Category: Donjoy

Living with Knee Osteoarthritis: How Knee OA Bracing Can Help Reduce Pain and Delay Surgery

Posted on | by Matthew Blackwell

Knee osteoarthritis (OA) is one of the most widespread musculoskeletal conditions in the world — and its impact on daily life can be profound. Whether you are a patient struggling to walk to the local shops, or a clinician searching for effective conservative management options, understanding the role of knee OA bracing is increasingly important. The evidence is compelling: the right brace, fitted correctly, can reduce pain, improve mobility, and in some cases delay or even prevent the need for surgery.

Knee OA: A Background

Knee OA affects an estimated 22.9% of people aged 40 and over — that is 654 million people globally in this age group alone.1 Radiographic evidence of knee OA is even more prevalent, detected in 28.7% of the population across all ages, though not all cases are symptomatic.1 The World Health Organization estimates that 344 million people living with osteoarthritis (across all joints) experience moderate or severe levels that could benefit from rehabilitation.2

For many patients, the journey from early symptoms to the operating theatre is a long one. Research by London et al. calculated that approximately 20% of American patients with symptomatic knee OA linger in what is known as the “treatment gap” — the period after conservative treatments have been exhausted but before surgical intervention — for up to 10 years. For younger patients, this gap can stretch to 20 years, a significant period of pain, reduced activity, and diminishing quality of life.3

Understanding the Vicious Cycle of Knee OA

Knee OA does not progress in a straight line. It is driven by a self-reinforcing cycle of interconnected problems. Malalignment of the knee — where the joint is not tracking correctly — leads to aberrant biomechanics and increased compartment loading, which in turn causes pain. Pain leads to decreased activity, which contributes to weight gain and muscle weakness, which further destabilizes the joint, and so the cycle continues.

Conventional pharmacological approaches such as analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can reduce pain and improve quality of life, but they do not address the underlying biomechanical causes of OA. There is also evidence that increased pain-free activity or walking speed following medication use may actually lead to increased joint loading4 and accelerated disease progression5 — a counterintuitive but important consideration for clinicians.

This is where off-loading knee bracing offers something fundamentally different.

How Knee OA Bracing Can Break the Cycle

A well-designed knee OA brace works by physically altering the forces acting on the knee during movement. The clinical evidence supporting this mechanism is substantial.

Increasing joint space

Research using highly accurate biplane radiography demonstrated in patients with medial knee OA that wearing a DonJoy OA Defiance brace can induce a significant increase of 0.3 mm in medial compartment dynamic joint space during gait — roughly a 10% increase during the impact phase of walking. This improvement was consistent from heel strike to terminal stance, meaning the joint is protected throughout the most demanding part of each step.6

Correcting malalignment

OA braces have been shown to shift the knee into a more corrected position in patients with varus (bow-legged) knees7,8 with the greatest corrective effect occurring at approximately 10% of the gait cycle — precisely the point of greatest loading.8,9 A biomechanical study using the OA Adjuster brace found a difference of 4° in varus angle between braced and unbraced conditions, a clinically meaningful correction.9

Reducing knee adduction moment

The knee adduction moment — the force that drives compression on the medial side of the joint — is a key driver of medial compartment OA progression. OA braces have been shown to reduce peak knee adduction moment by up to 32% during gait,7,9,10 with greater reductions achieved when the brace hinge is dialled in further.10 The adduction impulse, which accounts for both load and loading time, can be reduced by up to 37%.10

Improving stability and confidence

Muscle weakness and decreased stability contribute to reduced patient confidence in movement. OA bracing has been shown to improve both perceived and objective knee stability,11,12,13 which encourages patients to move more — breaking the inactivity cycle rather than perpetuating it.

The Impact of Knee OA on Pain and Everyday Life

The clinical outcomes for pain relief are striking. In a systematic review by Feehan et al. that included 15 clinical studies, 98.6% of 567 patients with medial knee OA experienced pain relief when fitted with an off-loading brace.14 In another study, both custom and off-the-shelf brace options produced significant reductions in pain and stiffness, with custom bracing also showing meaningful improvements in function.7

The effect on daily mobility is equally significant. A patient feedback study by Dries et al. (2022) found that wearing an OA Defiance brace considerably expanded mobility across all patient groups.15 The proportion of patients confined to their home environment reduced by 74%, while 42% of brace wearers reported being able to take a long walk or visit a local shop — activities that had previously been out of reach. This is not a minor quality-of-life improvement; for many patients, it represents a return to independence.

Can Knee OA Bracing Delay Surgery?

One of the most important questions for both patients and healthcare systems is whether bracing can delay or reduce the need for surgical intervention. The evidence here is encouraging.

A study by Lee et al. (2017) found that patients who wore an off-loading knee brace for two years or more did not require surgery at eight-year follow-up.16 Given that the off-loading knee brace is a cost-effective treatment option, its potential as a bridging therapy — reducing the burden of the treatment gap on both patients and healthcare systems — is considerable.16,17

A Place in Every Stage of Treatment

Modern OA bracing is not a one-size-fits-all solution. Braces are now designed to address a spectrum of OA severity, from early-stage support through to moderate and severe disease. This means clinicians can tailor brace selection to the individual patient’s needs, activity level, and degree of joint involvement.

For patients, the message is equally clear: living with knee OA does not have to mean accepting a steady decline in mobility and independence. For healthcare professionals, the evidence supports placing OA bracing earlier and more consistently in the conservative management pathway — not as a last resort before surgery, but as an active intervention that can protect the joint, relieve pain, and keep patients moving.

DonJoy® Knee OA Braces: For Every Stage of Osteoarthritis

Under the DonJoy® brand, Enovis™ offers a full portfolio of braces for all severities of knee OA and levels of patient activity.

DonJoy OA GO® helps provide relief from pain and mobility issues caused by mild to moderate knee osteoarthritis.17 With a simple twist of a dial, this innovative soft knee brace’s three-point offloading system quickly offloads the affected compartment to help relieve pain and ease movement.

ROAM™ OA helps patients say goodbye to knee pain. From picking up their grandkids to teeing off at the driving range, lightweight, low-profile joint offloading and support never felt so good—or was so easy to prescribe. ROAM helps improve mobility and provides relief by offloading the pressure of unicompartmental osteoarthritis or other knee pain.17

OA Nano™ is our lightest functional knee brace for mild to moderate osteoarthritis. Powered by DonJoy’s clinically proven Adjuster™ technology,17 it combines targeted offloading with minimal weight, helping patients maintain their activity levels in comfort. The flexibility of the streamlined aluminum frame allows for an intimate fit while providing offloading to support pain relief. OA Nano is designed to help people stay active and move freely, making patient compliance a reality.

For more information about managing knee osteoarthritis and finding the right support, visit donjoyoabraces.com.

Healthcare professionals interested in learning more about knee OA braces can contact their local Enovis representative or visit our website for detailed product information.

References

  1. Cui A, Li H, Wang D, et al. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020;29–30:100587.
  2. WHO July 2023 Osteoarthritis Key Facts. https://www.who.int/news-room/fact-sheets/detail/osteoarthritis
  3. London NJ, Miller LE, Block JE. Clinical and economic consequences of the treatment gap in knee osteoarthritis management. Med Hypotheses. 2011;76(6):887–92.
  4. Schnitzer TJ, Popovich JM, Anderson GBJ, Andriacchi TP. Effect of piroxicam on gait in patients with osteoarthritis of the knee. Arthritis and Rheumatism. 1993;9:1207–13.
  5. Huskisson EC, Berry H, Gishen P, et al. Effects of antiinflammatory drugs on the progression of osteoarthritis of the knee. Journal of Rheumatology. 1995;22:1941–6.
  6. Nagai K, Yang S, Fu FH, Anderst W. Unloader knee brace increases medial compartment joint space during gait in knee osteoarthritis patients. Knee Surg Sports Traumatol Arthrosc. 2019;27(7):2354–2360.
  7. Draganich L, Reider B, Rimington T, et al. The effectiveness of self-adjustable custom and off-the-shelf bracing in the treatment of varus gonarthrosis. J Bone Joint Surg Am. 2006;88(12):2645–52.
  8. Richards J, Jones R, Kim W. Biomechanical changes in the conservative treatment of medial compartment osteoarthritis of the knee using valgus bracing. ICRS 2006.
  9. The Comprehensive Textbook of Clinical Biomechanics, 2nd Edition. Elsevier 2018.
  10. Orishimo KF, Kremenic IJ, Lee SJ, et al. Is valgus unloader bracing effective in normally aligned individuals. Knee Surg Sports Traumatol Arthrosc. 2013;21(12):2661–6.
  11. Hart HF, Collins NJ, Ackland DC, et al. Immediate Effects of a Brace on Gait Biomechanics for Predominant Lateral Knee Osteoarthritis and Valgus Malalignment After ACL Reconstruction. Am J Sports Med. 2016;44(4):865–73.
  12. Hart HF, Crossley KM, Collins NJ, Ackland DC. Bracing of the Reconstructed and Osteoarthritic Knee during High Dynamic Load Tasks. Med Sci Sports Exerc. 2017;49(6):1086–1096.
  13. Kwaees TA, Richards J, Rawlinson G, et al. Can the use of proprioceptive knee braces have implications in the management of osteoarthritic knees. Prosthet Orthot Int. 2019;43(2):140–147.
  14. Feehan NL, Trexler GS, Barringer WJ. The Effectiveness of Off-Loading Knee Orthoses in the Reduction of Pain in Medial Compartment Knee Osteoarthritis: A Systematic Review. J Prosthet Orthot. 2012;24(1):39–49.
  15. Dries T, Van Der Windt JW, Akkerman W, et al. Effects of a semi-rigid knee brace on mobility and pain in people with knee osteoarthritis. J Rehabil Med Clin Commun. 2022;5:2483.
  16. Lee PY, Winfield TG, Harris SR, et al. Unloading knee brace is a cost-effective method to bridge and delay surgery in unicompartmental knee arthritis. BMJ Open Sport Exerc Med. 2017;2(1):e000195.
  17. Mistry DA, Chandratreya A, Lee PYF. An Update on Unloading Knee Braces in the Treatment of Unicompartmental Knee Osteoarthritis from the Last 10 Years: A Literature Review. Surg J (N Y). 2018;4(3):e110–e118.

