Knee Splints: Adjustment, Troubleshooting, and Care

How Do You Adjust a Knee Splint?

Adjusting a knee splint involves carefully positioning the brace on the limb, securing all straps to provide stable support without compromising circulation or causing discomfort, and ensuring any hinged components are set to the prescribed range of motion.

Understanding Knee Splints: Purpose and Types

Knee splints, often interchangeably called braces, are medical devices designed to support, protect, or immobilize the knee joint after injury, surgery, or due to chronic conditions. Their primary functions include:

• Immobilization: Preventing movement to allow healing (e.g., post-surgery, severe sprains).
• Stabilization: Providing external support to an unstable joint.
• Pain Reduction: Limiting movements that exacerbate pain.
• Controlled Motion: Allowing a specific, pre-determined range of motion during rehabilitation.

Common types include:

• Knee Immobilizers: Long, rigid splints that keep the knee completely straight.
• Hinged Knee Braces: Allow for controlled flexion and extension, often with adjustable range-of-motion (ROM) stops.
• Post-Operative Braces: Designed for specific surgical protocols, usually hinged.
• Patellar Stabilizers: Focus on keeping the kneecap aligned.

Essential Principles of Splint Adjustment

Proper adjustment is critical for the splint's effectiveness and patient comfort. The core principles are:

• Optimal Support: The splint must provide the intended level of support or immobilization.
• Circulation Integrity: Never impede blood flow. Numbness, tingling, or skin discoloration are red flags.
• Skin Protection: Avoid friction, pressure points, and skin breakdown.
• Patient Comfort: While some initial discomfort is normal, severe pain or persistent irritation indicates a poor fit.
• Prescribed Range of Motion (ROM): If hinged, the ROM settings must precisely match the physician's or physical therapist's instructions.

Step-by-Step Guide to Adjusting a Knee Splint

Always follow the specific instructions provided by your healthcare provider or the splint manufacturer. This general guide applies to most common knee splints:

1. Preparation:

   • Consult Instructions: Review the specific fitting guide that came with your splint.
   • Clean Skin: Ensure the skin underneath where the splint will sit is clean, dry, and free of lotions or oils.
   • Wear Appropriate Clothing: A thin, moisture-wicking sleeve or pant leg can be worn under the splint to prevent skin irritation, unless advised otherwise.
   • Inspect Splint: Check the splint for any damage, sharp edges, or worn components before application.

2. Initial Positioning:

   • Sit Comfortably: Sit or lie down in a position that allows you to fully extend your leg.
   • Align the Splint: Position the splint centrally on the leg, ensuring the hinges (if present) align with the knee joint's natural axis of rotation (usually around the middle of the kneecap). For immobilizers, ensure the splint extends adequately above and below the knee.
   • Patella Opening: If the splint has an opening for the kneecap, ensure the kneecap is centered within this opening.

3. Strap Management:

   • Start from Middle: Begin securing the straps, typically starting with the straps closest to the knee joint. This helps stabilize the splint.
   • Secure Methodically: Work your way up and down the leg, securing the remaining straps. Some splints may have specific numbering for strap order.
   • Snug, Not Tight: Tighten each strap until it is snug and the splint feels secure, but not uncomfortably tight. You should be able to comfortably slide one finger under each strap.
   • Even Tension: Ensure even tension across all straps to distribute pressure and prevent localized hot spots. Avoid overtightening one strap while others remain loose.

4. Hinge Adjustment (if applicable):

   • Locate Pins/Dials: Identify the pins, dials, or levers on the hinges used for adjusting the flexion and extension limits.
   • Set ROM: Carefully set the desired range of motion (e.g., 0-30 degrees extension, 0-90 degrees flexion) as prescribed by your doctor or therapist. This often involves inserting pins into specific holes or rotating dials to the correct numbers.
   • Confirm Settings: Double-check that both hinges (medial and lateral) are set to the identical ROM.

5. Final Checks:

   • Assess Comfort: The splint should feel supportive without pinching, rubbing, or causing excessive pressure.
   • Check Circulation: Look for signs of impaired circulation:
     • Color: Toes should remain their normal color.
     • Temperature: Toes should feel warm, not cold.
     • Sensation: Wiggle your toes; check for numbness or tingling.
     • Capillary Refill: Press on a toenail until it blanches, then release. Color should return within 2-3 seconds.
   • Test Stability: Gently move your leg to ensure the splint provides the intended support and does not slip or rotate excessively.
   • Movement Assessment (Hinged): If it's a hinged brace, carefully move your knee within the set ROM to ensure smooth movement without binding or discomfort.

Common Issues and Troubleshooting

• Splint Feels Too Tight:
  • Symptoms: Numbness, tingling, throbbing, coldness, pale or bluish discoloration of the foot/toes, increased pain.
  • Action: Immediately loosen all straps, then re-tighten more gently. Recheck circulation. If symptoms persist, remove the splint and contact your healthcare provider.
• Splint Feels Too Loose/Slipping:
  • Symptoms: Splint slides down the leg, rotates, or doesn't provide adequate support.
  • Action: Re-tighten all straps, ensuring even tension. Verify the splint's size is appropriate for your leg. Consider wearing a thin undersleeve to reduce friction if it's still slipping.
• Skin Irritation or Redness:
  • Symptoms: Red marks, blistering, sores, itching under the splint.
  • Action: Loosen straps slightly. Check for rough edges on the splint and pad them if necessary. Ensure skin is clean and dry. A thin stockinette or specialized brace sock can help. Persistent irritation requires professional evaluation.
• Increased Pain or Swelling:
  • Symptoms: New or worsening pain, swelling around or below the splint.
  • Action: Loosen straps and re-evaluate the fit. Elevate the leg. If pain or swelling persists or worsens significantly, contact your healthcare provider immediately.

When to Seek Professional Guidance

While minor adjustments can often be made independently, certain situations warrant immediate contact with your healthcare provider or physical therapist:

• Persistent pain, numbness, tingling, or swelling despite adjusting the splint.
• Signs of impaired circulation (coldness, pallor, blue discoloration of the foot/toes).
• Inability to achieve a comfortable and secure fit that provides the prescribed support.
• Skin breakdown, severe redness, or blistering under the splint.
• The splint feels broken, damaged, or no longer functions correctly.
• Any concerns regarding the prescribed range of motion or if the knee feels unstable within the splint.
• Signs of infection (e.g., fever, pus, increased redness or warmth around a wound).

Maintenance and Care of Your Knee Splint

Regular care ensures the longevity and hygiene of your splint:

• Cleaning: Follow manufacturer guidelines. Most soft components can be hand-washed with mild soap and air-dried. Wipe down rigid components with a damp cloth.
• Inspection: Periodically check straps for fraying, buckles for damage, and hinges for smooth operation.
• Storage: Store the splint in a clean, dry place away from direct sunlight or extreme temperatures when not in use.

Proper adjustment and diligent care of your knee splint are integral to your recovery and the effectiveness of your treatment plan. Always err on the side of caution and consult your healthcare professional if you have any doubts or concerns about your splint's fit or function.