Last year, 27 ACL tears occurred before the 2015 NFL regular season even started. With an average annual salary of almost $2M per athlete, there is a significant financial impact (albeit this is a very limited perspective of the actual financial implications of these injuries) on the league and our young men in American society because of ACL injuries. A recent epidemiological study of musculoskeletal injuries in the National Football League suggests that knee injuries accounted for 18% of all injuries- while lower extremity injuries accounted for 62% of all NFL injuries (Lawrence et al. 2015).
Outside the NFL, we are seeing over 200,000 ACL reconstructive surgeries per year in the U.S. These numbers are outdated too; this count is according to data published in 2010. We aren't even discussing the 4 Million Americans tearing their meniscus each year (we'll leave this for another post).
Although ACL tears have been monstrous injuries prevalent throughout the history of all sports, high profile athletes who tore their ACL in the past 5 years have helped garner the attention of society at large and shed light on the need for more advanced research, more rehabilitative programs with quantified data sets, and more advanced joint bracing methods to improve/ return the biomechanical functions of a healthy knee.
For those of us who have worn a functional ACL brace, we know that they provide another shade of misery in the rehab process because they don’t stay in the right place, they fall down our leg, they are uncomfortable as sh*t, they limit our natural movements, they impair our athletic talents, and most times they fit plain wrong. Even clinical research mirrors and validates our subjective experiences. Even further, the clinical research outright says that there is a significant “need for improved functional brace design” (Smith et al. 2013).
To improve functional bracing we have to establish a fundamental fact with the human body: the entire kinetic chain must be addressed in order to normalize joint biomechanics. In other words, the hipbone is connected to the thighbone, and the thighbone is connected to the shinbone… The whole is greater than the sum of the parts. We are a whole body. That’s a fact Jack. For a little real-life example, just ask someone who has faced the recovery process of knee surgery (or 99% of males for that matter) how their hip and iliotibial (IT) band felt. Or better yet, throw them on a higher density foam roller and have them roll that IT Band—it will hurt so good. So to properly support a specific joint like the knee and to help it find proper alignment, we have to at least somewhat address the surrounding body parts like the IT Band and the quadriceps that originate at the hip.
After accepting the fundamentals of the kinetic chain, next look at the layers of the body. The skin alone has 6+ layers—even knee joints are comprised of many layers. We are layers upon layers, and to properly create a support system we have to mirror this.
So, when we look to the current bracing methods available on the market, pose two simple questions: 1) are these functional braces addressing the entire kinetic chain? And 2) are these braces designed with layering methods? NO, and NO.
Most frustrating for some is the fact that very few knee braces on the market are actually custom--even though we are told they are. Most times, they take your measurements and then go to their “behind the counter shelves” and pick from an allotment of sizes (i.e. Medium- Short, Large-tall).
For the next wave of functional braces to push the status quo we need to see a system addressing more parts of the kinetic chain, layered designed combining multiple applications of support, data generation for further biomechanical research, dynamic uses in one brace for rehab and return to activity (i.e. a rehabilitative application appropriately stressing the joint for strengthening/ normalizing, or a prophylactic/ protective element once we return to activity), and crucially- true elements of customization.
There are no shortcuts around these needs of future functional orthopaedic support systems. They are not only necessary, but completely possible. And I assure you, it is happening.