Vertebral Fractures and Postural Dysfunction: How Back Bracing Can Support Recovery and Pain Relief

Posted on | by Matthew Blackwell

Back pain is one of the most common reasons people seek medical attention, and for many — particularly older women — the underlying cause is more serious than a simple muscle strain. Vertebral compression fractures and postural dysfunction driven by osteoporosis are increasingly prevalent conditions that can profoundly affect quality of life. The good news is that conservative management, including semi-rigid back bracing, offers a meaningful pathway to pain relief and functional recovery.

Understanding the Problem: Osteoporosis and Vertebral Fractures

Osteoporosis is a progressive condition that weakens bones, making them fragile and more likely to break. Bone loss is a natural part of ageing — by the age of 70, skeletal density has diminished by around a third — but for some people this process accelerates significantly. Women are particularly at risk, as bone loss speeds up markedly in the years following the menopause when oestrogen production falls.

Among the most serious consequences are Osteoporotic Vertebral Compression Fractures (OVCFs). These are the most common type of fracture associated with osteoporosis, with 1.5 million reported annual cases.1 OVCFs occur when the combined axial and bending loads on the spine exceed the strength of the vertebral body.

OVCFs are a major source of disability, as they can cause persistent back pain and kyphotic deformities (the characteristic forward curvature of the upper spine) that have a significant impact on the patients’ functional status and mortality rate.2,3

Conservative Treatment of Vertebral Fractures: Why Back Bracing Matters

The aim of OCVF treatment is to:

  • Minimize pain
  • Restore mobility
  • Prevent additional fractures

With surgical intervention reserved for those with persistent pain and accompanying neurological issues, most patients can be treated conservatively with a combination of pain management, physiotherapy, and back bracing.4

Bracing works through several hypothesized mechanisms. It limits spinal motion to control pain, stabilizes injured structures, provides pressure to promote postural correction, reduces fatigue, and supports function and participation in daily activities.5,6 Not all braces are equal, however. Rigid braces have traditionally been used, but their limitations — including poor patient compliance, atrophy of trunk muscles, and restricted respiration — have driven the development of alternative options.7

The Case for Semi-Rigid Back Bracing

The clinical evidence points clearly in one direction: semi-rigid, dynamic bracing consistently outperforms both rigid and soft bracing across key outcomes.

A 2011 study by Jacobs et al. found that patients with OVCFs wearing a semi-rigid thoracolumbar orthosis showed significant improvements in gait at six weeks — walking 14% faster, taking larger strides, and reporting 68% less pain compared to baseline. Crucially, these gains were maintained at six months.8

A randomized trial by Pfeifer et al. (also 2011) demonstrated that after six months, women with postmenopausal osteoporosis wearing a semi-rigid orthosis showed significant increases in back extensor strength, body height, and lung capacity, alongside meaningful reductions in kyphosis angle, body sway, and pain — all compared to a control group not wearing a brace.9

When semi-rigid bracing was compared directly with soft bracing in a prospective study by Dionyssiotis et al. (2015), the semi-rigid group achieved a 37% reduction in back pain scores after six months, alongside significant improvements in abdominal and extensor muscle strength. Compliance was also strikingly higher — 90% for the semi-rigid orthosis versus just 50% for the elastic alternative.10

Semi-rigid bracing also compares favorably against rigid bracing. A 2017 comparative study by Meccariello et al. found significantly better outcomes at three and six months for pain, disability, and respiration in the semi-rigid group, with far fewer complications (8 patients versus 28 in the rigid brace group).7

Even when set against an active exercise program, a randomized controlled trial by Kaijser et al. (2019) found that a dynamic orthosis increased back extensor strength by 26.9% at six months — comparable to the 22.1% achieved through structured exercise — suggesting bracing can serve as a viable alternative for patients who are unable to participate in formal training.11

Managing Vertebral Fractures with DonJoy Back Braces

DonJoy offers two semi-rigid back braces suited to the conditions discussed in this article, both designed to provide support, stabilization, and partial immobilization of the spine.

DonJoy Osteostrap is a two-part modular brace comprising a semi-rigid dorsal frame and an adjustable lumbar belt, worn together to provide postural correction and spinal stabilization. Its reverse shoulder straps use hook-and-loop strap tabs to draw the shoulders back and aid correction of kyphotic posture, while the lumbar belt pushes the dorsal stay towards the lumbar spine for stabilization. Increasing shoulder strap tension passively helps to correct thoracic hyper-kyphosis.

Osteostrap’s standout feature is its modular design, which allows 15 combinations of lumbar belt and dorsal frame sizes, accommodating a wide range of spine lengths (C7–S1) and waist circumferences. Carbon yarn woven into the fabric provides monoelasticity — elastic in one direction, supportive in the other — for an anatomical fit. Color-coded visual fitting dots guide patients and clinicians through a straightforward three-step application.

Indications include osteoporosis, stable vertebral fractures, dorsal hyper-kyphosis, osteoarthritis, traumatic fractures, postural dysfunction associated with Parkinson’s disease, and muscular weakness.

DonJoy Spinostrap is an entry-level semi-rigid back brace offering individualized thoracic support in a slim, low-profile design suited to everyday wear under clothing. Its moldable aluminum dorsal frame, adjustable shoulder straps, repositionable strap guide, and customizable lumbar belt allow prescribers and patients to fine-tune fit and corrective tension. Axillary shoulder pads and an optional sternal strap add underarm comfort. Materials are lightweight, breathable, hypoallergenic, and PVC and latex free.

Indications include support of stable spinal fractures, relief of pain and correction of postural dysfunction from dorsal hyper-kyphosis, postural dysfunction associated with Parkinson’s disease, muscular insufficiency or weakness, and spinal osteoarthritis.

Spinostrap is available in three sizes measured from C7 to S1.

A Note on Limitations

It is important to acknowledge that while the benefits of semi-rigid back bracing are well-supported across multiple studies, much of the available evidence is considered to be of low quality. High-quality prospective trials remain scarce, particularly for patients with acute or subacute fractures or severe osteoporosis, for whom bracing may not be appropriate. Clinical judgement remains essential, and bracing should always be prescribed and monitored by a qualified healthcare professional.

Conclusion

For patients with vertebral compression fractures, hyper-kyphosis, or postural dysfunction related to osteoporosis, semi-rigid back bracing represents a clinically supported, non-surgical pathway to pain relief, improved posture, and better quality of life. The evidence consistently favors it over both rigid and soft alternatives, with better compliance and fewer complications. Combined with appropriate medical management, it offers patients a meaningful tool to reclaim function and independence.

For more information on Enovis back braces and other products, visit our website or contact your local representative.

