Your Guide to Knee Braces

One of the most annoying things about having knee pain (aside from the pain itself, of course) is trying to figure out which of the 9 million kinds of braces you should get. Alright, so maybe it only feels like there are that many types of knee braces. The majority of knee braces fall under one of 4 categories: knee sleeves, lateral stabilizers, hinged braces, and patellar tendon straps. Learn what distinguishes these categories from each other, why you’d want to use any of these types of braces, and how to ensure that you’re wearing the brace correctly.

Knee Sleeves

Knee sleeves are grouped into 2 categories: Closed Knee and Open Knee. The distinction between the two is very simple: Open Knee sleeves have an opening in the center of the front where your kneecap goes and Closed Knee sleeves don’t.

Typically, knee sleeves come in very simple forms and usually have no specifically reinforced or padded areas. Sometimes, though, knee sleeves can come with lateral supports (there is a photo of this type of brace in the Hinged Knee Braces section below). Sleeves with lateral supports typically have a skinny piece of mildly flexible plastic that is about 1 inch wide and runs the length of the brace from top to bottom along the medial and lateral sides of the brace. These supports can help keep the brace on in the correct location, but they may not help much with protecting against knee injuries that are caused by medial or lateral forces. This is because the flimsy piece of plastic is simply not thick enough or strong enough to resist the amount of force that it takes to tear knee ligaments or menisci.

Why You Would Use One

There is a bit of a dispute about how effective knee sleeves can be: the brace companies swear by them, many medical professionals think there are better options available for most knee injuries.

The material (neoprene) and thickness of the sleeve can “trap” body heat, which produces the sensation of having the sleeve help keep the knee warm. This is different from actually having a warmed-up knee, but it can help keep the joint from “stiffening up” during brief periods of inactivity (like having another person’s solo in between the two pieces that you’re dancing).

Perhaps one of the most important things that knee sleeves can do is serve as a mental reminder that you are currently having pain in your knee. When you’re wearing a knee sleeve and you move your knee, you feel the brace against your skin. This tactile (touch) sensation reminds you that you can’t (or rather, shouldn’t) do everything you usually do, thereby reducing the likelihood of further aggravating your knee.

Ensuring a Proper Fit

When using Knee Sleeves, it is essential to get a proper fit for the brace.

1. The knee sleeve is supposed to be tight! If it’s not tight, it’s not doing its job. If it falls down on its own, it is too big for your leg. (If it cuts off circulation or you can’t get it to fit around your quads, you can go ahead and bump up to a larger size). You may have a hard time pulling the sleeve up your leg. If you have a problem with the brace “sticking” to your leg or not wanting to get all the way up to where it’s supposed to be, you can try putting baby powder or Gold Bond in the inside of the sleeve.
2. For open knee sleeves: The hole in the center of the front of the sleeve is supposed to go around your kneecap. One of the most common ways that these braces are worn incorrectly is that they are not pulled up high enough. Also, if the brace is twisted, the edges of the patellar opening can actually put slight pressure on one side of your patella and alter the way that your kneecap is tracking within the femoral groove. This can lead to pain and injury.

Pulling up the brace: If you are using an Open Knee Sleeve, do NOT grab the patellar opening to pull up your brace. This will stretch out the brace and reduce its ability to stay up on your leg.

Although knee sleeves are typically a popular first choice for a knee brace (partially because the choices are overwhelming and knee sleeves are the least threatening and partially because they’re usually the cheapest), these braces don’t tend to help athletes with an actual knee injury. You may be able to save yourself some money in the long run by figuring out exactly what your injury is and then getting yourself a more specialized brace specific to that injury. The specialized brace costs more than the sleeve, but if you start out on the sleeve, you’re most likely going to continue having symptoms (or get them again in the near future). Eventually, you will likely end up buying a specialized brace. Skip the first (typically not helpful) step and just go straight to the effective one (a more specialized brace).

Lateral Stabilizers/J-Braces

Lateral Stabilizing Braces are also called Patellar Stabilizers or J-Braces. The reason this brace is called a J-Brace is because the part of the brace that provides the lateral stabilization for the patella looks like the letter “J”.

