Saturday, August 1, 2015

On Wearing Supports for Knee Pain

I enjoy the Ask Well column at the New York Times website. It’s well-written and does a nice job of summarizing important research/studies and doesn’t blindly follow the fad of the day. I was intrigued when the idea of knee supports came up for discussion.

My completely unresearched position is that knee supports could make sense. After all, one challenge for a patient is unloading the joint. Wouldn’t a good support do just that?

So I was curious about what this (rather short) column found.

First, the most common, cheaper supports, the elastic sleeves that you tug over your aching joints, probably don’t provide meaningful mechanical support. Which means they don’t work? Not necessarily.

Neoprene sleeves are thought to help by aiding proprioception, according to   Dr. Robert A. Gallo, an associate professor of orthopedic sports medicine. Proprioception is the body’s sense of where it’s positioned in space (interestingly, this ability appears to decay among knee pain sufferers).

We are told:
In theory, improved proprioception around the knee joint could augment knee stability by improving your balance.
Of course there’s another reason why they might work: the placebo effect. The placebo effect can be very powerful. I think it’s behind a lot of glucosamine’s perceived benefits, for example. I’m very skeptical of the glucosamine story, after the supplement did absolutely nothing for me and my research uncovered no reasons why it should have.

But back to knee supports: So let’s say neoprene doesn’t mechanically unload the joint (which isn’t surprising, if you think about it -- that a small piece of synthetic rubber could significantly alter the alignment or movement of a joint that regularly handles loads of your body’s weight plus; it would be kind of like expecting a reed of straw to hold up a brick). What then would help?

What could be useful, Ask Well says, are bulkier braces that really do unload the joint. These are more complex (and expensive) and sort of make you look like a cyborg. These braces have been shown in studies to help people with knee arthritis.

Me, I never used a brace/support. I did try patellar taping. Once that seemed to work really well. And on other occasions it didn’t work at all.

Oh well. Maybe that was the placebo effect too.


  1. Placebo effect ='s idiopathic resolution? Translation: Cartilage heals and we don't know why. Here's a thought- Maybe right now, in this paradigm, we can't know why. With that in mind, are the following statements equivalent? I know how I healed my cartilage and cartilage cant heal...?

    One problem with speaking cartilage, or more specifically, with people healing bad cartilage, is that their status quo, their normal, lies (pun intended) at the origin of orthopedia. We presuppose that orthopedic surgeons know something, have real working knowledge, about how to make cartilage better (for arguments sake, here, I am speaking on behalf of the middle age person). Maybe they don't. Maybe choosing an ortho is like choosing a knee brace: Sometimes it helps, sometimes it doesn't and knees are so damn complicated that now one, except a charlatan, would pretend to know why.
    OK. That said, it is easy to imagine a world where all knee braces (and OS') are not created equal.

    1. That's an intriguing suggestion, that the placebo effect may actually indicate a resolution, but of unknown pathway. This may be true in some cases, but I suspect it would be a minority of cases, because if you look at a classic instance of a placebo effect (reaction to taking glucosamine), I think the brain arrives at a conclusion ("Hey I feel better") faster than actual healing could have occurred.

      But there is much that is unknown, that is true. Without giving in to a "nihilism of the knee" -- that we can't know, that we can never know, that nothing can be known -- I think knee pain sufferers should be careful about people who profess to know more than they actually probably do. Give arrogant orthopedic surgeons a wide berth, for sure.

    2. "I think knee pain sufferers should be careful about people who profess to know more than they actually probably do."
      Yes, exactly. But how to know?

    3. This is a good point. Of course you'll never know for sure. But I think your best chance of spotting one is to become a well-informed patient. Because there is a lot of uncertainty around healing bad knees, I would be wary of arrogant doctors. I would be wary also of doctors whose solutions involve mainly surgery and pills.

  2. Round 14years ago knee reconstruction, round 2 micro fracture and prp injections for no cartilage left in trochlea groove on femur, 6 months traditional physio rehab knee worst than ever. Going to start high rep training. Would anyone suggest any ideas for rehab, The runners bible? I don't want to give up, just sick of knee. Thanks for the blog.

    1. Welcome, and sorry to hear of your ordeal. Doug Kelsey is the way to go, in my opinion, if you want good suggestions for knee-friendly, high-repetition exercises. I wrote about his latest book below. It has exercise descriptions, photos, video links. After reading his writing online, I was convinced I could heal my knees -- and I did.

    2. Thanks for that and thanks for your book, help me a lot. Which book would be best. Do you know the difference?

    3. I'm not sure. His latest one (reviewed above) is probably fine.