References

  1. Alexandru, D., & So, W. (2012). Evaluation and management of vertebral compression fractures. The Permanente journal, 16(4), 46–51.
  2. Beall, D., Lorio, M. P., Yun, B. M., Runa, M. J., Ong, K. L., & Warner, C. B. (2018). Review of Vertebral Augmentation: An Updated Meta-analysis of the Effectiveness. International journal of spine surgery, 12(3), 295–321.
  3. Rutenberg, T. F., Hershkovitz, A., Jabareen, R., Vitenberg, M., Daglan, E., Iflah, M., Drexler, M., & Shemesh, S. (2023). Can nutritional and inflammatory indices predict 90-day mortality in fragility hip fracture patients?. SICOT-J, 9, 30.
  4. Madassery S. (2020). Vertebral Compression Fractures: Evaluation and Management. Seminars in interventional radiology, 37(2), 214–219.
  5. Kato, T., Inose, H., Ichimura, S., Tokuhashi, Y., Nakamura, H., Hoshino, M., Togawa, D., Hirano, T., Haro, H., Ohba, T., Tsuji, T., Sato, K., Sasao, Y., Takahata, M., Otani, K., Momoshima, S., Tateishi, U., Tomita, M., Takemasa, R., Yuasa, M., … Okawa, A. (2019). Comparison of Rigid and Soft-Brace Treatments for Acute Osteoporotic Vertebral Compression Fracture: A Prospective, Randomized, Multicenter Study. Journal of clinical medicine, 8(2), 198.
  6. Newman, M., Lowe, C.M. and Barker, K., 2016. Spinal orthoses for vertebral osteoporosis and osteoporotic vertebral fracture: a systematic review. Archives of physical medicine and rehabilitation, 97(6), pp.1013-1025.
  7. Meccariello, L., Muzii, V. F., Falzarano, G., Medici, A., Carta, S., Fortina, M., & Ferrata, P. (2017). Dynamic corset versus three-point brace in the treatment of osteoporotic compression fractures of the thoracic and lumbar spine: a prospective, comparative study. Aging clinical and experimental research, 29(3), 443–449.
  8. Jacobs, E., Senden, R., McCrum, C., van Rhijn, L. W., Meijer, K., & Willems, P. C. (2019). Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture. Clinical interventions in aging, 14, 671–680.
  9. Pfeifer, M., Kohlwey, L., Begerow, B., & Minne, H. W. (2011). Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: a randomized trial. American journal of physical medicine & rehabilitation, 90(10), 805–815.
  10. Dionyssiotis, Y., Trovas, G., Thoma, S., Lyritis, G., & Papaioannou, N. (2015). Prospective study of spinal orthoses in women. Prosthetics and orthotics international, 39(6), 487–495.
  11. Kaijser Alin, C., Uzunel, E., Grahn Kronhed, A. C., Alinaghizadeh, H., & Salminen, H. (2019). Effect of treatment on back pain and back extensor strength with a spinal orthosis in older women with osteoporosis: a randomized controlled trial. Archives of osteoporosis, 14(1), 5.

Managing Chronic Low Back Pain Conservatively: The Role of Lumbar Bracing in Everyday Life

Posted on | by Matthew Blackwell

Chronic low back pain (CLBP) remains one of the most prevalent musculoskeletal conditions seen in clinical practice, affecting functional independence and quality of life across all demographics. Conservative management strategies — including patient education, exercise, and, where appropriate, manual therapy — are commonly used as first-line approaches for low back pain. Lumbar bracing remains a more selective intervention, with emerging evidence suggesting potential benefits in specific patient groups when prescribed as part of a broader care plan.

What Does the Evidence Say?

A 2023 systematic review by Oleiwi et al. brought together the highest-quality research on lumbar bracing for low back pain. After screening more than 14,600 published studies, the authors identified 13 randomized controlled trials — involving 1,838 patients in total — that met their inclusion criteria. All 13 were rated as the highest level of clinical evidence. When the results were pooled, lumbar bracing was shown to significantly reduce both pain and disability compared with control groups. The findings for disability were particularly consistent across the included trials. Among the different brace types studied, semi-rigid designs were associated with greater functional improvement than softer, more elastic supports — suggesting that a firmer level of support may offer more meaningful benefit during everyday activities.1

However, the authors also conceded that more rigorous randomized controlled trials are still needed to identify the type (rigid, flexible) of brace most useful, the mechanism of action, and the duration (short term, long term) of wearing the brace. Due to a smaller number of studies in their meta-analysis sections, their conclusion was limited and not generalizable, and more rigorous research is needed for a solid conclusion.

Addressing the ‘Muscle Weakness’ Concern

A persistent clinical concern is that prolonged lumbar brace use may lead to trunk muscle deconditioning. Two systematic reviews have directly examined this question. Azadinia et al. concluded that the available evidence does not support the assertion that lumbar bracing causes muscle weakness or atrophy during short-to-medium-term use.2 A systematic review with meta-analysis by Takasaki and Miki further demonstrated that lumbar-brace wear does not result in significant reductions in trunk muscle activity during functional tasks.3

These findings are reinforced by ultrasound imaging data showing no measurable atrophy of abdominal and lumbar muscles over four weeks of lumbar brace use.5

How Do Lumbar Braces Work?

Research using perturbation testing has quantified the biomechanical effects of lumbar braces, demonstrating increases in passive trunk stiffness alongside modulation of reflexive muscle responses — suggesting that braces support the spine through both mechanical and neuromuscular pathways.6 Beyond physical mechanisms, RCT data indicate that lumbar brace use is associated with reductions in pain-related anxiety and improvements in self-efficacy — psychosocial factors increasingly recognized as central to CLBP management.7

Outcomes in Daily Practice

One frequently cited randomized study in subacute low back pain comes from a multicenter randomized controlled trial (n=197) studying the use of a semi-rigid lumbar brace over three months, which demonstrated clinically meaningful improvements in both pain and disability outcomes. Another recorded benefit was the significant reduction in the consumption of pain medication in the braced group.8

A retrospective analysis of 199 patients using a rigid lumbar brace reported improvements in pain and disability scores that exceeded minimum clinically important differences at 3, 6, and 12 months.9 Although the latter study lacked a control group and therefore cannot establish causation, the subgroup analyses by diagnosis, age, and BMI provide a useful clinical picture of expected response patterns.

Matching the Orthosis to the Patient: DonJoy® Lumbar Bracing

Enovis™ offers two complementary lumbar support platforms under the DonJoy® brand, designed to match orthosis selection to individual patient needs across a spectrum of activity levels and clinical indications.

The DonJoy® Strap Range provides elastic and semi-rigid lumbar supports mapped across an activity–support matrix from light to strong. Skinstrap™, for instance, is a discreet, lightweight option with elastic webbing construction, four anatomically shaped dorsal stays, and dual hand loops for patient-controlled compression. Available in two heights (21 cm and 26 cm), it suits patients requiring support during daily activities without restricting mobility. The range extends through the Actistrap™ 2.0, and Porostrap models to the Immostrap 2.0 for maximum stabilization, with breathable materials and optional accessories including hot/cold therapy packs and massaging pads.

The DonJoy® LumboForce® range is a modular system of six products (LumboForce Sacro through LumboForce 5) incorporating patented adjustable technology. The range is indication-matched: LumboForce Sacro addresses symphysis and sacroiliac joint conditions; LumboForce 1–2 suit lumbalgia and degenerative conditions such as osteochondrosis; LumboForce 3 provides de-lordosis pain relief for disc herniation (stages 1–2) and facet syndrome; and LumboForce 4–5 offer rigid stabilization for more severe indications including advanced disc herniation, vertebral fractures, stenosis, and post-decompression support.

Clinical Considerations

Emerging evidence suggests lumbar bracing may offer selected patients short-to-medium-term support as part of a broader conservative management plan, although recommendations vary between guidelines and bracing should be prescribed according to clinical need. The available systematic review and RCT data indicate that short-to-medium-term brace use does not cause trunk muscle deconditioning,2,3 may improve postural stability and self-efficacy,5,7 and can complement exercise-based programmes.9 Matching the brace to the patient’s clinical indication, activity level, and functional goals remains essential for optimal outcomes.

For more information about the Enovis spine support portfolio, visit enovis-medtech.eu, or contact your local representative.

References

  1. Oleiwi M, et al. Efficacy of orthotic support in mitigating low back pain and disability in low back pain sufferers. J Back Musculoskelet Rehabil. 2023;36(5):1111-1125.
  2. Azadinia F, et al. Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature. The Spine Journal. 2016;17(4):589–602.
  3. Takasaki H, Miki T. The impact of continuous use of lumbosacral orthoses on trunk motor performance: a systematic review with meta-analysis. Spine J. 2017;17(6):889-900.
  4. Cholewicki J, et al. The effects of a three-week use of lumbosacral orthoses on trunk muscle activity and on the muscular response to trunk perturbations. BMC Musculoskeletal Disorders. 2010;11:154.
  5. Azadinia F, et al. The Effect of Lumbosacral Orthosis on the Thickness of Deep Trunk Muscles Using Ultrasound Imaging: A Randomized Controlled Trial in Patients With Chronic Low Back Pain. Am J Phys Med Rehabil. 2019 Jul;98(7):536-544.
  6. Ludvig D, et al. The effect of extensible and non-extensible lumbar belts on trunk muscle activity and lumbar stiffness in subjects with and without low-back pain. Clin Biomech. 2019 Jul;67:45-51.
  7. Im S, et al. Analysis of the Effect of Wearing Extensible and Non-Extensible Lumbar Belts on Biomechanical Factors of the Sit-to-Stand Movement and Pain-Related Psychological Factors Affecting Office Workers with Low Back Pain. Healthcare (Basel). 2021 Nov 22;9(11):1601.
  8. Calmels P, et al. Effectiveness of a lumbar belt in subacute low back pain: an open, multicentric, and randomized clinical study. Spine. 2009;34(3):215–220.
  9. Vick T, et al. Efficacy of Back Bracing in Treating Chronic Low Back Pain. Brain Sci. 2024 Oct 30;14(11):1100.

