Need a high-quality knee brace to save my summer!

Discussion in 'Health & Fitness' started by DonDiego, Mar 14, 2013.

  1. DonDiego

    DonDiego Hall of Fame

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    I have a bruised ligament on the inside of my knee. It used to bother me just a little for a couple of months, so I did wear a low-end knee brace while playing. But yesterday I aggravated it. I plan on resting for a couple of months so I can play when summer comes. And then, I'll wear a high-qulity brace (level 4 support, quite expensive).

    I'm looking into this model: http://www.braceshop.com/productcart/pc/Medtherapies-Motion-Pro-Knee-Brace-438p17220.htm

    Has any of you ever played with a similar brace (or any in the 250$ or more category), and could tell me how you like it in terms of support/protection and playability ? Thanks
     
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  2. Say Chi Sin Lo

    Say Chi Sin Lo Legend

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    Jeez, if you're going to spend upwards of $250 on a brace, you may as well go into rehab and get it strengthen to prevent future injuries.
     
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  3. Relinquis

    Relinquis Hall of Fame

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    Nadal took several months off from competition and spent time in rehab, treatment and strengthening his knees.

    Treatment and rest is important (more so if you play hardcourts). Dunno what brace to use though. Perhaps other posters can chime in.

    Good luck.
     
    Last edited: Mar 15, 2013
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  4. OHBH

    OHBH Semi-Pro

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    I you don't do rehab and rely on the brace, you'll be stuck with the brace for quite a long time. One day you'll feel pretty good and decide not to wear the brace and aggravate the injury all over again.
     
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  5. DonDiego

    DonDiego Hall of Fame

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    Wise advices guys, thanks.
    I'll look up some exercises to streghten those muscles and ligament around my knee.

    Edit: I'm still looking for opinions about these braces, though. Cause altough I will work on rehab, I prefer playing with a brace when I'm better, just to make sure. I'm just a recreational player (4.5) so I don't mind wearing that thing when playing. And at the age of 39, my main concern is being able to go out there and have fun once or twice a week for as long as I can.
     
    Last edited: Mar 15, 2013
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  6. charliefedererer

    charliefedererer Legend

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    Just don't do leg raises on a machine with weights.

    [​IMG]

    This drags the kneecap (patella) over the end of the femur and puts undue stress on the patella tendon.
    Patella tendonitis(jumper's knee) is all too common among tennis players already, and you'll end up with the knee problem that plagues Nadal.

    [​IMG]

    6 Exercise Machines You Should Do Without http://www.menshealth.com/mhlists/avoid_lifting_injuries/The_Seated_Leg_Extension.php


    Squats will strengthen ALL the leg muscles both above and below the knee. They can be started as body weight squats and you can advance to dumbbell and even barbell squats.

    [​IMG]

    Plus, they strengthen the core (back and abdominals) plus the muscles that connect the core to the legs (hip flexors).

    No machine does all of this exercise at the same time!

    Don't overlook that having a strong core and muscles that connect the core to the legs is very important.

    It helps us as tennis players to keep our center of gravity over our legs so there is less stress on the knee.

    We "squat" every time we hit a ground stroke and serve so squatting is a great functional exercise for tennis.

    Here is what the American Society of of Sports Medicine says about doing squats to strengthen the knee ligaments:

    "Various forms of exercise have been shown to increase ligament strength. In animal studies, endurance exercise has been shown to increase the strength of the ligament-bone attachment, as well as increasing the diameter and collagen content of ligaments. When bone-ligament preparations are tested at high speeds, they fail at a higher maximum load. In athletes rehabilitating injured knees, closed-chain exercises such as the squat are currently used because in the squat, the hamstrings co-contract with other leg muscles to increase the stability of the knee, thus putting less stress on the anterior cruciate ligament.
    There are certainly times in the healing of injuries where the squat, and other exercises that stress the knee, should be avoided. However, once soft tissues have healed, exercises should be chosen that are the most effective at improving strength to protect the knee joint from further injury."
    - http://www.acsm.org/docs/current-comments/safetysquat.pdf



