To Brace, or Not to Brace?

Physical therapists are often asked about our opinion of braces.  There are many types of braces, including support braces for the spine, as well as sport/recreational/occupational braces for many areas of the body, including the knee and ankle.  My opinion of braces varies on a case-by-case basis.  We need to look at a variety of factors to determine whether wearing a brace is appropriate or not.  

In general, I am not typically in favor of wearing spinal braces.  The exception would be in a post surgical case, where the surgeon has specifically told the patient to wear a brace, normally to prevent movement while the body heals.  However, once this healing has taken place, we want the patient to wean out of the brace as soon as possible.  The reason for this is that the brace immobilizes the spine, leading to stiffness, loss of flexibility, and loss of strength due to inactivity.  The spinal muscles, when operating efficiently, will provide a natural “brace” of support for the spine.  If a patient becomes reliant on a brace for their support, their muscles will weaken due to not being used, and their problem actually worsens.

There are certain types of braces that I will recommend for a limited time, as long as they are not used as a long term solution.  Examples would be a “tennis elbow” brace, a patellar support brace, an ankle support brace initially after an ankle injury, or a shoulder sling.  In all of these cases, we are only using the brace for a limited period of time to allow the body to heal, or recover.  We are still trying to rehabilitate the body to work properly in the long term, so that the brace will not be needed long term.

Often the trickiest decision regarding braces comes when discussing the use of preventative braces during sports.  Examples would be ankle support braces for volleyball or basketball or knee braces for football linemen.  In each of these cases, the rationale for wearing the brace is to prevent potential injury by providing additional support for the joints.  Strong cases can be made for wearing the braces, as well as for not wearing the braces.  There is not even consensus within the medical field as to which is the better option!

In summary, the decision about whether or not to wear a brace is often complex and not clear cut.  The key is to have a thorough discussion of the pros and cons of bracing, so that each individual patient can make their own well informed decision.  

By: Mason Riegel, PT

---