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You have completed the stages of wondering what could be wrong with your knee and then worrying whether you've made the right treatment choice. Now, in the stage of rehabilitating your knee, you are in charge. Doctors and rehabilitation specialists may prescribe, but acting on their recommendations is up to you. Of course, that could also be the bad news, if you're not bound and determined to do what you must do to heal.
If you don't follow the proper rehabilitation protocol, you could find yourself right back where you started, or worse, with a weak and stiff immobile knee.
This chapter examines some of the tools you'll use to help you on the road to recovery and then presents the rehabilitative therapies particular to each knee problem. Some of the protocols and information have been adapted from Clinical Orthopedic Rehabilitation by S. Brent Brotzman. Much of the information in this chapter I developed with my friend and colleague Dr. Gary Brazina, one of the finest and most caring of orthopedists.
Knee bracing ranges from restrictive, long-legged braces that prohibit movement to simple straps that facilitate it. Braces are categorized by function as rehabilitative, functional, prophylactic, or transitional.
Rehabilitative braces are used during the acute or initial phase after injury or surgery. To maintain stability, they are usually long legged and have adjustable hinges that limit motion to a specific degree. They give maximum support and allow minimum freedom of motion. They may limit the amount of knee flexion or knee extension or both. These braces are used for a short time in the postoperative or postinjury period.
Functional braces control rotation of the knee and typically are used for sports activities to stabilize an unstable knee. Athletes who have had significant knee injuries use them to return to sports early while still protecting their knees. The braces are usually custom-made of light materials, such as titanium, but, because these materials cost about $1,000 per brace, generally only affluent patients or those whose insurance will cover the cost can afford functional braces.
Functional braces can be used before or after surgery. Patients who have decided not to undergo an ACL reconstruction may use a functional brace to return to some level of activity and often perform well. After ACL reconstruction, the brace may be used to protect the repair. However, a functional brace is not as restrictive as a rehabilitative brace.
Many functional bracing designs have been developed, all with advantages and disadvantages. The biggest disadvantage is that the brace may slip out of its initial position when used by a vigorous athlete, such as a skier or basketball player. The brace then causes discomfort and limits the mobility or speed the athlete needs for top performance.
Some functional braces, particularly the patellar-supporting type, are much less restrictive than others, since their main purpose is to keep the patella from slipping, tilting, or subluxing (partially dislocating). This version is useful during rehabilitation of patellofemoral syndrome.
McConnell taping can be used alone or in combination with a patellar brace. Taping has a disadvantage because it applies uncomfortable traction to the skin, which some patients find hard to tolerate. However, to stabilize a dislocating patella, a lateral buttress needs to be placed on the side of the brace.
Prophylactic braces are used to prevent injury to the knee. The most common type has a lateral post with two straps, one going around the tibia and one going around the femur. Bracing the outside of the knee was thought to minimize tears of the MCL, but several studies show that it actually increases the risk of injury because it puts an extra load on the medial side of the knee. Injuries may also occur with this brace because athletes feel they are protected when in fact they are not (sometimes called "the kamikaze syndrome").
Instead of using prophylactic bracing to protect your knees, try making changes in your playing surface and the type of shoes you wear. For example, use soccer-style spikes rather than the long football spikes that tend to anchor your feet in place when your body moves, forcing your knees into excess rotation.
Transitional braces are less restrictive than rehabilitative braces and often are converted versions of rehabilitative devices. They may be used after rehabilitative and before functional braces, but they are used sparingly for a variety of reasons. First, they are expensive, and insurance companies are hesitant to pay for more than two braces per patient (usually rehabilitative and functional). Second, leg girth generally increases greatly during the rehabilitative process, as muscle mass and strength are restored. A transitional brace is much more difficult to fit to accommodate the change in girth than a functional brace is.
Gait (the way the legs and feet move while walking) plays a vital role in knee health (see chapter 1). If you have an irregular gait, orthotics may be used to correct it. Orthotics are devices inserted into shoes, and they are often used (1) to adjust the position of the standing foot, for example, if it rolls too far outward (supination) or inward (pronation) while walking; and (2) to adjust irregularities in the arch, either high arches or flat-footedness.
Orthotics range from simple over-the-counter purchases to complex and expensive pieces designed specifically for you. Whichever you use, first obtain the advice of a specialist. An orthopedist, sports rehabilitation specialist, or chiropractor is versed in gait problems and corrections.
Excess Q-angle (discussed in chapter 1), more common in females and runners, can often be prevented by correcting the pronation and supination of the foot. Changing foot mechanics with orthotics can correct misalignment of the tibia, femur, and patella.
The most common types of orthotics are the following:
WebMD does not provide medical advice, diagnosis or treatment. See additional information.
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