Knee injuries are so common, and not just for sportspeople, this type of injury and pain is prevalent among young, old, active and inactive people. The most successful treatments are the ones that address the cause of the pain and problem and go about strengthening and stabilizing the joints, muscles and improving overall coordination and movement skill. Knee braces can be very useful if used in conjunction with exercises and movements used to correct the weakness or dysfunction. However they are relatively useless in helping your knee pain go away, without using a corrective exercise program. The same is true for anti inflammatory medication and even surgery! All of these common forms of treating your pain are not really dealing with the cause of the problem, they are merely just treating the symptoms. This article we will look at exactly what braces and sleeves are, how best to use them, and also what you need to do to get rid of your pain for good so you don't need to wear a sleeve anymore.
Knee Sleeves versus Knee Braces
Firstly sleeves and braces are not the same.
The pictures below represent the difference between a sleeve (left) which is what is most often used, versus a brace (right) which is mainly used after a serious injury like an ACL rupture or post surgery from an operation and the patient needs to keep the joint stable so the ligaments can repair and mend. I myself suffered a torn ACL a few years ago and I used the brace in the 2 weeks after the injury happened before progressing to the sleeve once my rehab program began.
More recently I have been using the sleeve for a meniscus tear that I sustained. The sleeve provides me with that little bit of extra support to help me get through the day but the main benefit I find is the compression helps to prevent the knee from swelling up.
The main difference between knee braces and knee sleeves is that the brace is much more restrictive of movement and is meant to protect the anterior knee and patella from any further damage. Whereas the knee sleeve does not provide the same ligamentous support. Hence why you use the brace after the initial injury or post surgery when the knee is vulnerable and unstable you need a brace and not a sleeve. The sleeve will do very little to fix or stabilize the knee.
What Does The Sleeve Actually Do?
Knee sleeves are what you see most people working out in, or on the basketball court or football field. They are generally made from neoprene material and slide on over the knee. In simple terms, the idea behind the knee sleeve is to reduce pain. They are useful to use when exercising or playing sport in that they do a few key things.
- Increase blood flow
- Keep the joint warm
- Reduce patella movement
- Can increase vmo activation and proprioception
- Give a sense of stability
Increased blood flow is very important for any injury for we need blood to heal the damaged area, which helps to reduce pain, and not only during exercise but also afterwards. The reason is that a compressed knee, keeps the joint warm and encourages blood flow through the blood vessels of the knee. (This is the main reason why torn ACL do not heal for they do not receive any blood due to the ligament being housed inside synovial fluid.
Read our article on ACL rehab for detail on this.
Using a knee sleeve results in less pain and swelling during and after performance.
In addition to the blood flow and warmth, the sleeve limits patella movement, and can increase proprioception (the capacity to feel the position of a joint in space as sensed by the central nervous system). I would also highly recommend using a sleeve with the small hole for the knee to stick through as opposed to a slide on sleeve as these do provide that little bit extra support and better patella tracking.
Research has found that a sleeve and even taping of the knee for that matter, can make a big difference in providing activation of an important muscle known as the VMO (vastus medialis oblique) in activating and providing stability of the knee. In fact they have found that even if you put the tape on incorrectly it is still better than no tape at all. This has something to do with the proprioceptive receptors in the muscles surrounding the joint.
See a video below on how to tape your knee.
Lastly and not to be forgotten is the overall mental security a sleeve can provide. There is a real sense of feeling more stable and secure, that helps the person feel in control of the movements they are about to do. Even if this is a placebo effect it can have a tremendous impact on how they move. By not guarding their movements they move more naturally and recruit the right muscles at the right time. Whereas when trying to move with a feeling of impending pain, compensatory movements kick in and injury is almost certain. The impact of sleeves for this cannot be understated and their use is of real significance in sports.
But how effective are they?
In the book "Understanding and Preventing Non Contact ACL Injuries" they had an entire chapter that looked at this exact question.
One of the interesting research studies they completed was a randomized study of 1396 cadets playing tackle football at the US Military Academy. The study showed that prophylactic knee brace did not significantly decrease the severity of ACL and MCL injuries. The was a trend toward a reduced rate of less severe ACL and MCL injuries in athletes who used braces. Only 16 ACL injuries occurred, 4 in the brace and 12 with no brace. They concluded more research needed to be done.
I would advise using sleeves if you have a knee problem when you exercise. But do not think that you are bullet proof and guaranteed to be injury free.
Sleeves Do Not Fix Your Problem
Now even though there is some great things that sleeves can provide, they do not solve anything to do with your knee pain. They are merely a tool to assist you in completing what you really need to do. Which is a corrective strength and stability training program. And if you do this right you will not need to wear a sleeve anymore!
You will need more than just a few leg exercises to target your quads, for what is needed is a comprehensive rehabilitation program that targets the reason you developed the pain in the first place. And guess what? In 90% of the time it has nothing to do with the knee itself! Most of the knee problems are caused from a problem elsewhere, usually the hips, the ankles or a movement dysfunction.
I highly suggest reading this article When You Have Knee Pain Rarely Is The Knee The Problem to see exactly in great detail where knee pain is created.