    Lunges are also a great functional exercise that are also have tennis specific application:

    [​IMG]




    Down the road, doing agility drills in a deliberate way, and slowly increasing the speed you do them subjects the medial and lateral knee ligatments to stress, but in a more controlled way than during the sudden change of direction that happens during match play.
    Doing these drills in the future should help protect against the inside knee ligament instability that you are currently suffering from.
    USTA agility drills: http://assets.usta.com/assets/1/USTA_Import/USTA/dps/doc_437_269.pdf
     
    Last edited: Mar 15, 2013
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  7. charliefedererer

    charliefedererer Legend

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    In general, expensive braces are best obtained after being examined and determined that such a brace is needed.


    While the specific brace you picture "looks" to provide stability, it's likely to slow you down considerably.

    The site you provide seems to indicate that this brace is particularly applicable for anterior and posterior stability.

    But you describe medial (inside) problems. So this brace may be more than you need [although it "looks" like because it is fairly form fitting it would provide medial/lateral protection as well.



    Are you sure you wouldn't rather do a rehab period to strengthen your muslces/ligaments around the knee?

    Isn't your knee valuable enough to you that having a proper evaluation would be in order before subjecting the stability of your knee to a device being commented on by someone on-line that has not examined you?
     
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  8. DonDiego

    DonDiego Hall of Fame

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    thanks Charlie.
    Yes, this morning I took an appointment with a doctor, I'll see him in a few days. I'll get an MRI and we'll know exactly what part is damaged. From there I'll do rehab.

    Actually (and ironically), I started doing squats last week cause I realized it was such a great exercise for tennis players... I'll keep doing them as soon as the doc clears me for that!
     
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  9. SystemicAnomaly

    SystemicAnomaly G.O.A.T.

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    For the most part, I would heed CharlieF's advice regarding leg extension machines. Truth be told, however, I do use such machines with a very light weight load for a warmup. Never use these machines with a heavy weight (or a medium weight, for that matter). Also, I never use the upper leg (thigh) restraint on machines that have them. It probably isolates the quads too much and may place added stress to the knee. Better to use squats or leg presses for heavier weights.

    http://www.menshealth.com/mhlists/avoid_lifting_injuries/The_Seated_Leg_Extension.php
     
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  10. polytheist

    polytheist Rookie

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    Charlie,

    Do you recommend squats for individuals with patellar chondromalacia?
     
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  11. Sumo

    Sumo Semi-Pro

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    I got a brace very similar to this after acl surgery (made by donjoy).

    I agree with everything Charlie is saying about that brace being overkill for what you've described, as it really is designed to support a different part of the knee.

    But....having wore something similar, I disagree with it slowing you down. I never noticed any effects while wearing it, and barely knew it was on while being active with it.
     
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  12. LeeD

    LeeD Bionic Poster

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    Looks like a high tech single sided brace, good enough for your and my needs. I have one from 20 years prior, and it works well to stabilize the medial or lateral collaterals while playing tennis, motocross, or surfing.
    The double side ones need more professional fitting, and can go out of whack pretty easily, and needing 2 grand or more (Orthos or CTI's).
    I like double wide velcro on both the thigh and the calf.
     
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  13. charliefedererer

    charliefedererer Legend

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    How active is the patellar chondromalacia?

    How "off track" are the quads pulling your patella (kneecap) to the side?

    [​IMG]

    Or is the problem not your quads, but a weak gluteus medius that lets the pelvis tip down?

    [​IMG]

    [​IMG]

    Are you also a runner, and have the typical runner's muscle imbalance of stronger hamstrings than quads?
    THE BEST QUAD EXERCISES FOR RUNNERS http://www.livestrong.com/article/452997-the-best-quad-exercises-for-runners/

    I ask these questions not to give you a hard time, but to help understand that there are different exercises recommended for different causes of patellar chondromalacia.

