To Brace or Not to Brace? Finding the Right Support for Hypermobility

To brace or not to brace, that is the question!

One of the most common questions I get from our patients who live with symptomatic hypermobility is, “But is it ok to wear a brace?”

Let’s break it down so you feel like you have a solid understanding of the why behind wearing a brace and if it might be a good treatment strategy for you.

Ok, so we’re talking about bracing for people living with symptomatic hypermobility, most commonly diagnosed with hEDS or HSD (though many are not yet diagnosed). Symptoms that you may be experiencing if you have symptomatic joint hypermobility could include joint pain, swelling, instability, tendon pain, muscle tension, dislocations or subluxations. In general, you hurt and you might not know why. You also might not even realize how unstable a joint is because it just feels like “normal” to you. For example, if you roll your ankle a lot, hyperextend your knees, feel like your pelvis is unstable and causes sacroiliac joint pain, your shoulders are constantly popping out of place or your neck feels like a bobble head on your neck, wearing a brace might be a helpful strategy for you. 

What do we mean by “bracing?” A brace is a supportive device worn over a joint to provide stability to a joint, reduce swelling or pain and protect against further injury. It can also serve to provide proprioceptive input, which is something that people living with hypermobility syndrome struggle to find internally. A brace could be more rigid and stiff, designed to reduce range of motion, or it could be soft and flexible to provide gentle compression and reduce swelling and achy joints. 

Now that we know a little bit about bracing, why would we even consider wearing one? When you live with joint hypermobility, your end range joint motion can go beyond neutral, into hyperextension. This hyperextended position isn’t necessarily bad and something to avoid all the time, but it puts a lot of stress on the joint and asks a lot of the muscles to stabilize in that lengthened position. In people with hypermobility, joints are also more unstable because the ligaments around the joint that are there to provide stability are more lax and stretchy, so the joint can move around more easily, causing sprains, subluxations or dislocations. 

Back to our original question: to brace or not to brace?

People are often very hesitant to wear braces because they’ve been told not to (with no good explanation), they’ve been told their muscles will atrophy if they start wearing a brace, or they think they’re too uncomfortable and bulky and would never actually put one on. For many years as a PT, I was more hesitant to use braces and then I started putting them on my patients and watched what happened. So, now? I think that bracing can be incredibly beneficial in the hypermobile population and I think that we often don’t wear them enough! 

How do they help?

So now that you know I’m pro-bracing, let’s get into why they’re helpful and not harmful and how to utilize them most effectively. 

The biggest misconception is that your muscles will atrophy if you wear a brace. This might be true if you wear a rigid brace 24/7 and aren’t able to move normally. These types of braces are typically used for acute injury, like an ACL tear or after a shoulder dislocation, and are not the type of brace often recommended for people with hypermobility. 

Instead, we most commonly recommend a compression sleeve that provides input to the joint to help you know where it is in space and protect it from hyperextending and causing tissue strain. When wearing these types of braces, you should be able to move normally and often it feels better to move because now the joint is stable! This often leads people to be more active and move more, which is our overall goal. 

Another important piece to factor in is that people with hypermobility are often overusing large muscle groups and underusing deep stabilizers. Putting a brace on will provide joint stability so that the large muscle groups can relax and stop overworking. In turn, having the joint be stabilized in better alignment allows for optimization of the deep muscle stabilizers so that the body gets the postural stability it needs. I often see patients put on a brace and suddenly be able to activate the muscles that they’ve struggled to find for so long, and now they’re using those muscles effectively and that is the opposite of letting muscles atrophy! 

Because of this, it can be helpful to use braces as a retraining device. Wearing them can help you teach your body where your joint is in space by providing external input, allow you to understand where a neutral joint position is, and effectively activate the muscles we want to use while relaxing the muscles we don’t want to be using. I advise my patients to wear braces while doing their exercises, really tune into what it feels like to have a stable joint and notice which muscles are active and which are not, then take off the brace and try to reproduce the same sensation with that exercise. 

Another great time to use braces is when you’re going to be doing more than your body can tolerate without compensating. As much as we want to pace well, we all have those days where we know we’re going to push a bit past our limits by walking further than we’re used to, standing longer or being more active. Wearing a brace allows you to participate in the activity that you want to do without fatiguing so quickly and dropping into poor posture or movement patterns that might lead to pain. The idea here is to use braces to improve your activity tolerance while reducing a flare up of symptoms. 

Overall, braces are an effective strategy to improve body awareness, optimize muscle activation, improve joint stability and limit pain. I recommend starting with the least restrictive brace, like a compression sleeve, and moving to a more rigid brace only as needed. If you’re looking for more help with what braces might be appropriate for your body and how to use them effectively, reach out to us at Intrinsic PT, we’d be happy to help!