Does patellofemoral Bracing Work?
We see people all the time walking around with knee braces that have holes cut out of the front. There are many of these braces on the market to better stabilize the knee cap in it’s groove. The basic concept is that one side or another of the knee cap may be rubbing and causing the cartilage to wear out, so by better taking control of the knee cap with a special brace, it must be possible to keep the knee cap away from the side that’s rubbing. At face value it makes sense, but does it work? Not according to this randomized trial of patellofemoral bracing for patellofemoral arthritis.This group conducted a sophisticated study of a PF realigning brace for the patella in patients with known patellofemoral pain due to arthritis. Eighty patients wore the brace for 6 weeks. One of my criticisms of the study was the group they tested was elderly (average age 61 years) and in my experience, most patients who wear these braces and swear by them are much younger (usually in their 30’s to 50’s). The fact that these patients were elderly may have meant that these patients had more severe arthritis than the average person wearing these braces for pain relief. I commonly see these “recruitment confounders” from university based, funded studies, meaning that the researchers can only usually attract patients for a study that aren’t like the patients who usually use the therapy. So do these knee cap braces work? Who knows, but I doubt this study shows more than elderly patients who don’t usually wear these braces won’t get much use out of them. What might work better to control knee cap motion? The knee cap is controlled actively by the big quadriceps muscles. In our experience, the patella is often out of active alignment because one side of this big four part muscle is inhibited by muscle trigger points. Nerve irritation in the low back nerves that supply the muscle (there’s a a section in our book, Orthopedics 2.0 that explains this knee muscle imbalance problem in more detail) can often lead to these quadriceps trigger points. As a result, we see many of our chronic low back patients develop patellofemoral arthritis. Usually trigger point deactivation therapies like IMS can make a big difference. If that doesn’t work, then injections of the patient’s own stem cells into this knee cap area may help.