The amount of people I see each week in our rehabilitation program with knee pain who have very stiff and tight ankles, in combination with a weak butt is astounding! (close to 90% fail our assessments in these two areas!) Most of them did not even know they had stiff ankles! The ankles are not in pain so they did not think anything was wrong.
If the knee brace and sleeve is all about trying to keep the knee stable and prevent any lateral or rotation movement that can cause severe pain, then the joints above and below the knee being the hips and the ankles are all about being able to freely move with rotation and multi directional movement! If either of these joints become restricted you are bound for trouble. The knee will be forced into a poorly produced compensatory movement due to a restriction at either the hip or the ankle. The body will find a way, it will be less than ideal and it will risk injuring the knee but it has no choice.
What Can You Do About Correcting The Problem?
The answer to this question is you need to complete an assessment to identify areas that are potentially restricting your movement. You will find a detailed article that takes you through all of this process here - How to complete a knee pain assessment.
To help you right now I have provided some videos below that quickly take you through this process starting with looking for mobility restrictions.
Next you need to work on assessing stability of the feet and pelvis. This part is critical and often where you find hidden weaknesses that keep the injury from fully healing. In some cases we see great mobility but poor stability in a standing position which leads to stiff movements that create pain. It is impossible to develop strength if your stability is compromised and you must start here before progressing to the more difficult strength exercises to come.
The video below explains what I do in this stage.
Now you are up to the point where you assess your movement skills in a standing position.
This is by far the most critical stage. You can spend all the time mobilizing and working on isolated glute strength as you want and you will make no difference to how you move. For if the body only knows how to move in poor positions anything you do in step 1-4 will be automatically erased the minute you move.
The more a motor program is used the more efficient it becomes. But this is where it gets interesting. For the brain does not question if it is good or if it is bad, it only wants to perform the movement in the most efficient way it can using what it has learned.
We must assess all of the fundamental movement patterns of the body to see how well you coordinate movement but for the sake of this article I will break this down to the big 3 for knee pain.
- Squat
- Deadlift
- Single Leg Stability
The squat is always the most difficult movement to complete when you have knee pain for it really places a huge amount of compression. This does not mean you avoid it altogether, what it means is you have to identify the areas that are preventing you from moving correctly. You have to find a way to make this movement stronger if you want to get rid of your pain for good. The video below shows you 10 ways we would try to improve the squat pattern and it also explains what the most efficient technique is.
I would rate the deadlift and the single leg exercises better choices to use with most people in the early stages of rehabilitation before I use the squat. The glutes are a big part of the problem which is why the deadlift and single leg exercises are so important in the beginning. It is vital you learn how to strengthen these muscles in combination with all of the body, not just isolating them with clams and bridges etc. This is essential to do, but you must complete the previous steps first in order to do this safely and correctly.
Below are some videos to explain this for you in more detail.
Last but not least, you need to learn how to move at high speed. Braking is the key aspect to learn here and this is where we see all the disastrous non contact ACL injuries occur.
Even if you have completed the previous stages this can all be undone if you are using faulty patterns of movement or you have never truly learned how to land correctly from a jump or what the best way to pivot or twist and turn. Watch the videos below to see some great examples and also a detailed explanation of this stage.
Do You Need More Help?
For the complete program that gives you everything mapped out from start to finish with all the tests, a 6 month program, and over 60 specific knee pain exercises and mobility drills and stretches you will find is in our Knee Pain program. I cannot rate this highly enough as we have used this program successfully for many years with all types of knee pain injuries. Read our testimonials page on our website for proof of this program. You can download the 60 minute video instantly and receive the PDF report that goes through exactly how to complete the program. Click here to see more about this program or click the image below to go straight to the Online Shop and get it now.
Conclusion
I hope this gives you some clarity on the value of knee sleeves and braces. While they can be very useful and I do encourage their use if you play sport and have had knee problems before. Also you must appreciate that they will not solve your problem either, and most likely not prevent any further damage if you do not address the real problems by using a specific and individualized strength and stability training program. You must have exercises that target tight areas which are usually tight ankles, hips and thoracic spine, and also address weak areas such as glutes and stabilizer muscles of the core.
Lastly and by far the most important you must develop and coordinate all of the key movement patterns. Only by adopting a specific program to you that addresses these weaknesses and dysfunction are you much better positioned to never suffer pain again. And to be honest why would you need a brace if you did all of this!
And if you live in Melbourne and would like to schedule a free postural and movement assessment click the image below and I will be in touch within 24 hours to book a time.
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About The Author
Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Movement - By Gray Cook
- Corrective Exercise Solutions - by Evan Osar
- Athletes Acceleration Speed Training & Game Like Speed - by Lee Taft
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Low Back Disorders - by Stuart McGill
- Knee Injuries In Athletes - by Sports Injury Bulletin
- The ACL Solution - by Robert G Marx
- Understanding & Preventing Non-Contact ACL Injuries - American Orthopaedic Society For Sports Medicine
- Anatomy Trains - by Thomas Meyers
- Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- Scientific Core Conditioning Correspondence Course - By Paul Chek