The Role of Bracing: Common Questions in Clinical Practice

Have you noticed that many patients come into the clinic not only in sneakers and activewear but also sporting various braces—whether on the knee, ankle, elbow, or elsewhere? With these braces come plenty of questions: When should they be worn? When should they be removed? Are they even necessary? If you’ve ever wished for clearer answers, you’re not alone. In this edition, we explore what current research tells us so you can confidently guide your patients when they ask, “What should I do?”

Balancing Support and Recovery

There is a multitude of brands and variations of braces available for most joints in the body. Each of these devices evokes the same general purpose that can be surmised in one word: ‘stabilization’. Bracing can range anywhere from flexible store bought options with brand names like CopperFit or Ace Brand, up to more rigid and complex articulating braces that are given post surgery or to athletes. What your patient presents with is going to vary but, in general, more acute injuries are going to have more rigid bracing prescribed by a physician, whereas flexible bracing will be seen with chronic conditions and may be purchased without any qualified healthcare advice.

The essential question remains: “When is ‘stabilization’ truly necessary?” As physical therapists, we know that stabilization happens because of naturally occurring soft tissue structures. However, there is no guarantee that these structures are in working order, especially when coming to see us. Acute conditions such as surgical repair of a ligament tear require rigid stabilization due to the 8-12 week process of soft tissue repair, where undue stress needs to be mitigated. When a patient presents with these conditions, a timeline is typically recommended by the physician or a clinical practice guideline to assist physical therapists in decision making as to when the brace can be removed.

A more complicated situation occurs when patients arrive with chronic conditions and bracing. I have seen patients and family members use flexible bracing for a variety of chronic conditions like instability or joint pain. Often, these braces come from family members that have had previous injuries and leave the wearer with a potentially poorly fitting option aimed at relieving pain. In these cases, the root cause often is repetitive injury to the problematic structure because of faulty movement patterns, postural deficits, or a variety of contributing factors. These factors result in pain and instability.

Managing the Patient Concern

The use of a brace for chronic conditions should be something that we are initiating conversations about. Many times these conditions are associated with emotional overlay that can perpetuate a chronic illness. Patients may purchase a brace as a first line of attack in efforts to take charge of their condition. As practitioners, we must recognize that relying on external interventions can significantly influence a patient’s self-perception and sense of independence. In the same way that some patients may become reliant on medications to resolve long term problems, bracing can hinder the rehabilitative process by providing a short term patch as opposed to a long term solution. The flip side to this coin is that a brace may empower a patient to regain confidence in their ability to participate in daily activities, providing the support needed to engage their muscles and other stabilizing structures, ultimately improving joint stability and overall function. 

In short, we must lean on our subjective skills to determine what psychological purpose the brace is serving for our patients in order to provide holistic care.

What Does Current Evidence Say?

According to studies published in 2016 and 2024, flexible bracing does not alter muscle development around the joint compared to not wearing a brace, and may enhance muscle recruitment at the joint due to the provided proprioceptive feedback. The study conducted in 2016 followed 108 participants with knee osteoarthritis who were enrolled in a randomized control trial to evaluate quadricep strength between groups that wore a flexible knee brace versus those who did not. It was found that there was no significant difference in quadricep strength at 6 weeks, and a significant increase in strength at 12 weeks due to reduced joint pain. This contradicts previously held beliefs that braces were detrimental to muscle strength¹. In the 2024 study, a small sample of 5 healthy runners were randomized and evaluated for quadricep and hamstring activity while running with or without a flexible knee brace. The results of this study advocate that flexible bracing is beneficial for the prevention and treatment of injuries related to abnormal knee extensor mechanics by increasing proprioception and more efficient motor recruitment².

Utilizing Research in Practice

Information is great, but it is the application to practice that is truly important so our patients continue to benefit from current research. As with any intervention strategy, overall patient presentation needs to be taken into account. Bracing for acute injuries typically follows guidelines set by the physicians that prescribe them or clinical practice guidelines specific to the condition. Physical therapists should use their best clinical reasoning to ensure that patients are appropriately adhering to these guidelines and that the brace is fitted properly. In scenarios where the patient has a chronic injury paired with no previous use of a brace, introducing a flexible brace could be a productive method to achieve therapy goals. Of course, the benefits of using a flexible brace described above are best used in conjunction with skilled therapy that can take advantage of its benefits. In scenarios where the patient has been using a brace long term and has not progressed in their therapy, it would be beneficial for the therapist to make sure that there is not a negative psychological component perpetuated by the brace. It is important to keep in mind that we should be constantly re-evaluating the care we provide to our patients to ensure optimal and holistic care. 

Parting Thoughts

With the information above, we hope that you feel more prepared to answer questions about bracing, with the confidence that you are backed by current research. Braces can be a valuable tool, but their use must be carefully tailored to each patient’s unique situation. This requires considering not only the physical and functional aspects of their condition, but also the emotional and psychological impacts that bracing may have. By applying evidence-based strategies and maintaining a patient-centered approach, we can ensure bracing serves as a complement to recovery, rather than a crutch that impedes it.

What patient scenarios have you been in that would have benefitted from more knowledge about bracing? How do you like to approach the discussion of emotional overlay that can be present in patients that use braces? We encourage you to comment and subscribe to expand this conversation further with our community of readers.

References:

1. Callaghan MJ, Parkes MJ, Felson DT. The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy. 2016;46(1):19-25. doi:10.2519/jospt.2016.5093

2. Zhang X, Wang X, Ren W, Jan YK, Yao J, Pu F. Effect of Different Soft Knee Braces on Quadriceps and Hamstring Activity During Running. In: 2024 17th International Convention on Rehabilitation Engineering and Assistive Technology (i-CREATe). ; 2024:1-5. doi:10.1109/i-CREATe62067.2024.10776293

Disclaimer:

We are current Doctor of Physical Therapy (DPT) students sharing information based on our formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While we strive to provide accurate and up-to-date information, our knowledge is based on our current academic and clinical rotations and ongoing learning, not extensive clinical practice.