Early Mechanical Control After Acute ACL Rupture: What Bracing Teaches Us About Healing and Stability

Posted on | by Matthew Blackwell

Anterior cruciate ligament (ACL) injuries are among the most significant musculoskeletal injuries encountered in clinical practice, affecting active individuals and athletes across a wide range of sports and activity levels. The immediate post-injury period has traditionally been viewed as a preparatory phase before surgical or non-surgical treatment begins. However, emerging evidence suggests that the decisions made in the first days and weeks after injury – including whether and how to brace the knee – may have a meaningful influence on both healing biology and joint stability.

This article examines two recent clinical studies that shed new light on early mechanical control as an active component of acute ACL management, with implications for clinicians across both non-surgical and surgical care pathways.

Why Early Mechanical Control Matters in Acute ACL Injury

Early management is a well‑established component of acute anterior cruciate ligament (ACL) injury care. Emerging evidence now places increased focus on the mechanical environment created in the immediate post‑injury phase, suggesting that early mechanical control of the knee may influence both biological healing processes and functional stability.

Recent clinical studies examining early bracing strategies highlight that temporary immobilization after ACL rupture may be associated with favorable outcomes through different but complementary mechanisms, supporting ligament healing pathways identifiable on MRI in selected patients, and reducing high‑grade rotational instability associated with injury to anterolateral knee structures. Together, these findings invite a closer examination of early bracing as an active component of acute ACL injury management rather than a purely interim measure.

MRI-Guided Healing Pathways: The Cross-Bracing Protocol

A prospective case series1 investigated outcomes in 80 consecutive patients who presented within 4 weeks of acute ACL rupture and were managed non‑surgically using the Cross‑Bracing Protocol (CBP). The protocol involved knee immobilization at 90° of flexion in a 4-point knee ligament brace with ROM control for 4 weeks, followed by progressive increases in range of motion until brace removal at 12 weeks, alongside physiotherapist‑supervised, goal‑oriented rehabilitation. MRI was performed at 3 and 6 months, with ACL healing graded using the ACL Osteoarthritis Score (ACLOAS).

At 3 months, 90% (72/80) of patients demonstrated MRI evidence of ACL continuity. Healing was graded as ACLOAS grade 1 (thickened or taut ligament) in 50%, grade 2 (thinned or elongated ligament) in 40%, and grade 3 (absent ligament or discontinuity) in 10% of patients. Patients with ACLOAS grade 1 reported higher Lysholm and ACL‑QOL scores, demonstrated lower passive knee laxity, and had higher rates of return to pre‑injury sport at 12 months compared with those graded ACLOAS 2–3. ACL re‑injury occurred in 14% of patients, primarily during high‑force or high‑velocity activities.

Refining Patient Selection: ACL-ARCH MRI Criteria

Building on experience managing over 1080 active individuals and athletes with CBP, a subsequent publication2 proposed the ACL Acute Rupture Characteristics for Healing (ACL‑ARCH) MRI criteria to better characterize acute ACL rupture severity in relation to potential non‑surgical healing. The authors describe four key MRI features relevant to healing potential: integrity of femoral and tibial attachment, displacement of ACL tissue outside the intercondylar notch, gap distance between torn ends, and retraction of ACL ends into rounded stumps (“involution”).

Within the first 80 patients treated with CBP, partial femoral avulsion and displacement of ACL tissue outside the intercondylar notch were more frequently observed in patients with thinned, elongated, or absent healing on 3‑month MRI. Larger gap distances (≥7 mm) were also more common in patients with poorer healing outcomes.

The authors recommend minimum 1.5T MRI (3T preferred) and the use of double‑oblique sequences to optimize visualization of ACL fibers when assessing these features.

Early Post-Traumatic Bracing and Rotational Knee Stability

A multicenter retrospective consecutive study3 examined 168 patients who underwent ACL reconstruction and compared outcomes between those who received early post‑traumatic knee immobilization and those who did not. Of the total cohort, 132 patients received a knee brace (hinged or non‑hinged), while 36 patients received no immobilization. The mean time from trauma to bracing was 0.8 days, and the mean duration of immobilization was 23.9 days. Patients were allowed full weight-bearing after immobilization.

The primary outcome was the severity of pivot shift, assessed intra‑operatively under general anesthesia. A grade 3 pivot shift was observed in 27% (44/168) of patients overall and was significantly more frequent in patients without a brace compared with those who received early bracing (50% vs 19.7%, p = 0.0012). Both hinged and non‑hinged braces were associated with a lower risk of grade 3 pivot shift, with odds ratios of 0.221 and 0.232, respectively. Immobilization lasting ≤3 weeks was associated with a higher risk of grade 3 pivot shift compared with immobilization for >3 weeks.

The authors conclude that early post-injury bracing was associated with a lower incidence of high-grade rotational instability before ACL reconstruction. They suggest that systematic immobilization after knee trauma could be advocated based on these findings.

Two Studies, One Shared Message

Although the two studies differ in design, patient populations, and primary outcomes, they converge on a shared principle: the early mechanical environment of the injured knee matters. The CBP and ACL-ARCH publications describe how early immobilization combined with MRI assessment can provide insight into ACL healing characteristics and rupture severity, while the multicenter surgical cohort study demonstrates that early bracing is associated with reduced high-grade rotational instability at the time of reconstruction. Together, these findings highlight early bracing as a potentially influential factor across different acute ACL care pathways.

Key Take-Home Messages

  • Early mechanical control of the knee is a management variable in the acute phase after after ACL rupture
  • Structured early bracing has been associated with:
    • MRI‑observed ACL healing characteristics
    • Reduced incidence of high‑grade pivot shift before ACL reconstruction
  • Healing potential and rotational stability represent distinct but complementary outcomes
  • Early bracing may be relevant across both non‑surgical and surgical ACL care pathways

Supporting ACL Care with DonJoy® Bracing Solutions

The evidence discussed in this article points to the importance of providing appropriate mechanical control at every stage of ACL injury management – from the immediate post-injury period through to return to sport. Enovis™ offers two DonJoy® bracing solutions designed to support clinicians across this continuum of care.

DonJoy® X-ROM™ Post-Op Knee Brace: Early Post-Traumatic and Post-Operative Immobilization

The DonJoy X-ROM™ Post-Op Knee Brace is designed to aid immobilization and provide protected range of motion (ROM) following ACL, PCL, LCL, and MCL surgeries, as well as meniscal repairs. Its updated hinge design allows precise ROM control in 10-degree increments, from -10° to 90° extension and -10° to 120° flexion, with a quick-lock feature for easy setting at a specific angle. Four independently telescoping sliders with push-button control enable rapid, precise fitting across a wide range of patient anatomies. The brace is universal-fit, accommodating patients from 150 cm to 195 cm, and bendable hinge bars allow additional varus or valgus contouring where needed.

For clinicians considering early bracing as part of acute ACL management – whether in the context of the Cross-Bracing Protocol or early post-traumatic immobilization prior to surgery – the X-ROM offers a structured, adjustable platform to deliver controlled immobilization and progressive range of motion as rehabilitation advances.

DonJoy X-ROM post-op knee brace

DonJoy® Armor FourcePoint™: Functional Bracing and Return to Sport

The DonJoy Armor FourcePoint™ delivers strong, lightweight protection for moderate to severe ligament instabilities – appropriate for active users and extreme‑sport athletes – combining a moldable aircraft‑grade aluminum frame with the patented Four‑Points‑of‑Leverage™ System and the FourcePoint™ hinge, which dampens knee extension in the high‑risk zone to support stability, reduce re‑injury risk, and ensure a secure, comfortable fit across a wide size range.

A steel-reinforced hinge plate and T6061 aluminum frame deliver robust, lightweight durability suited to contact and extreme sports including football, skiing, snowboarding, and motocross.

For patients who demonstrate favorable healing characteristics on MRI or who are returning to high-demand sport following ACL reconstruction, the Armor FourcePoint provides an evidence-informed, off-the-shelf option to support ongoing knee stability and reduce re-injury risk. Available in seven sizes and two calf lengths, it accommodates bilateral use without impeding performance.

DonJoy Armor FourcePoint knee ligament brace

Armor is also available in a version that swaps the FourcePoint hinge for a standard polycentric hinge. By adding flexion stops of (0°), 45°, 60°, 75°, or 90°, or extension stops of 0°, 10°, 20°, 30°, or 40°, this allows incremental flexion-extension ROM control to support different phases of rehabilitation.

For more information on Enovis™ products, visit our website or contact your local Enovis representative.

References

  1. Filbay SR et al. Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. Br J Sports Med. 2023 Dec;57(23):1490-1497.
  2. Filbay SR et al. A new way of grading severity of ACL rupture on acute MRI to consider potential for non-surgical healing with the Cross Bracing Protocol: ACL Acute Rupture Characteristics for Healing (ACL-ARCH) MRI criteria. J Sci Med Sport. 2026 Feb;29(2):145-148.
  3. Murgier J et al. Does an early post traumatic knee brace reduce the incidence of knee rotational instability? Arch Orthop Trauma Surg. 2024 Mar;144(3):1161-1169.

Walker Boots vs Plaster Casts: Cost-Effectiveness and Clinical Outcomes

Posted on | by Matthew Blackwell

For decades, plaster casts have been the default choice for immobilizing lower-limb injuries such as Achilles tendon ruptures and ankle fractures. However, growing clinical evidence suggests that functional walker boots offer a cost-effective alternative without compromising patient outcomes or safety.

