Bracing

The use of braces as a support for joints while an athlete is participating in sports has been a very common and well-established practice during the past 30 to 40 years. Today, bracing has grown into a large industry in the United States. However, there is conflicting evidence as to the effectiveness of braces in sports activity.

Bracing is thought to influence the efficacy and performance of a joint in multiple ways. It is widely thought that there are structural benefits in bracing a joint. These benefits include limiting the range of motion of a joint; this becomes important particularly when forces applied to a joint may cause the joint to exceed its normal range of motion, thereby creating the potential for injury. It is also thought that a brace, in the face of an injury force, may help dissipate and limit the force applied to the joint. Finally, it is thought that bracing may provide some benefit by limiting the ground reaction forces that are applied to a joint during sports activities.

There is also evidence for other types of benefits from braces. It is widely accepted that braces can affect the kinesthesia of a joint, or the sensation of muscle movement that one experiences during sports activity. It is thought that this, coupled with the proprioceptive benefit that braces provide, leads to an increased sense of joint position and function, thereby leading to increased performance. There is evidence that braces also affect the neuromuscular responses of the muscle groups that are affected by a brace; studies have shown that muscle groups may have decreased strength of contraction as well as a slowed response with bracing.

These neuromuscular responses highlight one of the difficulties in determining the effectiveness of braces as a class. In some instances (e.g., injury), it is advantageous for an athlete to have decreased contraction of muscles and increased periods of muscle rest. However, in the case of athletes trying to perform at their peak, this would not be a desired side effect of a brace. Research into the neuromuscular response of muscles with both acute and chronic brace use has been common over the past two decades; however, there have been conflicting results, making it unclear whether the use of braces is beneficial or harmful with regard to athletic performance.

In fact, research on the use of braces has its own limitations. In general, most research that is done with bracing involves the use of cadavers rather than live subjects. This type of research is often used to show the restriction in the range of motion of a joint while using a brace; however, cadaveric tissue does not respond in the same way as a live tissue would, as there are, among other problems, changes in the skin, in the muscles themselves, and, most important, in the neuromuscular response. However, there are also difficulties in using live subjects. These include the difficulties in finding an effective placebo for a brace, as well as the difficulties in standardizing brace-fitting as well as research protocols.

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