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| by Dr. Michael Ackland |
| Dr.
Ackland is a board certified Orthopedic Surgeon specializing in Sports Medicine. Dr. Ackland practices at New England Baptist Hospital in Boston and Cape Cod Hospital in Hyannis. I am always entertained by the number of people who are either using the wrong type of brace or have their brace fitted improperly. Little do they realize that the wrong brace will not help them. Braces can be divided into four basic groups; prophylactic, rehabilitative, patella femoral and functional. Prophylactic braces are used in normal knees to prevent possible injury. These are large braces with a hinge on the outside of the knee serving to protect the athlete from a blow on the outer aspect of the knee that could result in damage to the medial collateral ligament. You often see these type of braces in football used by interior linemen to protect themselves when blocking. There has been some controversy over the last few years as to whether these braces actually work to prevent injury. A study performed at West Point offered evidence that the braces did in fact lower the incidence of knee injury in this use. Certainly, the vast majority of athletes do not need these braces in most sports. If the braces are to be effective at all, they must be fitted perfectly to the specific athlete. Rehabilitative braces are used in the post operative period to protect the knee during the healing phase after surgery. The most common use is after a ligament operation such as an anterior cruciate reconstruction. As the healing process progresses, the patient can gradually be weaned off this brace as the tissue around the knee heals and is capable of assuming its role in maintaining knee stability. I commonly use these braces for a period of two to three weeks after my arthroscopic cruciate ligament reconstruction. Patella femoral braces are probably the most common type of braces. These braces are usually neoprene sleeves with a hole in the middle over the kneecap. The theory is that they help stabilize the patella (kneecap) when abnormal movement is responsible for knee pain. They are most commonly worn by young female athletes who are predisposed to patella femoral problems. Functional braces are designed to control normal motion around the knee on a long term basis after a knee is damaged and no longer can resist abnormal movements without some help. On occasion, I prescribe these braces on a long term basis for high demand athletes in stressful sports such as downhill skiing after an anterior cruciate reconstruction. The decision to use these custom made braces is made on an individual basis since not every athlete requires it. Before using any brace, make sure you have consulted a professional to make sure the brace you wish to use will produce the desired effect and is fitted properly. |
 The Role of Scapular Stability During Shoulder Function and Rehabilitation The Athletic Trainer has to be prepared at all times for the possibility of injury. The shoulder complex is always at risk to become the trainer’s next challenge. When rehabilitating the shoulder complex, no matter what the injury, I find that some aspect of rehabilitation should include scapular action in relation to shoulder function. The function of the shoulder depends on the ability of the scapula to perform its job or dysfunction is the result. Postural changes, muscle weakness, loss of flexibility (anterior muscles) and muscle spasm (upper trapezium) are all signs and symptoms associated with scapular instability. The ability of the Athletic Trainer to effectively manage these conditions will increase the chances for successful rehabilitation of the shoulder complex. When we treat shoulder injuries for the industrial athlete, there is not the possibility of an "off season." Return to competition as quickly and safely as possible is the sports medicine approach that has served the athletic community for years. At our facility, we find that early intervention with postural training, therapeutic exercise and passive modalities progresses normal healing with minimal loss of function. Education regarding the use of postural muscles to reduce stress on bony structures and decrease fatigue of muscles is the first component of scapular stability. The use of the cervical alignment (the ear with the lateral deltoid part of the shoulder), will begin to assist in better recruitment of the scapular stabilizers. Active contractions of the Rhomboid group (major and minor) are paramount in the role of scapular stability. Scapular retraction exercises, such as seated or standing rows with the arms held close to the body, increase recruitment of the rhomboid group. Rotator cuff strengthening must be included in the rehabilitation program to ensure that all components of the shoulder function are restored. Normalization of the shoulder girdle actions is always the trainer’s goal. No matter the protocol you employ, the role of scapular stability should be a part of any rehabilitation program. The only way to ensure compliance by the athlete is to maintain open and effective lines of communication with all members of the team. Feedback regarding the status of the injury with the athlete, coach, parents, supervisor and the trainer is the most important factor in the management of any condition.
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