So what does the latest research actually tell us? And how should this influence treatment decisions in modern orthopedic care?

Rethinking Immobilization: Why Cost-Effectiveness Matters

Healthcare systems are under increasing pressure to deliver high-quality outcomes while controlling costs. Immobilization strategies play a significant role in this equation, not just in terms of device cost, but also:

  • Time and resources required for application and removal
  • Follow-up appointments and unplanned hospital visits
  • Need for informal care and support
  • Speed of functional recovery and return to work

Multiple studies now indicate that walker boots consistently perform well across these areas, particularly when early weight-bearing protocols are used.

Achilles Tendon Rupture: Comparable Outcomes, Lower Overall Costs

One of the most robust datasets comes from the UKSTAR trial by Costa et al.1, a large multicenter randomized controlled study involving 527 patients across 39 NHS hospitals. The trial compared:

  • Traditional plaster casting (8 weeks, delayed weight bearing)
  • Functional walker boot (8 weeks, immediate weight bearing)

Key findings:

  • Total health and social care costs were slightly lower in the walker group (by approximately £103 per patient), although the difference was not statistically significant
  • No difference in functional outcome at 9 months, measured using the Achilles Tendon Total Rupture Score (ATRS)
  • No difference in re-rupture rates, confirming comparable safety profiles

In other words, functional bracing delivered equivalent clinical results at a lower or comparable cost, while enabling earlier mobilization.

Importantly, clinicians concluded that early weight-bearing in a walker boot can be considered a safe and cost-effective alternative to plaster casting.

Why Walker Boots May Support Better Recovery

The cost-utility advantage of walker boots is not purely financial, it is closely linked to how patients recover.

Evidence suggests improved functional recovery may be related to:

  • Greater comfort and convenience for patients2
  • Compatibility with early weight-bearing protocols1,3,4
  • Ability to remove the boot for controlled mobilization exercises1,5,6
  • Reduced reliance on informal carers7

These factors can translate into faster return to normal activity and work1,4,7, which has major societal and economic implications beyond direct healthcare costs.

Ankle Fractures: Strong Evidence Across Operative and Non-Operative Care

The evidence is equally compelling for ankle fractures. A UK multicenter randomized trial evaluated cast immobilization versus walker boots in 669 patients across 20 NHS trauma units.

Clinical outcomes:

  • No significant difference in functional outcomes at 4 months or 2 years8,9
  • Functional outcomes measured using the Olerud-Molander Ankle Score (OMAS) were equivalent8,9
  • Complication rates were similar between cast and walker groups8,9

Economic outcomes:

  • Cost-utility analysis showed that, from an NHS perspective, removable braces were cost-effective under commonly accepted willingness-to-pay thresholds10

The authors concluded that a removable walker boot is as effective and safe as a plaster cast, for both operative and non-operative ankle fracture management, and remains so in the long term.

Post-Operative Ankle Fractures: The Case for Early Weight Bearing

Recent studies have added another important dimension: timing of weight bearing.

Two major UK trials provide valuable insights:

1. Ankle Recovery Trial (ART)

  • Compared walker boots versus casts after ankle fracture surgery
  • Found the total treatment cost per patient was £676 lower in the walker group
  • Analysis included not only device cost, but also informal care and productivity losses

2. Weight-bearing in Ankle Fracture (WAX) Trial

  • Compared early vs delayed weight bearing post-operatively
  • Early weight bearing was associated with £722 lower mean societal costs, largely due to reduced work absence

Taken together, these findings suggest that early weight bearing in a walker boot may offer substantial cost savings compared to delayed weight bearing in a cast, without compromising safety or outcomes4,7.

What This Means for Clinical Practice

Across Achilles tendon rupture and ankle fracture management – both conservative and post-operative – the evidence consistently shows that walker boots:

  • Are at least as effective as plaster casts
  • Offer comparable safety profiles
  • Support earlier mobilization and weight bearing
  • Can deliver meaningful cost savings, especially when societal costs are considered

For clinicians and healthcare systems alike, this supports a shift toward functional immobilization strategies where clinically appropriate.

Conclusion: Walker Boots are Evidence-Based, Patient-Centered, Cost-Effective

Modern functional walkers allow clinicians to align clinical outcomes, patient experience, and economic efficiency. As the evidence base continues to grow, walker boots are increasingly positioned not as an alternative, but as a first-line option for many lower-limb injuries.

As always, individual patient factors and clinical judgement remain paramount, but the data clearly supports giving functional bracing serious consideration in contemporary orthopedic care.

DonJoy® Nextep Xcel™: a New Cost-Effective Walker Range from Enovis™

DonJoy Nextep Xcel walker boot range

Healthcare professionals need dependable orthopedic solutions that are designed to deliver consistent patient outcomes while remaining practical. The new DonJoy® Nextep Xcel™ range meets these needs through a family of full-shell walker boots for post-operative and post-trauma foot and ankle care.

By integrating established technology with streamlined design, Nextep Xcel offers a comprehensive approach to patient mobility management. The range provides the clinical performance clinicians expect while supporting efficiency within practices.

The Nextep Xcel range represents a balanced approach to orthopedic care, delivering the functionality patients need and the reliability clinicians value.

For more information on Enovis’s portfolio of orthopedic walker boots, visit our website or contact your local Enovis representative.

References

  1. Costa ML et al. UKSTAR trial collaborators. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448.
  2. Hampton MJ et al. Functional Walker Boots are Preferred to Synthetic Casts by Patients and Carers in the Management of Pediatric Stable Ankle Injuries. J Pediatr Orthop. 2024 Feb 1;44(2):99-105.
  3. Ghaddaf AA et al. Early versus late weightbearing in conservative management of acute achilles tendon rupture: A systematic review and meta-analysis of randomized controlled trials. Injury. 2022 Apr;53(4):1543-1551.
  4. Bretherton CP et al. WAX Investigators. Early versus delayed weight-bearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomised controlled trial. Lancet. 2024 Jun 29;403(10446):2787-2797.
  5. Egol KA et al. Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a functional brace. J Bone Joint Surg Br. 2000 Mar;82(2):246-9.
  6. Barile F et al. To cast or not to cast? Postoperative care of ankle fractures: a meta-analysis of randomized controlled trials. Musculoskelet Surg. 2024 Dec;108(4):383-393.
  7. Baji P et al. Use of removable support boot versus cast for early mobilisation after ankle fracture surgery: cost-effectiveness analysis and qualitative findings of the Ankle Recovery Trial (ART). BMJ Open. 2024 Jan 11;14(1):e073542.
  8. Kearney R et al. AIR trial collaborators. Use of cast immobilisation versus removable brace in adults with an ankle fracture: multicentre randomised controlled trial. BMJ. 2021 Jul 5;374:n1506.
  9. Nwankwo H et al. Cost-utility analysis of cast compared to removable brace in the management of adult patients with ankle fractures. Bone Jt Open. 2022 Jun;3(6):455-462.
  10. Haque A et al. the AIR Trial collaborators. Use of cast immobilization versus removable brace in adults with an ankle fracture: two-year follow-up of a multicentre randomized controlled trial. Bone Joint J. 2023 Mar 15;105-B(4):382-388.

How Therapeutic Shoes Help Protect Feet with Diabetic Neuropathy

Posted on | by Matthew Blackwell

For people living with diabetes, caring for the feet is essential. High blood glucose over time can lead to diabetic neuropathy – nerve damage that reduces sensation in the feet. When the feet lose feeling, everyday pressure, friction, or minor injuries may go unnoticed. Over time, these stresses can develop into diabetic foot ulcers, affecting mobility, independence, and overall quality of life.

That is why choosing the right footwear is so important.

Therapeutic shoes are designed to help protect feet affected by diabetes-related nerve damage by supporting healthy movement, reducing stress on vulnerable tissue, and lowering the risk of skin breakdown. Research shows that specialized footwear can significantly reduce pressure and tissue strain on the foot – two key factors linked to ulcer development – making it a vital part of diabetic foot care for many patients.

In this article, we explore how therapeutic footwear helps safeguard the feet in people with diabetic neuropathy, and how Enovis™ is supporting safer, more confident mobility with the new DonJoy® therapeutic shoe collection.

Why Diabetic Neuropathy Increases Foot Ulcer Risk

Diabetic neuropathy affects the nerves that supply sensation to the feet. Without the ability to feel pain or irritation, patients may not recognise when harmful pressure, heat, or friction is occurring.

This can lead to:

  • Loss of protective sensation
  • Increased risk of skin breakdown
  • Higher likelihood of ulcer formation
  • Reduced balance and gait stability

Because these risks often develop gradually, preventative foot care – including protective footwear – is a cornerstone of long-term diabetic health management.

The Role of Therapeutic Footwear in Diabetic Foot Protection

How footwear reduces pressure and tissue strain

When walking, weight and ground-reaction forces concentrate under the forefoot, especially beneath the metatarsal heads. In diabetic neuropathy, these forces can silently damage tissue.

