The Fallacy of Knee Braces 
Preventing Football Injuries
Ross Hauser, M.D.
 

A football player lays on the ground in agony, the announces hush as the trainers look at a knee. "That is a career ending injury," says one announcer. "Let's hope it is not the ACL," says the other announcer. 

Nothing stops a football player's career more frequently than a knee blowout. But can a knee blowout be repaired to 100%?

This is a pretty easy questions for a Prolotherapist to answer because, as long as the injury does not involve a complete tear of a tendons or ligament, the injury can be completely healed with Prolotherapy.

The anterior cruciate ligament (ACL) main functions are to prevent anterior (forward) movement of the tibia on the femur, to check external rotation of the tibia in flexion, and to a lesser extent, to check extension (backward) and hyperextension of the knee. The ACL is the most-often, seriously-injured ligament in the knee.Any impact onto the knee has the potential to injure the ACL. Typically, these injuries occur as a result of collisions, but can also occur without body contact, in twisting and other movements that exceed the normal range of motion. Because the ACL is one of the main stabilizers of the knee, a weak or stretched ACL is an extremely serious injury for any football player. Without stability in the knee, the career is over.

The Brace
In the late 70's Oakland Raiders' Superbowl and All-Pro quarterback Ken Stabler had a bad knee, the Raiders' head trainer George Anderson, developed a brace for him (Anderson Knee Stabilizer, 1978), to protect Stabler's previously injured knee ligaments from re-injury. Anderson's colleagues in the professional and college ranks were impressed with the reports of its effectiveness, and began using it to outfit their athletes who had sustained medial collateral ligament (MCL) injuries. Subsequently the medical staffs of several teams decided that the brace could also be used to prevent injury. A frenzy hit the sports injury field and the brace was universally applauded, and consequently, the growth of this market was rapid, with at least eight different manufacturers entering the market within five years. Unfortunately, the manufacturers provided no quantitative data to validate this bracing concept, and there were no independent studies to show that braces prevent injury.

The Brace As A Knee Hazard
American Association of Orthopedic Surgery and American Academy of Pediatrics Caution Against Bracing. In 1984, the American Orthopaedic Society of Sports Medicine called for research into seeing whether or not using a brace prior to injury would prevent a serious knee injury. The end result of this was that the American Academy of Orthopaedic Surgeons issued a position statement, cautioning clinicians regarding recommending the use of prophylactic (injury preventive) braces. Why do you think this happened? Because the studies showed that braces did not prevent injury and some were showing that braces actually increased knee injury rates.

The Research Reports:
Dr. George Hewson and associates conducted a four year study on football players at the University of Arizonia in Tucson to determine whether the knee brace prevented injury. The study keyed on linemen, linebackers, and tight ends because they are the most likely players to sustain injury. The researchers conclusions was that there was no significant reduction in the number or type of knee injuries. 
 

Football players at the University of North Carolina at Chapel Hill were studied next. Researchers statistically analyzed all knee injuries that occurred five years before and two years after braces began to be used. There was no change in the total number of medial collateral ligament or anterior cruciate ligament injuries.

Football players at Wake Forest University were studied. This study should have caused the abandonment of bracing football players. It showed an increase in the number of serious knee injuries when athletes braced their knees. There were three times the number of severe grade-three anterior cruciate ligament injuries in those using braces. There was an overall increase in knee injuries of 20 percent. The number of surgical procedures on knees increased by almost 50 percent during the bracing years. The overall injury incidence went up from 6.1 (unbraced) to 7.5 (braced) per 100.

Another study on knee bracing involved looking at seven of the most popular functional knee braces used to control anterior tibial displacement in people with ACL laxity. This study confirmed what researchers had already seen, the brace was a myth. The study's authors (Beck, C. et. al. Instrumented testing of functional knee braces. American Journal of Sports Medicine. 1986; 14:253-256.) noted, "Our data also supports the conclusions of other investigators, that as forces increase, the effectiveness of the functional knee braces in controlling anterior tibial displacement decreases. This was evident even at the forces used in our testing modes which, of necessity, were much lower than forces encountered in actual clinical settings." Some of the braces were showing almost no ACL support at the 40-pound of pressure mark. Imagine how the braces would hold up with a 250 pound linebacker smashing them. Other studies confirmed that even the most state-of-the-art braces did not significantly reduce the laxity in an ACL tear or injury. Athletes also found the braces to be unacceptable for running distances or jogging because of discomfort and migration of the brace distally on the knee. A great percentage of the athletes also noticed that the braces did not help them regain their previous athletic status. The only thing that can bring the athlete back to their previous athletic status is Prolotherapy.

Large NCAA Study
The largest study to date, involved looking at seventy-one schools which were members of Division 1 of the NCAA, to assess whether the use of so-called "preventive braces for the knee" was associated with a decrease in either the severity or the incidence (or both) of injuries to the knee in collegiate football players. In the first year of the study, the athletes wearing the braces were twice as likely to be injured. In the second year of the study, the risk of injury was increased by 50 percent. In addition to these facts, the braced athletes were much more likely to receive surgical procedures.