Finding the Right Bracing Solution
Your Health-Care Team
Treating osteoarthritis (OA) often requires a team approach in which you benefit from the expertise of health professional from different disciplines. A family physician, a physician specializing in internal medicine, or a physician who is familiar with arthritis, such as a rheumatologist or an orthopaedic surgeon, may act as your health-care team leader.
Consultation with a rheumatologist is recommended when the diagnosis is in doubt, or if your symptoms worsen or fail to improve. A rheumatologist is a physician with special training in arthritis and other diseases of the bones, muscles and joints. In some cases, your rheumatologist may refer you to another type of health-care professional who specializes in bracing. The rheumatologist acts as a consultant, all the while assuming primary responsibility for the medical treatment of your arthritis.
Other health professionals, such as physical therapists, occupational therapists, orthotists, nurses, orthopaedic surgeons and social workers, often play important roles in helping you manage the disease.
Physical therapists can help you manage pain, build strength and endurance, and improve mobility by using therapeutic exercise and heat, cold or water therapy. They can tailor home exercise programs for their patients.
Occupational therapists teach patients how to more easily perform everyday activities (cooking, driving, dressing) that may have become challenging as a result of pain or loss of mobility.
Orthotists specialize in designing, building and fitting braces and other orthotic devices. Orthotists are not medical doctors.
Orthopaedic surgeons evaluate and treat disorders and diseases of the bones, joints, tendons and ligaments. They use various treatments, including medications, bracing and surgery, to treat their patients. Some orthopaedic surgeons specialize in particular types of surgery.
The Initial Evaluation
Your rheumatologist, orthopaedic surgeon or doctor who has significant experience in managing arthritis is the best person to write a prescription for an orthotic device such as a brace. You may be referred to a board-certified orthotist for further evaluation and design and fitting of a brace.
First the orthotist will obtain a thorough medical history, perform a detailed structural analysis of the affected joint and interview you about your physical and functional capabilities and limitations. The orthotist uses this information to determine what bracing approach will work best for you, such as limitation of motion, weight-shifting or stress relief. Together, you and the orthotist will set treatment options.
Getting the Proper Fit
Braces that don’t fit right can cause problems. In addition to being uncomfortable to wear, ill-fitting braces can slip out of place or produce excessive pressure, which can lead to skin problems and soreness. Poorly fitted braces also may cause harm by restricting the use of nearby joints that are otherwise uninvolved.
To make sure braces fit well, orthotists may create a cast mold or use a custom measuring device to make a model of the limb. The brace is built to fit the contours of the model before making the final adjustments to the brace while the patient is wearing it. Once the brace is adjusted and the knee is properly aligned, the orthotist gives the patient instructions about how to wear the brace and what to expect.
Follow-up requires regular monitoring of the patient’s progress toward treatment goals and ongoing adjustment to or replacement of the brace, as needed.