    Thus, if you have clearly have severely abnormal tracking, and active inflammation, you don't want to be doing squats right now, even though at some point the squat would be an ideal exercise to maintain proper tracking and prevent a recurrence.

    So you may have to start with exercises like those below:

    [​IMG]
    - http://tophealthfaq.com/wp-content/uploads/2013/02/Patellofemoral-Pain-Syndrome-Exercises.jpg


    These include more specific exercises to address the specific muscle imbalances that YOU have.

    So an exam and selection of the best exercises would be the best course of action.


    I mention this not only to prevent you having even more problems, but to understand why some sites will recommend squats to maintain quad and glute strength to prevent a recurrence.

    CHONDROMALACIA PATELLA EXERCISES: LIVESTRONG
    "Box Squat
    The box squat is performed with the feet spread wide apart and the shins perpendicular to the floor throughout the exercise. With a bar across your shoulders, push your hips back to a box between 12 and 20 inches in height. Tap the box gently, and stand back up. This allows the hips to be loaded without loading the knee excessively. Perform the exercise sitting to a progressively lower box for two to four sets of five to eight repetitions."
    - Read more: http://www.livestrong.com/article/415235-chondromalacia-patella-exercises/#ixzz2O7EHWIrV


    So if you can "get over the hump" of current painful patellar chondromalacia, the squat - which works all the muscles of the legs, glutes, back/core and the muscles that connect the legs to the back/core bilaterally - then you may have a GREAT exercise.

    But I just urge caution about the above points rather than launching into squats now.

    [Perhaps Posture Guy, who is kind enough to comment on muscle imbalances here on Talk Tennis will comment.]
     
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  14. DonDiego

    DonDiego Hall of Fame

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    Went to see the doctor, and I have a minor medial meniscus tear.

    From all the info I was able to gather here and there (and from my doc), here's my plan:

    -stretching exercises and some stationary bike (that's pretty much all I'll do for the first week or two, but will keep doing it after)
    -From week 3 and on, in addition to bike and stretching, start working out 2-3 times a week to strengthen my leg muscles (squats, lunges, etc.)
    -Lose 10-15 pounds and get more hours of sleep every night
    -Play tennis again in about 6 weeks, if all goes well. But I'll start very slowly, probably with a ball machine at first (avoiding lateral movement)
    -For the rest of the year (and my recreational career?), play no more than 2-3 times a week. And switching my style from a wanna-be Pat Rafter S&Volleyer to a baseliner/all-courter who finishes the point early.

    And I'll wear the same brace I already have, which is a shock doctor costing 60$ or so. I'm told no brace can do much for a meniscus problem. But the brace adds a little support for shock and twist, so why not. It doesn't bother me when I play anyway.
     
    Last edited: Mar 20, 2013
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  15. charliefedererer

    charliefedererer Legend

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    Thanks for the update. Sounds like a good plan. Good luck!
     
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  16. polytheist

    polytheist Rookie

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    Charlie,

    Thanks so much for the great info. Not sure how much "to the side" it tracks. Is it supposed to track exactly up/down? Mine track inward somewhat as i go from squatting to standing. About 5mm inward from legs being 90 degrees bent to full extension.
     
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  17. charliefedererer

    charliefedererer Legend

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    I'm no "expert" in this area, and can only give you the following general information. (Again, it would be great if Posture Guy or someone else on this board who has more experience here could comment.)

    But the fact that your patellar tendon tracks inward 5mm as you go from squatting to standing may mean one of two things:

    1. Your patellar tendon abnormally tracked 5mm outward/ laterally as you were were squatting (as was seen in the study below in those with patellofemoral pain)

    Or

    2. Your pattellar tendon tracked 5 mm inward/medially as you were squatting, and was just returning to the normal position as you went from squatting to standing (the "normal" group in the study below).

