Dr Paulos said that the #1 indication for prescribing load shifting braces is arthritis of the knee (Esp. Osteoarthritis -OA), and yes, based on all the literature, shoe wedges and knee braces do work to lessen pain.
The following is more from Dr. Paulos's presentation.
What is knee OA? It is the articular cartilage breakdown or loss (smooth lining that covers bone to decrease joint friction. OA can occur in the medial and/or lateral comparment of the knee joint.
The prevalence of knee OA is 12% overall in the USA and begins in the 4th decade, increasing in prevalence with age. OA affects women at a younger age, but is more prevalent in men. The risk factors for knee OA are advancing age, genetic make-up, gender, and hormonal status. Dr. Paulos also includes developmental deformity, muscle weakness that limits flexibility, decreased joint proprioception, obesity, join overuse or injury from repetitive activity, and poor nutrition as potential causes of knee OA.
Sports also can induce knee OA. Dr. Paulos stated that moderate running showed no risk unless the runner had been injured or had a structural abnormality, and that the evidence of OA in older runners was similar to that of non-runners. The highest prevalence of OA, especially at the elite level, was in soccer, and that the risk of hip and knee arthrosis is high with injuries excluded. Weightlifters had a positive risk for patella femoral OA possibly due to body mss and squatting maneuvers.
There is a problem. Arthritis is America's new epidemic. 1 in 5 Americans have arthritis, and OA affects an estimated 20.7 million Americans. OA is the leading cause of disability in the United States.
What are the treatments? A few are to self-medicate, on-line advice, friends, family practice/primary care, rheumatologists, and or surgeon.
Pharmacological Treatments? acetaminophen, NSAID's, analgesics/topicals (Dr. Paulos seemed especially fond of topicals), intra-articular injections (viscosupplementation / HA Supartz, Hyalgan, Synvisc, Orthovisc, Euflexya) cortisone or steroidal, nutriceuticals/supplements.
Non-pharma & nonsurgical interventions? A few would be orthopedic devices (canes, orthotic wedges, and braces).
Surgical intervention? Athroscopy debridement with a osteochondral transplant known as an OAT's procedure. Tissue engineering (Genzyme/Carticel) known as autologous chondrocyte implantation. In this procedure the surgeon removes a small healthy tissue sample and cultures it in the lab for 4-6 weeks. The cells are implanted to cover the defect with membrane. Adhesion occurs with fibrin glue. High tibilal osteotomy and uni/total knee arthroplasty are other surgical procedures.
Patient education: modify risk factors by decreasing frequency and intensty or a complete change in activity, rehabilitation, fitness (lose weight) assistive devices and bracing.
Obesity is a leading cause of OA. The forces across the knee is 3 times the body weight with each step - 10 times with stairs. Weight loss of 11 pounds can decrease OA by 50% with the strongest effect in women and a stonger correlation for weight loss than gain.
Physical Therapy can improve joint ROM and periarticular muscle strength, improve joint proprioception, and develop exercise habit. The exercise habit in increase strength, endurance and flexibility. Exercise will optimize weight, protect joints through improved biomechanics, improve cardio vascular function and a state of well-being.
Orthotics and Braces: heel wedges, heel and sole wedges, brace, sleeve, valgus or varus-producing functional brace, Biona-Care - electromagnet sleeves.
Knee Arthritis - Orthotic Treatment: The literature indicates that patients with mild knee OA did best with an in-shoe heel and sole wedge 1/8 - 1/4". Their pain scores decreased while their functional scores increased
Knee Arthritis -Bracing - Fact and Fiction: Hypothesis - by unloading an arthritic compartment of the knee...patients will experience less pain:increased activity. How does OA bracing reduce symptoms associated with compartmental osteoarthritis? It does so by creating an externally applied three point bending moment tht reduces contact pressure, reducing OA pain. The longer the brace the greater magnitude of the brace., and regardless of brace design ratonale (push or pull) the mechanics of three-point bending are identical.
Do Braces Really Work? - An emphatic - YES! All studies evaluating medial OA using valgus producing knee braces found that biomechanical unloading occurs, and that pain scores decreased and functional scores increased. But not all braces a created equal! Our surrogate studies (Finger and Paulos) have shown that DonJoy's OAadjuster to be 3 times more effective in load shifting, and is why I use the OAadjuster for my moderate unicompartmental OA patients who want to remain active.
The Most Important Use of the OAadjuster? I use the OAadjuster for my varus or valgus osteotomy patients to protect their ligament, meniscal, chondral or osseous procedures over a finite period of time.
Summary - Load shifting braces work to control coupled motions, shift the load where desired, and work best at full extension. DonJoy's line of OA braces allow me to match the product with the patient for best results.
Thank You - Lonnie Paulos, MD
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