To Brace or Not to Brace

If you’ve ever gone through ACL rehab (personally or been part of the support

system), you are very aware of the question, “to brace or not to brace?”

So first, when people ask me about braces, I need to know which brace they’re

referring to. We have the rehab brace that is usually prescribed immediately post

op and is typically worn from 4-6 weeks depending on the patient and surgery.

Then we have the functional brace that is customized and prescribed for return

to sport. In all the rehabs I’ve done, I’ve seen both used, I’ve seen only one used

and I’ve seen none used. Most of the research is done on the functional brace but

this is often not clear in the verbiage and therefore a lot of people use this info

and apply it to any and all bracing in rehab, which isn’t necessarily fair.

So, what the heck is the deal with them?

I will share both what the research says and what I’ve seen in clinic and you can

decide from that.

The rehab brace:

Its function is to keep the knee locked in extension early on in rehab to protect

the graph (or meniscus if that was also injured) as the quad is still very weak and

the leg is unstable. I can tell you for sure that most athletes here hated it. It’s not

comfortable, it can slide down the leg, it can cause skin abrasion and sleep is

terrible. The research (studies done in 2006, 2015, 2024 and 2025) have

generalized that two groups (one who was braced early on and the other who

was not) did not have any significant differences from 1-5 years later in regard to

swelling, pain, function, and fear of movement. However, there is also research

that shows that fear is one of the biggest limiting factors that patients feel when it

comes to rehab, bigger than any physical part. And a supportive brace early on

just might help this.

Resting comfortably at home, a person recovers from ACL surgery with their leg securely wrapped in a supportive brace.

BUT from my experience, having the brace early is very different in the first couple months. That quad is still very weak and if they don’t have a brace to help,I tend to see a bent knee when they put their weight on that leg which can and often does lead to difficulty in maintaining full knee extension. Some may argue that without the brace, there is more force to get their quad to activate which, I admit, definitely has value. The other big piece of the rehab brace is a variable that is different from athlete to athlete (like most things, right?) and that is the thing between their ears. The psychological piece of loading all your weight on a leg that does not feel stable without any help can be very scary, especially at first.Having a big hug around that knee can help them feel more secure when beginning weight bearing which then helps the quad and nervous system feel

safer to make progress.

My personal opinion is to have them in this brace for at least a couple weeks after

surgery. I would rather hear them complaining about having an annoying brace

than hear them worried about putting weight on their leg or worried their

extension/quad strength is behind. It’s great that down the road there isn’t a big

difference between the two groups, but the first few months of rehab are rough

enough and if my patient is feeling more secure, stable and can feel progress

because of that thing during those early days, I’m all for it. Also, if I’m being

honest, this population is usually adolescent and they often benefit from a little

reminder that they are limited in their movements at this time. I am always going

to be gentle with their feelings about rehab, that doesn’t mean they aren’t being

pushed to make progress.

The functional brace:

The function is to provide customized support to the knee as well as protect the

graft during high impact, high risk cutting and directional change movements in

sport. These are expensive and often take multiple appointments to get the

correct measurements (expected, since ideally the quad and thigh girth is

increasing as the athlete gets closer to return to sport). So, what does the research

say about these?

A young person actively engages in physical therapy exercises, wearing a supportive brace following ACL surgery.

Someone smarter than me already dug into this and found that unfortunately,

there is not a high-quality randomized trial in the highest risk group which is

adolescent athletes. There are studies done, but not on the people we need or the

environment we need. In addition to that, another soapbox presents itself in that

most of this research is done on men when most of the injuries happen to women

(don’t even get me started on that one).

SO. Not much to go on there. So, what I do go on is my girls who have used a

functional brace and who have not. The girls who have worn them tell me they

are clunky and make them feel like a target (for the other team, “hey look I’ve

hurt my knee”). The girls who have not worn them tell me that as soon as they get

their first contact experience out of the way, they feel like they don’t need any

support/brace.

I do not require my athletes to go back with a brace but I do not discourage them

if they want to. I also will never go against a surgeon or parent if they require

their patients/child to go back with a brace. My sad opinion is that if an athlete is

in a position to re-tear, I don’t think a brace will stop it. Can it help make the

injury less severe? Maybe.

So overall, like so many things in this field (and I’m certain you’ve heard these

words if you’ve been a patient here), the answer is: it depends 😊

Kenzie Danner PT, DPT, CSMT, SFMA, Certified Sportsmetrics, Certified Functional Dry Needling L1