A clinical biomechanics study investigating people with diabetes, peripheral neuropathy, and previous plantar ulcers found that therapeutic footwear significantly reduced both plantar pressure and soft-tissue strain – mechanical factors that contribute to ulcer formation1.

Compared to barefoot loading, therapeutic shoes and supportive inserts progressively lowered harmful forces beneath the foot:

  • Pressure and strain were highest barefoot
  • Both reduced significantly with therapeutic shoes
  • Additional reductions occurred with total-contact inserts and metatarsal pads

Why reducing pressure matters for patients with nerve damage

Lower pressure and controlled strain help limit stress on vulnerable tissue, supporting:

  • Protection against ulcer recurrence
  • Safer daily mobility
  • Improved comfort in weight-bearing activities
  • Confidence in returning to everyday routines

In neuropathic feet, pressure relief isn’t just comfort, it’s injury prevention.

Clinical Evidence: How Supportive Footwear Helps Protect the Diabetic Foot

The study demonstrated clear biomechanical benefits from appropriate footwear for people with diabetic neuropathy:

  • Pressure at the second metatarsal head decreased across all therapeutic footwear conditions
  • Soft-tissue strain also reduced proportionally
  • The most protective configuration (shoe + insert + metatarsal pad) produced the greatest benefit1

This evidence reinforces clinical practice guidance: properly designed therapeutic shoes support pressure redistribution, help protect insensate tissue, and reduce ulcer risk2,3.

Key Features of Effective Therapeutic Shoes for Diabetic Feet

High-quality therapeutic footwear typically includes:

  • Wide toe box to accommodate deformities and swelling
  • Smooth interior with minimal seams to reduce friction
  • Cushioned insole to help distribute pressure
  • Stable, anti-slip outsole for safer walking
  • Breathable, lightweight materials to support long periods of wear
  • Easy fastening systems (zip or hook-and-loop) to support patients with reduced dexterity

These design features work together to help maintain mobility and protect vulnerable feet in everyday environments.

Introducing the New DonJoy® Therapeutic Shoes Collection

Foot health is fundamental to movement, and movement is essential for life. That’s why DonJoy has expanded its trusted orthopedic offering to include a new range of therapeutic footwear designed for patients with diabetes, vascular conditions, post-operative needs, and other foot-health challenges.

The four new models bring therapeutic protection together with everyday style:

Stanley – versatile tennis-style shoe

Lightweight, ventilated upper, easy zip closure, cushioned insole, anti-slip outsole

Newton – casual, breathable sneaker

Perforated upper, generous toe box, zip closure, supportive cushioned interior

Nina – elegant therapeutic loafer for women

Slip-on, elasticated opening, cushioned insole, discreet therapeutic profile

Gaby – soft indoor therapeutic slipper

Hook-and-loop fastening, seamless padded interior, lightweight design

Together, these designs offer options that protect vulnerable feet without compromising appearance or comfort.

Supporting Safer Steps for People with Diabetes

Protecting the feet is essential for anyone living with diabetic neuropathy. Therapeutic footwear provides a clinically supported way to reduce harmful pressure, lower ulcer risk, and support daily mobility and independence.

With the new DonJoy therapeutic shoe collection, patients can move confidently with footwear engineered for comfort, protection, and style – wherever life takes them.

To learn more or request information, visit enovis-medtech.eu or speak with your local Enovis representative.

References

  1. Lott DJ, Hastings MK, Commean PK, Smith KE, Mueller MJ. Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot. Clin Biomech (Bristol). 2007;22(3):352-359.
  2. Schaper NC, van Netten JJ, Apelqvist J, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 Suppl 1:e3266.
  3. Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3651.

How Shoulder Braces Support Post-Operative Shoulder Recovery

Posted on | by Matthew Blackwell

Shoulder surgery represents a significant step toward resolving chronic pain or repairing damage, but the recovery process demands careful attention and appropriate support. Shoulder braces, such as the DonJoy PSI Plus, play an essential role in this recovery journey, providing stability and protection while healing progresses.

The Purpose of Shoulder Braces After Surgery

Following shoulder procedures such as rotator cuff repairs, labral reconstructions, or joint replacements, shoulder braces serve several critical recovery functions:

  • Immobilizing the joint to protect surgical repairs
  • Limiting potentially harmful movements
  • Reducing stress on healing tissues
  • Offering external support during rehabilitation phases

Types of Shoulder Braces for Post-Surgical Recovery

Different surgical procedures require specific types of support:

Immobilization Slings

These devices hold the arm close to the body, preventing movement during the initial healing phase. They typically feature:

  • Adjustable straps for proper positioning
  • Cushioning to prevent skin irritation
  • Simple design for ease of application

Example: DonJoy PSI Plus

Abduction Slings

For procedures requiring the arm to be held away from the body:

  • Maintains the shoulder in a specific abducted position
  • Includes a pillow or wedge to establish proper joint spacing
  • Helps reduce tension on certain repaired structures

Example: UltraSling PRO

Functional Braces

As recovery progresses, functional braces allow:

  • Controlled range of motion within safe parameters
  • Adjustable settings to gradually increase mobility
  • Support during rehabilitation exercises

Example: UltraSling Quadrant

Progression of Shoulder Brace Usage Throughout Recovery

The timeline for shoulder brace usage typically follows this pattern:

  • Stage 1: Strict immobilization with limited removal for hygiene or prescribed exercises
  • Stage 2: Transition to braces allowing controlled movement, often worn during physical therapy and daily activities
  • Stage 3: Decreased dependence on bracing with continued use during challenging activities or exercise
  • Stage 4: Occasional use for protection during high-risk activities or as needed for comfort

Benefits of Proper Brace Usage

Research indicates that appropriate bracing contributes to recovery by:

  • Promoting proper healing alignment of tissues1
  • Reducing the risk of re-injury during vulnerable healing phases2
  • Decreasing pain through stabilization3
  • Building patient confidence during rehabilitation4

Wearing a Shoulder Brace

For maximum benefit from a shoulder brace, patients should:

  • Follow their surgeon’s specific instructions regarding wear time
  • Ensure proper fit—too loose provides inadequate support, too tight may impair circulation
  • Inspect their skin regularly for irritation or pressure points
  • Maintain cleanliness of the brace according to manufacturer guidelines
  • Report any issues with fit or function to their healthcare provider

A New Brace for Post-Op Shoulder Recovery: DonJoy PSI Plus

The DonJoy PSI Plus shoulder immobilizer represents a thoughtful approach to post-operative shoulder support, addressing both clinical and patient needs.

Designed for Adaptability

The PSI Plus features a bilateral design that converts between left and right arm use by simply repositioning the arm and shoulder strap. This versatility:

  • Simplifies inventory management for healthcare facilities
  • Ensures appropriate support regardless of which shoulder requires immobilization

Patient-Centered Features

Several design elements focus on improving the patient experience:

  • A quick-access hand pocket supports the forearm in internal rotation
  • Lightweight, open construction promotes air circulation to reduce heat buildup
  • Enhanced comfort during extended wear periods supports treatment compliance
DonJoy PSI Plus shoulder immobilizer

Clinical Efficiency

Healthcare providers benefit from:

  • Intuitive strap configuration that reduces application time
  • Design that minimizes the risk of incorrect positioning
  • The ability to perform examinations without removing the entire sling

Practical Functionality

The PSI Plus includes an adjustable shoulder strap with a quick-release mechanism, enabling single-handed removal and attachment. This feature proves particularly valuable for patients managing daily activities during recovery.

For more information on DonJoy PSI Plus, contact your local Enovis representative here.

References

  1. Hurley ET, Fried JW, Alaia MJ, Strauss EJ, Jazrawi LM, Matache BA. Immobilisation in external rotation after first-time traumatic anterior shoulder instability reduces recurrent instability: a meta-analysis. J ISAKOS. 2021 Jan;6(1):22-27.
  2. Grubhofer F, Ernstbrunner L, Gerber C, Hochreiter B, Schwihla I, Wieser K, Bouaicha S. Effect of Abduction Brace Wearing Compliance on the Results of Arthroscopic Rotator Cuff Repair. JB JS Open Access. 2022 May 5;7(2):e21.00148.
  3. Conti M, Garofalo R, Castagna A. Does a brace influence clinical outcomes after arthroscopic rotator cuff repair? Musculoskelet Surg. 2015 Sep;99 Suppl 1:S31-5.
  4. Chu JC, Kane EJ, Arnold BL, Gansneder BM. The Effect of a Neoprene Shoulder Stabilizer on Active Joint-Reposition Sense in Subjects With Stable and Unstable Shoulders. J Athl Train. 2002 Jun;37(2):141-145.

Cold Therapy and Compression for Post-Operative Knee Recovery: What the Latest Evidence Says

Posted on | by Matthew Blackwell

Effective post-operative recovery following knee surgeries represents a significant challenge for healthcare providers as well as their patients. Procedures such as total knee arthroplasty (TKA), anterior cruciate ligament (ACL) reconstruction, and arthroscopic interventions require comprehensive recovery protocols to ensure optimal outcomes. Among the various supportive modalities available, cold therapy and compression have emerged as approaches worthy of consideration within orthopedic recovery protocols. 