    "At 90 degrees of knee flexion, the patella demonstrated significantly more lateral translation in subjects with patellofemoral pain (mean, 5.05 +/- 3.73 mm) than in healthy subjects (mean, -4.93 +/- 3.93 mm) (p < 0.001)."
    - http://www.ncbi.nlm.nih.gov/pubmed/19255215

    [​IMG]

    So while that 5 mm tracking abnormality in those with patellofemoral pain was exactly the same amount of abnormal tracking that you report,
    either you yourself would have to be pretty expert to tell whether the the patella was tracking abnormally laterally as you went down into your squat
    OR
    you should see a therapist with experience who could make a proper evaluation.


    I would vote on seeing a therapist who could do a proper evaluation, and IF needed, do the proper exercises to strengthen your inner quads and/or gluteus medius.

    Then you could be sure you weren't exacerbating the problem by doing squats while you have abnormal tracking.
     
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  18. Chas Tennis

    Chas Tennis Hall of Fame

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    Another Posture Issue - Short/Tight Rectus Femorus?

    The knee has two joints - the one between the femur and tibia with the meniscus, etc., and the one under the knee cap, the patellar-femoral joint.

    In my opinion, pain under the knee cap is often caused by posture issues, quad strength & tightness, as discussed in the above replies.

    When I had an MRI for a torn meniscus, the MRI report included serious damage to the patellar-femoral joint. (Get the written MRI report from the imaging specialist, read it and research all issues even those not being treated or showing symptoms.)

    One particular issue, that of a short/tight rectus femorus, is described in this link

    http://www.mrtherapy.com/articles/article3.html

    BE AWARE THAT STRETCHING THE RECTUS FEMORUS MIGHT PUT STRESS ON THE LOWER BACK.

    The rectus femorus is special because it is the only quad that attaches above the hip joint, the other three quads attach to the femor.

    I believe that this is a good description, believe that I have a short rectus femorus, and that the stretch is very effective in correcting it. It may be my over-simplified picture, but I believe that a tight rectus femorus simply causes the patella to ride too high in the joint. This damages the cartilage separating the patella from the femur. Some of the other better known patella tracking problems involve lateral tracking issues, the patella being pulled to the side or 'tilted' relative to the joint track.

    Search: rectus femorus quadriceps anterior pelvic tilt
     
    Last edited: May 5, 2013
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  19. polytheist

    polytheist Rookie

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    Wow, that does look like me in the PFP group. This is hugely interesting. Going to try the rehab exercises (i already do most of them) and ease into squats and deadlifts. I work out all the time but i'm guessing the key is balance.

    Thanks again so much, i'll let you know how it goes.
     
    #19
  20. polytheist

    polytheist Rookie

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    (and if it gets worse, not better, i'll hit up the ortho for a PT script)
     
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  21. polytheist

    polytheist Rookie

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    And btw, i do have hip flexor issues, so adding Chas's rectus femoris stretching protocol.
     
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  22. Chas Tennis

    Chas Tennis Hall of Fame

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    #22
  23. RogueFLIP

    RogueFLIP Semi-Pro

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    While I agree with the rehab option and think that a brace may be overkill in this situation, I'll answer the OP's question directly as a "general" answer.

    After tearing my ACL in '98, I wound up getting a custom knee brace for protection and stability.

    I would strongly recommend that if your insurance company covers it, to get a custom brace. Same if you can afford it.

    Molded to my leg, the brace really gave excellent support without bothering me at all (of course after getting used to having a brace in the first place). Also it was much smaller and virtually unnoticeable under my work khakis.

    When I finally was able to resume tennis, I used it with no problems. Didn't feel bulky, excellent sense of security....too much in fact that I probably used it much longer than I needed.

    Custom if you can get it. :)
     
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  24. LeeD

    LeeD Bionic Poster

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    Don't those custom OrthoTech and CTI braces cost around $2,500, and need a doctor's approval (more dough), and final fitting?
    One sided knee braces from medical supply stores cost $250, have double velcro calf and thigh straps, and the pivot can be set exactly to the knee's pivot point. Just takes some judicious fitting and refitting the first several times.
     