J-Braces are based on an Open Knee Sleeve design. However, they have a “J”-shaped padded section along the bottom and lateral aspect of the patellar opening that extends up past the opening. Additionally, the brace has straps (typically 2) that are pulled medially from the lateral aspect of the brace. These straps are used to hold the “J” in place to provide more effective resistance against lateral translation of the patella.

Why You Would Use One

J-Braces are used:

• To attempt to prevent excessive lateral movement of the patella (either due to improper mechanics or anatomic structure)
• To treat repeated patellar subluxation (the kneecap pops out of place and then puts itself back in place again and again), or
• To treat anterior knee pain caused by tight lateral structures (this can cause poor patellar tracking).

Ensuring a Proper Fit

Just like with knee sleeves, J-Braces are supposed to be tight. And, just like open knee sleeves, the patellar opening should go around the kneecap. However, the most important aspect of ensuring a proper fit for J-Braces is getting the “J” in the correct spot.

The bottom of the “J” needs to go over the patellar tendon (this is the squishy part of the front of your knee between the bottom of the kneecap and the prominent part of the upper shin bone). The upright portion of the “J” needs to go along the side of the patella, not the side of your leg. The J does not necessarily need to be touching the patella at all times, since (depending on your specific condition and your anatomy) it is meant to restrict excessive lateral movement not push the knee cap medially.

Hinged Knee Braces and ACL Braces

Some hinged knee braces include a neoprene knee sleeve, others go over separate knee sleeves that are very thin and serve to protect the patient’s skin from being rubbed or pinched by the brace.

Among the type of hinged knee braces are ACL braces for wearing during rehabilitation after an ACL Reconstruction. Post-op braces can sometimes fit into the category of hinged knee braces, but they may also fall into the category of knee immobilizers.

Why You Would Use One

Hinged knee braces provide the most stability on the medial and lateral aspects of the knee against valgus and varus forces (forces coming from the sides of the knee). Hinged braces, especially ACL braces, are designed to reduce non-contact ligament tears by providing external stabilization for the knee. Typically, you would not perform on stage while wearing one of these braces unless it could be hidden under a costume (full-length and/or hoop skirt) or incorporated into your costume. However, just because you’re not going to perform with it on does not mean that you shouldn’t rehearse while wearing it.

Ensuring a Proper Fit

The most important thing when putting a hinged knee brace on is making sure that the hinge of the brace lines up with the hinge of your knee. Think about the hinge of a door: there are 2 pieces that are held together with a straight pin. When wearing a hinged knee brace, you line up the hinges on the sides of the brace with the hinge of your knee as though a straight rod would be able to go through them just like a door hinge. The most common way that people wear hinged knee braces incorrectly is they wear them too low.

All braces come with directions that include, among other things, instructions on how to wear the brace properly and how to put it on. I’m not trying to sound like your mom here, but read the directions!

If the brace is not worn in the way that it is designed to be worn, it will not protect you the way that it is intended to. In fact, wearing any brace incorrectly can actually put you at risk of developing an injury.

Patellar Tendon Straps

Patellar Tendon Straps, or PT Straps, do not look anything like the other knee braces discussed here. Most frequently, PT straps are made from neoprene and have Velcro on their ends. Some straps have a “bump” in the part that becomes the front of the knee. Often this bump is made of dense foam. Athletes often use foam underwrap, also called “pre-wrap”, to make homemade PT straps.

Why You Would Use One

As you’d expect, Patellar Tendon straps are used for patellar tendon problems, like patellar tendinitis. PT straps can also be used to try to hold the symptoms of Osgood-Schlatter’s Disease (“jumper’s knee”) at bay, but they don’t typically resolve the symptoms completely. Occasionally, PT straps can also be used for unspecified anterior knee pain.

Ensuring a Proper Fit

When you are looking for a PT Strap, your best bet is to take the strap out of the packaging and try it on (as long as you don’t have to break the packaging to do so). This is because the sizing guides on most PT Straps are incorrect. These guides are based on the circumference of your leg, but the size that they match up with your leg circumference is typically too small.

Once you’ve got one that’s big enough to actually fit around your leg, you need to put the front of the brace directly over the patellar tendon (you need it in the squishy part of the front of your knee between your kneecap and the big bump on the front of the top of your shin).