How Splints and Braces Help Your Joints
Splints and braces work by giving a joint support when in use, and letting it rest when you’re sleeping or sitting down. They can also help in the case of contracture, the shortening of the muscles, tendons, and tissues that results in rigidity and deformity of joints. “If you aren’t mindful about doing — or are unable to do — flexibility and range-of-motion exercises, you can get this extreme tightness. Wearing a splint or brace when resting at night can help maintain the joints in a neutral position,” says Mary Ann Wilmarth, a doctor of physical therapy who is a health and patient advocate and CEO of Back2Back Wellness in Massachusetts, and a psoriatic arthritis and osteoarthritis patient.
Effectiveness: Do Braces and Splints Help Improve RA Symptoms?
Wrist splints reduce pain and help improve grip strength for people with rheumatoid arthritis, according to a review published in the Journal of Rehabilitation Medicine. A Polish study published in Reumatologia in 2018 demonstrated that hand function of women with RA was limited due to reduction in grip quality and manual dexterity, but that wrist stabilization with wrist braces improves hand function in patients with RA. Another study published in 2018 in Arthritis Care & Research concluded that wearing a soft knee brace decreased pain and knee instability in people with OA.
Are You a Candidate for Splints? When to Use Supportive Devices
The decision to use a supportive device is something to discuss with your rheumatologist. In general, says Dr. Wilmarth, “It depends on the strength of the joint. The goal is to have you independent without a splint for as long as possible. It allows you to use your own strength and it is less cumbersome. But on the other hand, we also don’t want you to injure your joints further.”
Are There Any Risks to Using Splints and Other Supportive Gear?
There’s a fine line between using braces and splints just during certain activities and coming to rely on them all the time. Often your rheumatologist will start you with one part time, only when using that joint, to see if you can keep up your strength. Wilmarth cautions, “If you wear it too much and become too dependent on it, then you can get atrophy of the muscles. We want your muscles to be as strong as possible. We want to build strength over time, because that is what will give you your best control and defenses against pain. You need to use splints in conjunction with your exercise program — range of motion, flexibility, and strengthening, and ideally in conjunction with cardiovascular exercise. If you need to wear a splint every day, you will be given a very specific on-off program to make sure joints and muscles are moving appropriately, and to give the skin time to breath, and to avoid pressure points and irritations.” RELATED: Smart Tech for People With Rheumatoid Arthritis “I recommend constant use only if you have a chronic weakness or have a deformity — for example, a foot drop, which is a neurological condition that always need bracing so you can walk more safely,” says Dr. Koumpouras. He reports on other risks:
If a brace or splint is used inappropriately, you can further injure the joint.If a brace or splint isn’t fitted correctly, you can get a skin ulcer.Braces can be heavy, so the other side of the body can get overused to offset it. A cane can help provide balance.
Getting the Right Brace Size and Fit
If your need is light, some commercially made braces and splints can be bought off the shelf. These come in sizes ranging on average from XS to XL. According to Wilmarth, physical therapists and occupational therapists can both fit and fabricate splints for patients. In some cases, you may need to be specially fitted by an orthotist, a specialist who designs and makes medical supportive devices and measures and fits patients. Your rheumatologist can tell you what you need, and where to find a reputable orthotist; many physical therapy or rehabilitation centers have one. Swelling and pain can precede joint instability, therefore it is important to address these issues. The use of ice to decrease edema and inflammation or heat to improve stiff joints, blood flow and relax muscles can be used in conjunction with splints or braces. It is imperative to have the proper fit with these orthoses since any pressure points can compromise the integrity of the joint, the skin or even put pressure on nerves.
When to Consider Compression Gloves and Garments
Compression gloves are quite often used by patients with both inflammatory arthritis and osteoarthritis these days. The evidence is more anecdotal at this time rather than research based. “Many patients with arthritis swear by their compression gloves and I would personally attest to that," Wilmarth states, “I do not wear mine all the time, but when I need them, they are extremely helpful.” For those people who have hand and finger pain and swelling, these gloves can provide relief of symptoms so that performing activities of daily living becomes easier. Others prefer to wear them at night. It is important to ensure that you have the proper fit, not too loose, nor too tight. Some people have more than one pair depending on the season, their swelling and the size of their fingers at the time. In addition, you may want specific gloves for the kitchen, for computer work, and for bed. It is very individualized. Wilmarth states that she uses the brands that have open fingertips for better dexterity. Make sure to check with your doctor or physical or occupational therapist if you have any questions.
What About Supportive Socks?
Compression socks are another item to consider. Compression socks help to promote better blood circulation in the legs with resulting increased oxygen delivery to muscles and improved removal of lactic acid. Generally, there are two types of compression socks: graduated and anti-embolism stockings. Graduated socks are tighter around the ankle and get looser as they get higher up the calf or leg. Anti-embolism stockings are very specific and are always prescribed by your doctor to prevent blood clots, very often after surgery or if someone is confined to bed. However, Wilmarth warns that overusing compression socks and wearing them incorrectly can break your skin and create conditions where an infection can start. Contraindications can include severe reduction of heart function or severe peripheral arterial disease. As always, consult your doctor with any questions.
Finger Splints May Help Hands
Joint destruction and disease such as RA and OA can affect the alignment of ligaments and cause joint instability. This creates a loss of support and a decrease in power, particularly in the hands and fingers. Splints known as the silver ring splints help stabilize the finger and control the movement of the joint in its normal range.
Other Ways to Rest Your Joints
You don’t always have to use just splints or braces (known as orthoses) to rest your joints. Wilmarth also recommends the following strategies:
Use your larger, stronger muscles whenever possible.Practice good posture and body mechanics.Respect your fatigue; balance activity and rest periods.Consciously stop every 15 to 30 minutes in your day to make sure you rest your affected joint in a neutral position. Even if it’s only for 5 to 10 seconds. Make sure it’s completely relaxed. “People think they are relaxed, but their muscles are often still tense. Ideally, you want to make a conscious effort for 15 to 30 seconds (anything can help though) to let your entire body go. Take deep breaths. Do a mini meditation,” she says.Reduce the effort and force that you use with activities.Utilize tools and assistive devices that are made to ease the burden of arthritisDo very gentle repetitions of range of motions. For hands, open and close them, Wilmarth explains, “This lubricates joints and gets the blood flowing.”Work in your pain free range of motion. Avoid your positions of deformity.Try paraffin baths, which can help ease joint pain for the hands and feet while also moisturizing the skin.
