Knee injuries make up 35% of all snow sport injuries and the prevalence of serious knee injuries has been on the rise, although the overall injury rate for skiers has decreased. The most common knee injuries sustained by skiers are Medial Collateral Ligament tears.
Knee braces or supports are worn by many skiers and January to April is peak time for support and brace distributors! There are many different types available; some are tailored to a certain injury or to a particular sport. They come in a variety of designs and support levels, from simple neoprene or elastic sleeves to full aluminium, customised hinged braces.
Whilst knee supports are popular amongst skiers, there is plenty of controversy surrounding their use. How effective are they at protecting an injury? Will they weaken the knee joint in the long run? Could they cause further damage during a fall? Can they be worn to prevent an injury?
Protection Vs Prevention
Knee supports and braces can be used to protect a current, ongoing or old knee injury. They can also be used as a preventative measure, where there is no current knee injury.
The majority of skiers will only think to wear a knee brace to protect an injury they already have and I personally see this as their main function. I don’t think that knee braces should be worn as a prophylactic aid. There are three main reasons for this:
Firstly, there is no substitute for developing good knee strength and balance (proprioception) which will help prevent a knee injury anyway.
Secondly, a knee brace could result in a different injury occurring. Whilst the brace may prevent excess movement at the knee, that force has to be transferred somewhere else and as the foot is fixed in the boot, the most likely place is up to the hip or lower back.
Thirdly, they can result in a false sense of security, meaning the skier takes more risks which could cause injury to themselves and other slope users.
Even the use of braces for protection of an existing injury is controversial. Here are some of the main arguments for and against their use:
Arguments for Knee Brace Use
1. Warmth = flexibility and increased blood flow.
Warmer, more flexible tissues are less prone to injury. These benefits are particularly pertinent to arthritis sufferers and neoprene supports have shown to be beneficial for pain relief.
2. Reducing lateral and rotation movements
These movements are by far the most common way for the knee to be injured. Hinged knee braces reduce these movements considerably.
Knee braces can be used post-injury to increase the skier’s confidence in the joint. In many cases, the knee is strong but it is the individual’s fear of re-injuring the joint that stops them from returning to sports.
4. Get the most out of your skiing holiday
If you go away on an annual skiing holiday, you want to get the most out of your trip. If you have a history of knee pain or injury, a knee support or brace may help you do this.
Argument against Knee Brace Use
1. Knee braces may cause injury elsewhere
This is touched upon above and it is possible that forces can be transferred from the knee up to the thigh, hip or lower back. However, the risk of a serious injury in these areas is a lot lower than the risk of a serious knee injury and the forces transferred are minimal (unless the hinge is locked to a set position – which is never recommended for sports participation).
2. Knee braces may slow proprioceptive improvement post-injury
Proprioception is the joints ability to determine its position and movement within space. The sensors which detect this information are located in ligaments and so injuries to these structures may reduce proprioception. This sense can be re-trained using balance exercises and equipment like wobble boards to challenge the sensors and speed-up the connection between them and the brain. When wearing a knee brace, the sense of balance and positioning at the joint is not challenged to the same extent and so the re-training of proprioception may be delayed.
3. If you need a brace, should you really be skiing?
Some people argue that if you need a knee brace to enable you to ski, then you shouldn’t be skiing. Not being able to ski without a brace means your knees are not strong or stable enough to withstand the forces placed on them.
My personal opinion is that you should do what feels right for you and your knee.
I don’t see any need for wearing knee braces to prevent injury if you have undertaken a recommended pre-ski fitness and strengthening program and have strong, healthy knees with no history of injury.
The wearing of a knee brace following an injury is advisable for moderate to severe injuries in the short to medium term. Just bear in mind that if the knee is not strong enough to ski without a brace, you should also be addressing this weakness with a strengthening and proprioception program and not relying on a brace as a long-term solution.
About the author: Heidi Mills BSc (Hons) GSR is a Graduate Sports Rehabilitator who runs two sports injury rehabilitation clinics and works for www.sportsinjuryclinic.net