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  25. usta2050

    usta2050 Rookie

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    knee braces don't really work... you need to stretch and strengthen your legs and butt muscles.
     
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  26. RogueFLIP

    RogueFLIP Semi-Pro

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    I tend to agree that they will not necessarily prevent injuries, if the knee's gonna go, then the knee is going to go no matter what.

    However, at the time I blew my ACL, MCL, and had a lateral meniscal tear. The brace gave me a sense of mental security that my knee and leg would hold up while doing my job.

    After the surgery repair and rehab, getting back into sports, same thing. I don't think I would have been as confident playing without some sense of support.

    And I admitted that I used it way longer than I needed to only because of the mental aspect despite my leg being back to normal following all the strengthening.

    But it didn't interfere at all with my tennis and other sports activities.
     
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  27. RogueFLIP

    RogueFLIP Semi-Pro

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    Yes you are correct on all points.

    But why not custom molded to your leg if it's covered or you can afford it?

    Just my experience and opinion.
     
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  28. usta2050

    usta2050 Rookie

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    I agree, they do make you feel "secure" and in some cases, they do restrict your movement so you don't make your injuries worse...it's funny how well ankle braces work while knee braces don't do much.
     
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  29. LeeD

    LeeD Bionic Poster

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    Guys guys....
    Take a peek under the pants, at the knee, of NFL lineman, both defense and offense...please.
    75% of them hogs use a custom, double sided, carbon componsite knee brace! The team PAYS FOR IT, plus the fitting.
    YOU say it doesn't prevent injury.
    THEY say different. I tend to believe THEM, because they are backed by studies, doctor's advice, trainers, PT's, and sports medicine doctors.
     
    #29
  30. usta2050

    usta2050 Rookie

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    I don't think too many people on this board have access to a NFL orthopedic doctor. I've seen some of those carbon structures in action on tennis courts. My partner had one that was almost top of the line stuff and he couldn't move much side ways. He could move up a bit. So they prevent injuries by limiting your ability to make cuts.

    That's why you don't see running back wearing a brace in matches.

    Also, when I said ankle braces do work, I was referring to one type of ankle brace (ASO).
     
    #30
  31. LeeD

    LeeD Bionic Poster

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    AnquanBoldin, when he was still with the Cardinals, wore his OrthoTech for an entire season, during his recovery from a knee cruciate injury.
    Now true, he can't run fast (40 in 4.7), and doesn't need to cut like the little guy covering him (typical CB is 5'10, 185lbs.), but he IS a slot or left wideout, and he did catch and run for over 900 yards that season.
    I'd not take too much credence on ONE guy you saw on a court using a brace who couldnt' run side to side.
    I wore a single sided brace for a few years playing solid 4.0 level singles tennis. I was the quickest and fastest, and least determined player out of over 30 at the courts.
     
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  32. Chas Tennis

    Chas Tennis Hall of Fame

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    After my meniscus surgery in 2001 my Dr (surgeon also) prescribed a custom made strong hinged brace made by Donjoy. He prescribed it because, in the arthroscopic examination, he thought that perhaps my ACL had been injured earlier and might have healed with some extra slack, maybe it had contributed to my meniscus injury. The purpose of the Donjoy brace was to prevent the bottom of my leg from moving too far forward - a healthy ACL does that - and thereby prevent damaging the meniscus, etc.

    The brace looked and was heavy duty but I did not notice that it was on and did not notice lateral movement issues (but I not a strong mover). It just sort of limited the bottom of my leg from going forward.

    I kept wearing it after the Dr said I could stop using it at about 1 1/2 years after surgery. He said that maybe there was no structural problems with my ACL after all. At times during the next 2-2 1/2 years I felt as if something would briefly get out of place in my knee - but for just a few games. I guessed that it was my meniscus but don't know. That is why I wanted to continue wearing the brace even after the Dr said that I could stop. I finally stopped using it at 3-4 years after surgery after I worked out at the gym and could feel that the knee including ligaments was stronger and more secure.

