There’s a lot to consider when deciding whether to use a brace for extra support in knee arthritis.
It seems like a simple solution: a brace that will offload pressure from your knee and make it easier to move around. Although knee braces are most often medically indicated for rehabilitation after injury, many arthritis patients with both osteoarthritis and inflammatory arthritis also attested to their usefulness. “I find it does help — gives a bit of support and warmth,” Stephen B. told us on Facebook. “I mostly put it on when I start to feel a continuous strain or pain in my knees.”
Unfortunately, the science backing up knee braces’ effectiveness for arthritis patients has been mixed, with no clear indication that they will work for everyone. Still, using a knee brace might be worth trying, but only in conjunction with physical therapy and a regular exercise plan, and only under your doctor’s and physical therapist’s supervision.
How Does a Knee Brace Help Arthritis?
According to American Physical Therapy Association (APTA) spokesman Robert Gillanders, PT, DPT, the goal of a knee brace for arthritis patients is to provide support for the knee, and in doing so, to decrease pain and improve function. But exactly how it does this isn’t exactly known.
“There are many theories about how knee braces work in patients with arthritis, none of which have been proven conclusively,” says Kathleen Hogan, MD, an orthopedic surgeon at New Hampshire Orthopaedic Center in Nashua, New Hampshire, who specializes in hip and knee arthritis. “Braces may provide some compression and support to the soft tissues around the knee. Wearing a brace may improve proprioception [knowing where you are in relation to things around you]. Braces may allow people to feel more comfortable exercising, and there is evidence that exercise and strengthening help to treat the symptoms of knee arthritis.”
Although knee braces have mostly been studied in people with OA, people with rheumatoid arthritis and other inflammatory types that affect the knee may also share the benefits of wearing a knee brace. “Whether it’s osteoarthritis or rheumatoid arthritis, people have pain, swelling, muscle weakness, and impaired function of the leg,” says Gillanders, a physical therapist at Point Performance Therapy in Bethesda, Maryland. “The goal of the bracing [the knee] is very similar in that we’re trying to provide stability and manage the pain and associated swelling while we address some of the mechanical issues.”
Signs You Could Benefit from a Knee Brace
If you often feel like your knee if about to buckle or give way, you might benefit from a knee brace, as this is a sign of instability, says Gillanders. Another indication is if you have frequent pain or swelling in the knee. In these cases, you could “test drive” a brace to see if it helps.
“I encourage patients to register how frequently that’s happening and then we have an easy benchmark to say, for example, it was happening five times a day and now it’s happening once, so we’re seeing the influence of exercise and the knee bracing,” he says.
Your chances of benefitting from a knee brace may depend on your specific case. “Braces seem to work best in people with milder arthritis or arthritis only in one part of the knee,” Dr. Hogan says. (Tricompartmental knee arthritis is when you have arthritis in three parts of the knee joint.)
“They work particularly well when the knee is no longer straight, either varus (bow-legged) or valgus (knock-kneed) in orientation.” Your success may also be affected by your build, as she says people with heavier legs tend to have less relief from wearing a knee brace.
Different Kinds of Knee Braces
The choices of knee braces can seem overwhelming, but Dr. Hogan breaks down the four main types:
“They are a compressive wrap around the knee without hinges that may or may not have an opening for the patella, or kneecap,” Dr. Hogan says. “This type of brace works by providing compression to the soft tissue around the joint and may improve proprioception.” Nancy K. told us on Facebook she likes a knee sleeve with side stabilizer from Walgreens. “They have knee hole,” she says. “They are lighter than some with more wrap and brace but have gentle support and firm compression.”
Functional knee braces
“They have hinges to provide additional stability, but will not substitute for having strong muscles,” Dr. Hogan says. “These braces should be considered adjunctive treatment to a physical therapy program to strengthen quadriceps and hamstring muscles and improve balance and proprioception. Some patients with arthritis also find this type of brace more supportive than a compressive knee sleeve.” Nancy told us that sturdier braces, though, can get too hot and heavy.
“These are designed to treat patellofemoral [kneecap] instability and/or arthritis,” Dr. Hogan says. “These braces are typically smaller and have pads around the kneecap to prevent lateral subluxation [sliding out of joint].” They may be adjustable with Velcro.
Unloader knee braces
“These are specialized braces for the treatment of arthritis that attempt to alter the weight-bearing force on the knee, shifting it away from the part of the knee with arthritis,” Dr. Hogan says. “The most effective brace for arthritis is the unloader-style brace.” But, she says, they’re expensive (insurance may cover part of the cost with preauthorization) and available only through a physician. In addition, Dr. Hogan says they work best on thinner people with arthritis on only one side of the knee. They are generally intended for use during physical activity.
How to Choose the Right Knee Brace
The type of brace that will work best for you depends on where your arthritis is located in your knee, how bad your arthritis is, and what your particular issues are.
Compression sleeves, for example, might work to treat swelling; unloader braces work to shift the load from one part of the knee to another. Your doctor or physical therapist can help you decide which brace best meets your needs.