This article aims to summarize the current clinical evidence surrounding cold therapy and compression techniques in post-operative knee recovery and provide insights for healthcare professionals seeking to enhance patient care following these common orthopedic procedures. 

The Clinical Challenge: Pain, Swelling, and Rehabilitation 

Post-operative knee patients commonly face several challenges that can impede their recovery trajectory. Inflammation at the surgical site often leads to significant pain, which may limit mobility and delay rehabilitation milestones. Additionally, many patients develop a reliance on pain medications, particularly opioids, which carries risks of dependence and side effects. 

These complications underscore the importance of implementing effective, low-risk adjunctive therapies that can support recovery, potentially reduce medication requirements, and improve overall patient outcomes. As healthcare providers continue to refine recovery protocols, evidence-based approaches to managing these challenges become increasingly valuable. 

What the Research Shows: A Summary of Key Studies 

Studies supporting cold therapy after Total Knee Arthroplasty (TKA) 

Several studies support the application of cold therapy following total knee arthroplasty. 

In a 2015 study by Bech et al.1, it was found that although there was no additional benefit of using the DonJoy Iceman over ice bags for pain reduction, TKA patients using the device were significantly more satisfied, used the device more consistently, day and night, and were more likely to recommend this method of cooling.

In 2006, Kullenberg et al.2 demonstrated that the Aircast Cryo/Cuff achieved better pain control, ROM improvement, and shorter hospital stays amongst 86 patients undergoing TKA than with epidural analgesia, NSAIDs, and opioids. 

Holmström et al. (2005)3 found that Aircast Cryo/Cuff is a viable alternative for pain management following TKA, as it was shown to be as effective as epidural anesthesia for pain reduction, while also being well tolerated, non-invasive, and risk-free. 

In a meta-analysis of studies on cold therapy for pain in total knee replacement patients, Yildiz et al. (2024)4 found that the application of cryotherapy was important in relieving patients’ pain, reducing it by a factor of 2.9.

Studies supporting cold therapy after ACL reconstruction

There is good evidence to support the use of cold therapy following anterior cruciate ligament (ACL) reconstruction. 

In their 2022 study, Yonetani et al.5 found that film dressing enhanced the effect of the Aircast Cryo/Cuff and Ice bags with respect to pain control immediately after ACL reconstruction surgery compared with traditional gauze dressing with elastic wrap. 

Hart et al. (2014)6 demonstrated that after ACL reconstruction, patients with arthrogenic muscle inhibition AMI who received cryotherapy immediately before performing rehabilitation exercises experienced greater strength gains than those who performed cryotherapy or exercises alone. 

Raynor et al.’s 2005 study7 showed that cryotherapy reduces post-operative pain significantly and being fairly inexpensive, easy to use, and satisfactory to patients, is therefore beneficial in the post-operative management of knee surgery. 

Furthermore, Kotsifaki et al.’s 2023 study8 resulted in the publication of new Aspetar guidelines that recommended the use of cold and compression therapy, along with neuromuscular electronic stimulation (NMES) in the early rehab protocol of ACL reconstruction.

Studies supporting cold therapy after knee arthroscopy 

According to these studies, knee arthroscopy is another procedure that can benefit from post-operative cold therapy.

In 2011, Stalman et al.9 found a significant decrease of knee temperature and associated pain and inflammation marker PGE2 with post-op Knee Cryo/Cuff application.

Martin et al.’s 2001 study10 showed a significant decrease of intraarticular temperature of the knee after arthroscopy with Aircast Cryo/Cuff application.

And Song et al.’s 201611 meta-analysis found that cold and compression is more beneficial for reduction of pain and swelling at the early post-operative period for knee surgery than cold alone. 

Conclusion

The growing body of evidence surrounding cold therapy and compression for post-operative knee recovery provides healthcare professionals with valuable insights for enhancing patient care. Across multiple procedure types, research consistently demonstrates benefits in pain management and potentially decreased reliance on pharmacological interventions. 

As a low-risk, cost-effective adjunct to established recovery protocols, cold therapy merits consideration within comprehensive rehabilitation approaches. This data may offer clinicians additional perspectives to consider when evaluating their current post-operative management approaches, with cold therapy and compression representing potential options within comprehensive rehabilitation frameworks. 

By implementing evidence-based approaches to post-operative care, healthcare providers can continue to enhance recovery experiences and outcomes for knee surgery patients, supporting their journey toward restored function and improved quality of life. 

Healthcare professionals interested in Enovis’s portfolio of cold therapy products can contact their local sales representative here.

References

  1. Bech M, Moorhen J, Cho M, Lavergne MR, Stothers K, Hoens AM. Device or ice: the effect of consistent cooling using a device compared with intermittent cooling using an ice bag after total knee arthroplasty. Physiother Can. 2015 Winter;67(1):48-55. 
  2. Kullenberg B, Ylipää S, Söderlund K, Resch S. Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients. J Arthroplasty. 2006 Dec;21(8):1175-9. 
  3. Holmström A, Härdin BC. Cryo/Cuff compared to epidural anesthesia after knee unicompartmental arthroplasty: a prospective, randomized and controlled study of 60 patients with a 6-week follow-up. J Arthroplasty. 2005 Apr;20(3):316-21. 
  4. Yildiz T, Topcu O, Avcu C. The effect of cryotherapy on pain in patients with total knee replacement surgery: a meta-analysis. Acta Orthop Belg. 2024 Mar;90(1):123-129. 
  5. Yonetani Y, Kurokawa M, Amano H, Kusano M, Kanamoto T, Tanaka Y, Horibe S. The Wound Dressing Influenced Effectiveness of Cryotherapy After Anterior Cruciate Ligament Reconstruction: Case-Control Study Comparing Gauze Versus Film Dressing. Arthrosc Sports Med Rehabil. 2022 Mar 8;4(3):e965-e968. 
  6. Hart JM, Kuenze CM, Diduch DR, Ingersoll CD. Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction. J Athl Train. 2014 Nov-Dec;49(6):733-9. 
  7. Raynor MC, Pietrobon R, Guller U, Higgins LD. Cryotherapy after ACL reconstruction: a meta-analysis. J Knee Surg. 2005 Apr;18(2):123-9. 
  8. Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med. 2023 May;57(9):500-514. 
  9. Stålman A, Berglund L, Dungnerc E, Arner P, Felländer-Tsai L. Temperature-sensitive release of prostaglandin E₂ and diminished energy requirements in synovial tissue with postoperative cryotherapy: a prospective randomized study after knee arthroscopy. J Bone Joint Surg Am. 2011 Nov 2;93(21):1961-8. 
  10. Martin SS, Spindler KP, Tarter JW, Detwiler K, Petersen HA. Cryotherapy: an effective modality for decreasing intraarticular temperature after knee arthroscopy. Am J Sports Med. 2001 May-Jun;29(3):288-91. 
  11. Song M, Sun X, Tian X, Zhang X, Shi T, Sun R, Dai W. Compressive cryotherapy versus cryotherapy alone in patients undergoing knee surgery: a meta-analysis. Springerplus. 2016 Jul 13;5(1):1074. 

Enovis™ Unveils Unified Brand Identity

Posted on | by Matthew Blackwell

For decades, healthcare professionals have trusted products from DonJoy®, Chattanooga®, and Aircast® to deliver exceptional patient outcomes. These iconic brands, part of the Enovis™ family, have shaped orthopedic care and rehabilitation across the globe. Today, Enovis—a worldwide leader in medical technology solutions—announces a strategic visual transformation that unites these trusted names under a cohesive brand identity while preserving their individual legacies of innovation.

The Enovis Family: A Legacy of Innovative Brands

Enovis encompasses approximately a dozen specialized product brands within its comprehensive portfolio. Each brand brings distinctive expertise to the continuum of care, from prevention and rehabilitation to surgical intervention. Let’s explore the remarkable journeys of three cornerstone brands:

DonJoy® – Protecting Knees (and More) Since the 1970s

DonJoy has become virtually synonymous with knee bracing excellence. This cornerstone Enovis brand has manufactured and supplied braces for knee ligament protection since the late 1970s, utilizing patented technology specifically designed to reduce anterior cruciate ligament (ACL) strain1,2.

The Garage That Changed Orthopedics

In 1978, Philadelphia Eagles’ offensive line captain Mark Nordquist and lawyer Ken Reed founded a small company in a Carlsbad, California garage. They named their venture DonJoy after their wives, Donna and Joy—a personal touch that reflected their commitment to improving patients’ lives.

DonJoy initially focused on developing knee braces, and by the late 1990s, it was generating approximately $100 million in annual revenues through an expanding range of orthopedic products. Following a series of strategic acquisitions and mergers, the company evolved into DJO and later, Enovis. Throughout these transformations, the DonJoy name has endured for almost half a century, proudly displayed on products worn by millions worldwide.

Flagship Product: Defiance® PRO

The Defiance® PRO represents the culmination of decades of research in knee stability engineering. This custom-fit functional knee brace features aircraft-grade aluminum and proprietary hinge technology that mirrors natural knee movement while providing crucial support for ACL, PCL, MCL, and LCL injuries. Professional athletes and weekend warriors alike rely on its lightweight yet robust design for confidence during activity.

