Knee braces - unloading
Unloading brace
You used to take for granted that you could play a whole game of tennis or basketball without pain. But years of wear and tear have left their mark on your joints, and now your knees and hips hurt so much you can barely bend them. The pain you're feeling may be due to osteoarthritis, a problem many of us face as we get older. We all start out life with a thick layer of cartilage that cushions our joints in the space where the bones meet. That cartilage allows us to twist our legs to kick a soccer ball, or jump to shoot a basket. But years of running, jumping, and climbing stairs can wear out that cushion, leaving the bones rubbing painfully against each other. By age 70, just about everyone feels some pain and stiffness from osteoarthritis, especially when they get up in the morning or after they've overused the joint. You're more likely to have osteoarthritis if you're overweight. It's similar to what happens when you put extra weight on your bed. Eventually, you'll push on the springs so hard that you'll wear them out. The same is true for your joints. People who've had joint injuries or who have played certain sports are also more likely to get osteoarthritis. When you see your doctor about joint pain and stiffness, he'll check how well the joint moves and look for swelling around it. You probably won't be able to move the joint all the way. And when you do move it, it's likely to hurt and may make a cracking sound. An x-ray can confirm that you've lost cartilage around the joint. Unfortunately, there's no cure for osteoarthritis. But there are treatments to relieve the pain, including physical therapy, knee taping, special low load exercise programs, such as swimming, cycling, walking or stretching, and Tai chi in particular can be great for flexibility and strength. Over-the-counter medicines like topical Capsaicin, oral acetaminophen, aspirin, ibuprofen, and naproxen may help. Mud pack therapy may increase the benefit of whatever else you're doing. Your doctor may recommend getting a steroid injection into the joint to both relieve pain and reduce swelling. Another method, which injects artificial joint fluid into the knee, can relieve pain longer term, for up to six months. If the joint damage is really bad, you may need surgery to trim off damaged cartilage or to replace the affected joint in the knee, hip, shoulder, or elbow with an artificial joint. This is called joint replacement surgery, and is quite common for the both damaged hip and knee joints. Although it may hurt to move, staying active can help keep your joints healthy. Exercising can also help you lose the weight that's putting pressure on your sore joints. Ask your doctor to recommend a physical therapist, who can teach you exercises that strengthen the muscles supporting your joints. Osteoarthritis is different in everyone. Some people can get around fine with it while others have trouble doing even the simplest tasks, like bending down to get the morning paper. Before your joints get so stiff and painful that they limit your lifestyle, talk to your doctor about treatment and prevention options that can help you get around more like you used to.
Osteoarthritis is a chronic disease of the joint cartilage and bone, often thought to result from wear and tear on a joint, although there are other causes such as congenital defects, trauma and metabolic disorders. Joints appear larger, are stiff and painful and usually feel worse the more they are used throughout the day.
Osteoarthritis of the Knee
When most people talk about the arthritis in their knees, they are referring to a type of arthritis called osteoarthritis.
Osteoarthritis is caused by wear and tear inside your knee joints.
- Cartilage, the firm, rubbery tissue that cushions all of your bones and joints, lets the bones glide over one another.
- If the cartilage wears away, the bones rub together, causing pain, swelling, and stiffness.
- Bony spurs or growths form and the ligaments and muscles around the knee become weaker. Over time, your whole knee becomes stiffer and stiffer.
Unloading Braces for Knee Arthritis
In some people, arthritis may affect mostly the inside of the knee. This may be because the inside of the knee often bears more of a person's weight than the outside of the knee.
A special brace called an "unloading brace" may help take some of the pressure off the worn part of your knee when you are standing.
An unloading brace does not cure your arthritis. But it may help relieve symptoms such as knee pain or buckling when you move around. People who want to delay having knee replacement surgery may want to try using unloading braces. Unfortunately, these unloader braces are only effective when one side, either the inside or the outside part, of the knee is worn out. If the knee has generalized arthritis, the brace would not work well.
There are two types of unloading braces:
- An orthotist can make a custom fitted unloading brace. You will need a prescription from your health care provider. These braces often cost over $1,000 and insurance may not pay for them.
- Unloading braces may be bought in different sizes at a medical device store without a prescription. These braces cost a few hundred dollars. However, they may not fit as well and be as effective as custom braces.
It is not clear how effective unloading braces are. Some people say they have fewer symptoms when they use them. Some medical studies have tested these braces but this research has not proven whether or not unloading braces provide help for people with knee arthritis. However, using a brace does not cause harm and it can be used for early arthritis or while waiting for replacements.
References
Hui C, Thompson SR, Giffin JR. Knee arthritis. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 104.
Shultz ST. Orthoses for knee dysfunction. In: Chui KK, Jorge M, Yen S-C, Lusardi MM, eds. Orthotics and Prosthetics in Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 11.
Van Thiel GS, Rasheed A, Bach BR. Knee bracing for athletic injuries. In: Scott WN, ed. Insall & Scott Surgery of the Knee. 6th ed. Philadelphia, PA: Elsevier; 2018:chap 58.
Version Info
Last reviewed on: 8/12/2023
Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
