Knee wraps and knee braces

Whether aiming to lift heavier, squat deeper, or protect an injured knee, athletes often rely on specialized support devices. Knee wraps and knee braces each serve unique purposes, influencing performance, stability, and recovery. This article delves into how these tools can enhance strength, safeguard joints, and guide rehabilitation, offering practical insights for athletes and coaches seeking an edge in both training and injury management.

Knee Wraps in Strength Training (The Role, Performance Effects, and Risks)

Knee wraps differ widely, ranging from thin elastic versions sold in drug stores to heavy, tightly-woven wraps commonly used by powerlifters. Their use is often justified by the intention to enhance lifting performance or reduce injury risk, despite the limited amount of research available on their actual effectiveness. Current evidence demonstrates that knee wraps influence not just the athlete’s perception of stability but the mechanics of the squat itself, particularly through the added tension and recoil they produce during knee flexion and extension. These mechanical effects have direct implications for performance output and for the stresses placed on the patellofemoral joint.

Key Mechanical and Performance Findings:

• Heavy knee wraps can increase squat lifting force by approximately 25 lb.
• This enhancement results from a spring effect (the mechanical assistance provided by heavy knee wraps during resistance exercises), not just joint stabilization.
• Knee wraps provide direct mechanical assistance during knee extension.

While this performance benefit is notable, knee wraps are also associated with certain risks. Reports include skin irritation or damage, as well as chondromalacia patellae, which is linked to increased compression and friction on the posterior patellar surface during loaded squatting. Because there is no strong evidence supporting the idea that knee wraps prevent injury, their use should be limited to situations where maximal loads justify their performance-enhancing contribution. Proper maintenance and storage within training facilities are also recommended to ensure consistent and safe use.

Risks and Use Recommendations:

• Potential side effects: skin damage and chondromalacia patellae.
• No evidence that knee wraps prevent injury.
• Recommended for heaviest sets only, not regular training use.
• Should be kept functional and stored appropriately in strength facilities.

Knee Braces

Knee braces are essential tools in managing ligamentous and traumatic knee injuries, as they provide joint stability and help control the range of motion (ROM) during rehabilitation. Their use is common among athletes after both operative and nonoperative management of ligament injuries.

Use in Ligamentous Injuries:

ACL Injuries:

• Postoperative functional bracing is standard practice after Anterior Cruciate Ligament Reconstruction (ACLR).
• Some protocols recommend bracing in slight hyperextension (–5 degrees) for at least 3 weeks to prevent loss of extension.
• Evidence does not conclusively show that bracing reduces graft rupture risk.
• One prospective cohort study on professional skiers reported fewer medial collateral ligament, meniscal, and osteochondral injuries with functional brace use.

MCL Injuries:

• Nonoperative management of Grade II and III Medial Collateral Ligament (MCL) tears typically uses a hinged knee brace with free ROM for about 6 weeks.
• Athletes may begin biking and strength training early, as tolerated by pain levels, while wearing the brace.

PCL Injuries:

• Nonoperative management of Grade I and II Posterior Cruciate Ligament (PCL) tears uses dynamic PCL bracing immediately to prevent excess posterior translation (sag) and residual laxity.
• This approach is preferred over immobilization.
• For PCL reconstruction, rehabilitation is more restrictive, often involving a dynamic hinged brace with limited motion (0–90 degrees) and nonweightbearing for the first six weeks.

Conclusion

Knee wraps and knee braces serve complementary yet distinct purposes in athletic contexts. Knee wraps are primarily performance-oriented, providing mechanical assistance during heavy lifts and directly enhancing knee extension, particularly in exercises like the back squat. Their effectiveness, however, comes with potential risks, including skin irritation and increased patellofemoral stress, and they should be reserved for maximal load sets rather than regular training.

Knee braces, in contrast, are essential for injury management, particularly in ligamentous injuries such as ACL, MCL, and PCL tears. They stabilize the joint, control range of motion, and facilitate safe rehabilitation, whether used postoperatively or in nonoperative management. Evidence supports their role in reducing the incidence of secondary injuries and guiding safe return to activity, though protocols vary by ligament type and severity.

In practice, athletes and coaches must carefully distinguish the purpose of each device. Appropriate selection, correct application, and proper maintenance are critical to maximizing benefits while minimizing risks. Integrating knee wraps and knee braces wisely can optimize performance, protect joint integrity, and support long-term musculoskeletal health in both training and rehabilitation contexts.