Aircast® – Over Half a Century in Service of Medical Professionals

For more than 50 years, medical professionals worldwide have depended on Aircast for technological breakthroughs in patient care.

Rooted in sound scientific methods, each Aircast product is developed using the concept of “functional management,” setting progressive standards of care for lower limb fractures, ankle sprains, and other injuries with patented technology and graduated pneumatic compression.

Aircast was founded in 1972 by U.S. inventor Glenn Johnson Jr. after he created the eponymous pneumatic ankle brace system. The innovative air cell technology provides targeted compression and stabilization while allowing appropriate movement—a revolutionary approach to ankle injury management. Among Johnson’s other inventions was the VenaFlow™ system, a DVT-prevention device used in hospitals worldwide.

Flagship Product: AirSelect™ Walker

The AirSelect™ Walker exemplifies Aircast’s commitment to functional recovery. Its SoftStrike technology absorbs shock and reduces heel loading, while integrated air cells deliver customized compression. The intuitive pump system allows patients to adjust pressure levels independently, promoting compliance and improving outcomes. Clinical studies have demonstrated faster recovery times compared to traditional immobilization methods for appropriate indications.3,4

Chattanooga® – Supporting Physiotherapists Since 1947

Founded in Chattanooga, Tennessee, by local athletic trainer Lee Jensen and his business partner Jack Walker, the Chattanooga Group began as Chattanooga Pharmacal Company in 1947.

From Local Startup to Global Leader

The company initially created hot and cold therapy products for the physiotherapy market before expanding its innovation focus. A significant breakthrough came with the development of the Intelect line, which brought portable ultrasound and electrotherapy devices into private clinics and transformed treatment accessibility.

By the early 2000s, Chattanooga had established itself as the world’s largest manufacturer of rehabilitation equipment, contributing to improved treatment outcomes in hospitals, clinics, and home settings worldwide. After nearly 80 years, the Chattanooga brand continues to be associated with technological advancements in treating musculoskeletal, neurological, and soft tissue disorders.

Flagship Product: LightForce® Laser

The LightForce® laser therapy system represents a significant advancement in non-invasive pain management. Using specific wavelengths of light to penetrate tissue and stimulate cellular metabolism, this photobiomodulation therapy helps reduce inflammation and relieve pain.5 Clinicians appreciate its intuitive interface and customizable treatment protocols that address a wide range of conditions from tendinopathies to post-surgical recovery.

Introducing the Updated Enovis Product Brands

As a family of brands under the banner of Enovis, DonJoy, Aircast, Chattanooga, and their sister brands now share a cohesive visual identity that clearly communicates their relationship while honoring their individual histories.

Enovis product brand logo update

The refreshed type treatment applied to the product brand logos achieves a unified aesthetic while creating a clear hierarchy between the corporate brand and its product brands. The updated design maintains recognizable elements from each brand’s heritage while bringing them into alignment with Enovis’s forward-looking vision.

For healthcare professionals who have relied on these trusted brands throughout their careers, this unified identity signals not an ending but a strengthening—a commitment to continued excellence and innovation under the Enovis banner for decades to come.

Healthcare professionals interested in learning more about Enovis products can contact their local Enovis representative.

References

  1. Fleming BC et al. The influence of functional knee bracing on the anterior cruciate ligament strain biomechanics in weightbearing and nonweightbearing knees. Am J Sports Med 2000;28(6):815-24.
  2. Lin CF, Liu H, Garrett WE, Yu B. Effects of a knee extension constraint brace on selected lower extremity motion patterns during a stop-jump task. J Appl Biomech. 2008 May;24(2):158-65.
  3. Shahid MK, Punwar S, Boulind C, Bannister G. Aircast walking boot and below-knee walking cast for avulsion fractures of the base of the fifth metatarsal: a comparative cohort study. Foot Ankle Int. 2013 Jan;34(1):75-9.
  4. Haworth L, Booth N, Chohan A, Chapman G, Richards J. How does orthotic walker boot design influence lower limb and trunk function during gait? Prosthet Orthot Int. 2024 Mar. E-Pub ahead of publication.
  5. Chatterjee P, Srivastava AK, Kumar DA, Chakrawarty A, Khan MA, Ambashtha AK, Kumar V, De Taboada L, Dey AB. Effect of deep tissue laser therapy treatment on peripheral neuropathic pain in older adults with type 2 diabetes: a pilot randomized clinical trial. BMC Geriatr. 2019 Aug 12;19(1):218.

Understanding low back pain: facts, figures, and solutions for better living

Posted on | by Matthew Blackwell

Low back pain (LBP) affects millions globally, with an estimated 619 million people experiencing this condition in 2020. By 2050, experts project this number will reach 843 million cases, primarily due to population growth and aging demographics. This significant increase highlights the importance of understanding and effectively managing low back pain.

The growing impact of low back pain

Low back pain stands as the leading cause of disability worldwide among musculoskeletal conditions. Its effects reach across all demographics, but particularly impacts:

  • People aged 50-55 years
  • Women more frequently than men
  • Working populations, causing significant work absences
  • Quality of life across all demographics

The economic burden of low back pain extends beyond individual suffering, affecting workplace productivity and healthcare systems worldwide. Understanding this condition and its management options becomes increasingly crucial for both healthcare providers and patients.

Understanding different types of low back pain

Low back pain manifests in various forms, each requiring specific attention and treatment approaches:

Specific vs. non-specific pain

  • Specific LBP (10% of cases): Traced to particular diseases or structural issues in the spine, often requiring targeted medical intervention
  • Non-specific LBP (90% of cases): No identifiable structural cause, but potentially linked to lifestyle factors such as low physical activity, smoking, obesity, or occupational stress

Duration categories and their implications

  • Acute: Under 6 weeks, often resolving with proper care
  • Sub-acute: 6-12 weeks, requiring increased attention to prevent chronicity
  • Chronic: Over 12 weeks, necessitating comprehensive management strategies

The science behind bracing in low back pain management

Recent scientific research confirms that lumbar support bracing plays a significant role in managing low back pain and associated disability.1 Modern bracing solutions offer multiple benefits:

  1. Range-of-motion control: Protects against painful flexion and extension movements1
  2. Core stability: Increases intra-abdominal pressure for enhanced support2
  3. Posture enhancement: Improves overall balance and alignment3
  4. Proprioception benefits: Enhances body awareness and position sense4

Understanding proprioception

Proprioception, often called our “sixth sense,” helps us understand where our body is in space. Low back pain can disrupt this crucial sense, but proper bracing can help restore these important signals between body and brain.4

DonJoy® bracing solutions for lower back pain

Enovis™ offers a specialized range of lumbar supports within its DonJoy® orthopedics brand, each designed to address specific needs and activity levels:

DonJoy Skinstrap™

For patients seeking discrete support during daily activities:

  • Lightweight elastic webbing construction
  • Second-skin feel for maximum comfort
  • Ideal for sedentary to moderate activity levels

DonJoy Porostrap 2.0™

Engineered for breathability and comfort:

  • Advanced mesh materials
  • Vented bilateral straps
  • Suitable for various activity levels
  • Enhanced airflow for extended wear

DonJoy Actistrap 2.0™

Designed for active individuals requiring additional support:

  • Adjustable bilateral straps
  • Four semi-rigid dorsal stays
  • Enhanced postural control
  • Suitable for those with muscular weakness

DonJoy Immostrap 2.0™

Advanced support for specific conditions:

  • Independent upper and lower bilateral straps
  • Flexible dorsal stays
  • Targeted postural control
  • Suitable for herniated disc conditions

For more information about managing low back conditions and finding the right support solution, visit enovis-medtech.eu.

Healthcare professionals interested in learning more about the refreshed product line can contact their local Enovis representative or visit our website for detailed product information.

References

  1. Oleiwi MA, Shah SZA, Bilal H, Zeb A, Ahmad A, Hegazye FA, Chen H. Efficacy of orthotic support in mitigating low back pain and disability in low back pain sufferers. J Back Musculoskelet Rehabil. 2023;36(5):1111-1125.
  2. Ludvig D, Preuss R, Larivière C. The effect of extensible and non-extensible lumbar belts on trunk muscle activity and lumbar stiffness in subjects with and without low-back pain. Clin Biomech (Bristol). 2019 Jul;67:45-51. doi: 10.1016/j.clinbiomech.2019.04.019. Epub 2019 May 7. PMID: 31075735.
  3. Azadinia F, Ebrahimi-Takamjani I, Kamyab M, Parnianpour M, Asgari M. A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain. Med J Islam Repub Iran. 2017 May 1;31:26.
  4. Samani M, Shirazi ZR, Hadadi M, Sobhani S. A randomized controlled trial comparing the long-term use of soft lumbosacral orthoses at two different pressures in patients with chronic nonspecific low back pain. Clin Biomech (Bristol, Avon). 2019 Oct;69:87-95.
  5. WHO Facts sheet Low Back Pain 2023. https://www.who.int/news-room/fact-sheets/detail/low-back-pain.