for full recovery, the athlete should be removed from the brace as soon as the season finishes and the joint should be strengthened. All too often braces become a lifelong companion for individuals because they never properly recover from their injury and strengthen the injured joint; their brace makes them feel comfortable and confident all the while stabilizing the joint and maintaining its weakness.2   
1. Gray Cook, Athletic Body in Balance.

2. Eric Cressey, Magnificent Mobility.

8 comments:

  1. This is a really good topic to talk about. As you said we, athletic trainers, physical therapist, and related health care clinicians, often choose to brace and partially immobilize a joint, when it gets hurt; instead of looking at and fixing the problem. This is a quick solution, but rehabilitation and strengthening of the joint must never be overlooked. When we fail to take the individual through a full rehabilitation program, we are creating potential imbalances and susceptibility for other injuries. We should never forget that our body is a great machine that has the ability to heal by itself as long as we provide it with the proper resources that it needs; time, therapeutic exercises, and eustress.

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  2. This was a great topic and one that is often overlooked. Braces are used like band aids on cut, just there to comfort you and cover up what's hurt. Covering up a problem doesn't fix it. Although braces are needed at times one should always look to strengthen and rehabilitate the injury first. Tanner does an awesome job in educating us on this problem we have with injuries today.

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  3. I have to agree that this was a great topic in today's sports world, where it seems like every day we hear of a different professional athlete severely injuring a knee, ankle or other joint. As an athlete that had trouble with ankles and knees while playing soccer, I see where the problems from my knee came from after having an injury to my ankle. I chose not to have a brace on my ankle due to the mobility constraints that it put on my legs and feet while trying to play soccer. At the time it was no big deal because I played through the pain. However now when I play sports if it involves anytime of cutting, my ankle is very quick to roll due to the lack of rehabilitation and stabilization when I was first injured.

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  4. First off great blog! This information both personal trainers and strength & conditioning coaches need to know when & when not to use a brace in order to inform clients & athletes correctly. In my field, as a personal trainer, I see a lot of people wearing braces for various reasons and have become co-dependent on using them. They can’t imagine life free from their braces. Most people seem to view them as lifesavers instead of what the brace has truly become, “a Crutch.” I will print a copy of this blog, with your permission and pass this information on to open-minded gym members that might be interested in the possibility of being free from their braces. The only exception will be when someone says, “My doctor says I should always wear it when doing this.”

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  5. Great blog Tanner! From an athletic trainer's point of view, I couldn't agree more with Tanner. Many athletes want to just brace up their injury to get out of rehabilitation. However, as we both know, strengthening the surrounding area and letting the body be strong enough to support its own joints is ideal. Yes, as you said, braces are often used during the season, but it is always better to strengthen the muscles around the joint. The kinetic chain of the body is also important to address. It is very common for a secondary injury to occur because an athlete is favoring the original injury. As soon as we can get an athlete back to his or her normal range of motion he or she will be able to heal and get back into the game.

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  6. During high school I was a player that tended to roll my ankle more often than others. During season I would wrap my ankles or wear an ankle brace. It makes sense to me now that why I felt I needed to always wear a brace or have my ankle tapped. I never strengthen the joint after the season because I never stopped supporting my ankle. Even though tapping helped the stability of the joint I never had the full freedom of movement that I would have without the brace. Knowing what I know now I would not have worn a brace during the offseason, only during season if the injury had occurred again.

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  7. This was very informative. I have never known that you are supposed to strengthen the area that is hurt instead of just putting a brace on where it hurts. When I messed up my ankle playing football, my ankle was always in pain throughout the season. When I switched over to basketball I still was wearing a brace and playing through the pain, and I was wondering why it was still hurting after three months, but now I know that the injury never had time to properly heel. If would have just taking some time off I could have strengthen my ankle and been able to go back out there and play without a brace.

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