    USTA 2050, have you used one of the heavy duty hinged braces?
     
    Last edited: Mar 28, 2013
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  33. usta2050

    usta2050 Rookie

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    I have used the double hinge ones that you can buy from stores...I couldn't move much at all. didn't have a huge injury so i didn't spend thousands on the top of the line stuff.
     
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  34. RogueFLIP

    RogueFLIP Semi-Pro

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    That's why I suggested custom if you can get it baby!!! :twisted:
     
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  35. Sumo

    Sumo Semi-Pro

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    No pros are wearing those as a preventative measure.
    Almost all college o-linemen are wearing them, but none of the d-line. It has to do with the forces being put on he knee. D is going forward,while O is going backwards and in more danger.

    Those things are garbage and night and day different from something like a custom donjoy. I still wear mine while skiing, but it's a mental thing at this point.
     
    #35
  36. usta2050

    usta2050 Rookie

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    I agree, they are garbage. I tried everything the stores and Amazon had. They all had good reviews and didn't do much.

    Don't know if my doubles partner used donjoy but it was a few grand....he didn't play well in it at all. but maybe he wouldn't have been able to play if he didn't have the brace.
     
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  37. LeeD

    LeeD Bionic Poster

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    Would it depend on the specific injury we are trying to prevent.
    Mine... twisted medial collateral. I stepped down 4 steps in lush carpet, hit the bottom floor, turned right, foot stayed pointed straight. Medial popped, swelled to 1/4 a softball.. Had my foot turned to the right when I turned to the right, I'd been fine. Double velcro, on both the thigh and the upper calf, forces the lower leg to follow the thigh, when a twist force is applied.
    Might not work for YOUR specific injury, but I was windsurfing a week after the injury WITH the brace, and hobbled around without.
     
    #37
  38. DonDiego

    DonDiego Hall of Fame

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    Lee, thanks for all your answers. From your experience, do you have any brace model in mind in the 200-300$ range? (a link would be appreciated). My problem is the meniscus, so I believe the most important thing in a brace would be shock absorption. Thanks again.
     
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  39. LeeD

    LeeD Bionic Poster

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    Shock absorption, anti hyperextension, and alignment. They all do that.
    Most guys use gel insoles, orthodics also. And NO new shoes.
     
    #39
  40. Chas Tennis

    Chas Tennis Hall of Fame

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    The weight of the body above the knees is supported by the two femurs. The femors rest on the knee cartilages, the meniscus cartilages and articular cartilages. How can a brace applied to the flexible/stretchable skin support weight? It might restrict the knee from making excessive side movements and help the meniscus (?) but I can't see how it can take any weight off the meniscus cartilages. Try to find some research on this issue.
     
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  41. LeeD

    LeeD Bionic Poster

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    Braces can provide some shock absorption by limiting your extension so you knee joint never aligns straight, allowing the bending action to absorb shock. Some have dialed knee lockout knobs.
     
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  42. Chas Tennis

    Chas Tennis Hall of Fame

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    That's an interesting point, I see what you mean.
     
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  43. RogueFLIP

    RogueFLIP Semi-Pro

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    I'm not sure playing tennis on a limited ROM for your knee to try to prevent a knee injury is a good idea. Other areas of your body will try to compensate and you'll wind up putting more force in these areas which potentially could injure those areas.

    Now limiting your ROM to play tennis while you have an exisiting injury....well, also not the brighest of ideas, but as an addict of this game, I can sorta understand why one would do that.

    Either way, brace or no brace, full or limited ROM, if your knee's gonna go, it's gonna go and no amount of profalactives will prevent it.
     
    #43
  44. usta2050

    usta2050 Rookie

    Joined:
    Dec 28, 2010
    Messages:
    373
    the compensating part is so true...

    Leed's suggestion is the best. Let those good shots go. Don't chase after them.

    Or you can try to rally using 1/2 court.

    Playing a game is tricky if your opponent has a good serve. Once you jump up in the air for a return, anything can happen when you land.
     
    #44

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