It also may be a case of individual preference. “I have people go to a resource like the local pharmacy where they can try on several different knee brace styles and see what’s comfortable for them,” Gillanders says. “There’s a range available over the counter that you can work with. That’s a good starting point rather than spending big bucks on something custom.”
In addition, “the bigger bracing companies like Don Joy or Bauerfeind have certain pre-made sizes, so a physical therapist could measure for example the girth of the knee, look at these brand name options, and give you a recommendation on appropriate sizing,” Gillanders says. Dr. Hogan says orthopedic surgeons may have braces at their office to help fit you as well.
But, “not everyone finds knee braces to be comfortable,” Dr. Hogan says. “Many women for example, find that braces do not fit them well. Women’s thighs tend to be a bit heavier than men’s, and braces are not always designed to fit women’s bodies well.” If you’re uncomfortable in your knee brace, it defeats the purpose.
When to Use a Knee Brace
The health professionals we spoke to all said knee braces were best used during physical activity and should be removed at rest and at night. “Most people find braces to be most helpful when being active,” Dr. Hogan says. “Playing tennis, golf, skiing, and hiking are some activities where knee braces can be beneficial.”
“When I expect to do some extra walking — go to the shops, visit a museum — I find a soft knee sleeve very helpful,” Elena K. told us on Facebook.
“The knee is under its greatest loads in weight bearing, so I will commonly say when you’re on your feet when you’re out and about is when I want you to have it on, because that’s where it’s going to have its greatest impact,” Gillanders says. Although he doesn’t put a time limit on wearing a knee brace, he encourages patients not to use the brace more than necessary, and to take it off when resting.
Gillanders doesn’t often use knee braces during physical therapy. “I really want patients to maximize the impact of the exercise and have an understanding of how to control the leg and how to engage the muscles,” he says.
Why Knee Braces Aren’t a Quick Fix
Speaking of physical therapy, it’s incredibly important that arthritis patients continue with their exercise and therapy regimen in order to strengthen the muscles under the brace. “We’re not advocating for bracing in isolation,” Gillanders says. “Knee braces are used as an adjunct to corrective exercises and cardiovascular exercises, part of a collection of treatment options.”
Although knee braces probably can’t slow disease progression, they may be used to improve mobility and function in order to engage in an exercise program. “If the tissues are calm they’re going to be tolerant of exercise in a different way versus if they’re irritable,” Gillanders says. Thus, muscles may become stronger, which eliminates the need for the knee brace down the line.
On the other hand, using a knee brace alone without an exercise routine can have negative consequences.
“Prolonged use can lead to weakness; the muscles around the joint that help support the joint get weaker because of the artificial support,” says Rajat Bhatt, MD, a rheumatologist at Allergy and Rheumatology Specialists of Houston, who only recommends knee braces for acute injury.
“If you want to use a knee brace it’s better to have it in conjunction with physical therapy,” he says. “The best thing is if the person has failed physical therapy [alone] or failed other options to try out the brace in conjunction with the physical therapist see if it works for you. It should be a crutch to another goal, to get more functional; it should not be used long-term.” Also, be make sure your doctor is part of your treatment plan decisions.
More Dos and Don’ts for Using Knee Braces for Arthritis
Here are some more tips on using a knee brace from the health care professionals we spoke to and patients we heard from:
The knee brace shouldn’t be too loose or too snug. Watch for redness and chafing. “It should be just snug enough that it’s going to stay in place but not so snug that when you take it off after an hour you’ve got this crease in your thigh,” Gillanders says. Elena told us, “The most comfortable one I have is elastic so it holds the knee in place, but not too tight because too much pressure has the opposite effect.”
Keep your brace clean, especially in hot weather. “It is important to clean knee braces routinely as the bacteria in sweat can cause skin irritation and even infections,” Dr. Hogan says.
Don’t have anything between the brace and you. “Braces should be worn against the skin and not over clothing,” Dr. Hogan says.
Ask your doctor or PT to check your fit. “If you have a brace with hinges, make sure the hinges are centered at the knee joint,” Dr. Hogan says.
Don’t fall for scams. “Sometimes patients receive calls from device companies — do not entertain them because you need to have a follow-up if you’re going to have a knee brace,” Dr. Bhatt says. “A doctor should know about it; it should not be done over the phone.” In addition, Dr. Hogan says there’s no data that braces with copper provide better pain relief, so skip those.
More expensive doesn’t necessarily mean better. “Picking [knee braces] is just trial and error,” Hannah M. told us on Facebook. “I’ve tried multiple brands, and some of my favorites so far have been dollar store ones.”
If the brace doesn’t work for you, stop wearing it. “I’ve tried a compression sleeve — did not help,” Violet B. told us on Facebook. “I did feel relief with more of a brace, but it kept my leg straight and it was too hard to get up when sitting.”
Consider your leg as a whole. “The knee is influenced by the foot and the ankle, and so looking at things like inserts in your shoes can have an impact on your knee, and the stability of the hip can have an impact on the knee,” Dr. Gillanders says. “It’s all part of a package deal.”