In a patient with patellofemoral pain syndrome who reports that a knee brace relieves his symptoms, should the brace be used long‑term or only as an adjunct while emphasizing quadriceps/hip strengthening, load management, and activity modification?

Knee Brace Use in Patellofemoral Pain Syndrome

Use the knee brace as a temporary adjunct only while prioritizing quadriceps and hip strengthening exercises, which are the definitive treatment for patellofemoral pain syndrome. 1, 2

Primary Treatment Approach

The most effective treatment is a structured physiotherapy program combining quadriceps strengthening, hip abductor strengthening, and quadriceps stretching. 2, 3 This approach has the strongest evidence for reducing pain and improving function in patellofemoral pain syndrome, while bracing alone shows inconsistent objective benefits despite patient-reported symptom relief. 1

Role of Bracing

When to Use the Brace

• Use the patellofemoral brace as a short-term adjunct during the initial rehabilitation phase to provide symptom relief while the patient builds strength. 4, 5
• The brace may help during activities that provoke symptoms while the underlying muscle dysfunction is being corrected. 1

Critical Limitations of Bracing

• Patients consistently report subjective improvements that exceed objective findings, meaning the brace provides perceived benefit without measurable mechanical correction. 1, 4
• Evidence supporting brace effectiveness is weak and lacks well-controlled studies. 1, 6
• Lower extremity muscle strengthening, flexibility improvements, and activity modification are more important than bracing. 1

Rehabilitation Protocol to Emphasize

Strengthening Program

• Begin quadriceps strengthening immediately, focusing on both general quadriceps and hip abductor exercises. 2, 3
• Progress from isometric to concentric and eccentric exercises as pain allows. 7
• Closed kinetic chain exercises should be prioritized to reduce patellofemoral pain risk. 7

Load Management

• Modify activities that increase pain, particularly those involving knee flexion under load. 3
• Educate the patient about avoiding overuse and trauma that perpetuate symptoms. 3

Adjunctive Therapies

• Consider patellar taping or orthotics as additional adjuncts, though these show limited benefit when used alone. 2, 6
• Do not rely on the brace to provide actual joint protection—it may create a false sense of security without protective benefit. 7

Common Pitfalls to Avoid

• Do not allow long-term brace dependence without addressing the underlying muscle weakness and biomechanical dysfunction. 4, 8
• Avoid using the brace as the primary treatment modality; it should never replace a comprehensive strengthening program. 1, 2
• Do not continue bracing indefinitely based solely on patient preference when the evidence doesn't support long-term benefit. 8
• Ensure proper brace fitting if used: measure leg circumference 3 inches above and below mid-patella, position the lateral buttress correctly, and check periodically for migration. 1, 4

Clinical Algorithm

1. Initiate structured physiotherapy immediately with quadriceps and hip strengthening as the primary intervention. 2, 3
2. Allow brace use during symptomatic activities in the initial 4-8 weeks while strength is being built. 4, 5
3. Progressively wean the brace as muscle strength improves and symptoms decrease. 1
4. Discontinue the brace entirely once adequate strength is achieved and symptoms are controlled through proper biomechanics. 7, 8