PROXIMAL TIBIAL ACCELERATION WITH AND WITHOUT A KNEE BRACE

Aeli Jackson, Brittany Olive, Patricia Merten, Chelsey Voral, Bridgette Stevens,
Rachel Somes, Taylor Whittle,
Ghazal Razavi, Amber Fielding, Alyssa Wade
California State University, San Marcos, San Marcos, CA, 92096
ABSTRACT
Background: Increased tibial accelerations have been linked as a possible cause for ACL injury.
Prophylactic knee braces have conflicting evidence as to their efficacy, but have been shown to
promote lower levels of tibial acceleration. Aim: To investigate and quantify the effects of knee
braces on proximal tibial acceleration in healthy adults. Hypothesis: Wearing a knee brace will
reduce proximal tibial accelerations during jogging and jumping phases; will not affect jump
height. Methods: Twenty subjects (10 male, 10 female, 23.902.17 years, 72.504.35 inches,
74.7016.19 kilograms) were tested for proximal tibial acceleration using a wireless 3Daccelerometer for four different trials. The trials were jogging with brace, jogging without brace,
a run-stop-jump with brace, and a run-stop-jump without a brace and randomized among
subjects. Results: Proximal tibial acceleration during jogging was significantly lower with the
brace (p=0.000188) as well as during the run-stop-jump landing phase (p=0.000796). However,
proximal tibial acceleration during the run-stop-jump stance phase was not significantly different
(p=0.252). The knee brace also did not significantly reduce tibial acceleration in the anteriorposterior direction during a run-stop-jump (p=0.0512). Mean jump heights with knee brace and
without the knee brace were not significantly different (p=0.841). Conclusion: This study found
that a knee brace significantly reduced proximal tibial acceleration during jogging and the
landing of a jump. However, the brace did not significantly change the acceleration during the
plant of a run-stop-jump nor did it affect jump height.
INTRODUCTION
Anterior Cruciate Ligament (ACL) injury is very common, but the mechanisms for injury
are not completely understood. Among more common causes such as direct impact, it is
theorized that a small flexion angle during landing is a risk factor and potential mechanism of
injury [7]. It is also theorized that larger proximal tibial accelerations resulting in tibial
translation in the anteroposterior plane are among other potential risk factors for injury [3].
Muscle forces and knee joint angles play a great role in the overall forces and
accelerations of the lower leg [6]. It was found that impact forces in the knee were reduced when
there was greater knee flexion and greater muscle activation around the knee. It was also found
that the ACL is more susceptible to injury when proximal tibial accelerations are increased with
respect to the distal femur. Reduced tibial accelerations would therefore put the subject at less
risk for injury [6]. Greater knee flexion angles are also associated with decreased loading on the
ACL, which also decreases risk of injury [7].

For subjects who have experienced ACL injury, have had reconstructive surgery, or are at
risk for injury, prophylactic knee braces are often prescribed. In theory, a brace will create a
forced increase in knee flexion angle, thereby preventing full extension and protecting the
ligaments of the knee. In addition to limiting full knee extension (and thereby hyperextension),
prophylactic knee braces have been shown to significantly decrease tibial translation during both
weight bearing and non-weight bearing activities [1]. However, it was also been found that
greater knee flexion resulted in increased tibial acceleration, due to a decrease in muscle
activation around the joint and a weaker abutment [6]. This could potentially serve as a problem
to individuals with ACL injuries, as decreasing knee flexion would then result in greater impact
forces. Greater impact forces could be more harmful for the subjects knees and make
rehabilitation more difficult. Therefore, a knee brace may be able to help with stabilizing the
knee while allowing sufficient knee flexion, but reducing overall impact because the forced
flexion is minimal.
However, many athletes avoid using knee braces because they believe that the brace will
obstruct their movement or reduce their performance. Whether or not prophylactic braces do all
that they claim remains inconclusive. Some studies link activities with the brace to early fatigue,
decreased performance, and only minimal protection from injury [5]. It has been shown that
certain types of prophylactic knee braces, such as lateral braces that prevent valgus loading, can
reduce the peak torque at the knee joint, and cause a sprinter to run slower than they would
without a brace [2]. Other studies link no change to performance levels, increases in knee
stability, and decreased pain levels [4]. The American Academy of Orthopaedic Surgeons
published a paper that agreed with several other studies, stating that off-the-shelf prophylactic
knee braces provide twenty to thirty percent greater knee ligament protection [5]. People who
suffer from anterior cruciate ligament (ACL) injuries may be better equipped for their sport or
activity if they had a knee brace to assist them, but data in this area is also conflicting. One study
showed that subjects with ACL injuries performed a jump test better with a brace on, while
healthy individuals experienced a decrease in performance levels [4]. However, jump height may
not be affected by either neoprene or prophylactic knee braces in healthy athletes either [5].
With differing reports on the effects and usefulness of knee braces, it is necessary to
further examine their role in decreasing tibial acceleration, thereby stabilizing the knee during
activities. The aim of this study is to investigate and quantify the effects of knee braces on
proximal tibial acceleration in healthy adults during both leisurely jogging and run-stop-jump
tasks. It is hypothesized that wearing a knee brace will reduce proximal tibial acceleration during
jogging and jumping but will not significantly affect jump height.
METHODS
Subjects
The study consisted of 20 subjects (10 male, 10 female, meanstandard deviation of age, height,
and weight are equal to 23.902.17 years, 72.504.35 inches, 74.7016.19 kilograms,
respectively). All were college age students attending California State University, San Marcos.

All subjects were healthy, without previous or current knee injury. All subjects provided consent
prior to testing and experiment procedures were approved by Dr. Jeff Nessler, associate professor
at California State University, San Marcos.
Materials
The materials used for testing included a Vision Fitness treadmill for the walking and jogging
portion of the study. Tibial acceleration was measured and analyzed via a wireless 3Daccelerometer and data logging system, the KinetiSense Biokinetic Analysis System, Great
Lakes NeuroTechnologies. DONJOY FourcePoint knee braces were used, all in the locked
position. Jump height was measured via a Vertec vertical height jump tester manufactured by
Sports Imports. All subjects wore self-provided athletic shoes, brands varied.
Procedure
Setup
All procedures took place in the Biomechanics Laboratory (University Hall 260) at California
State University, San Marcos. Prior to testing, all subjects were fitted with the properly sized
knee brace (sizes included extra small, small, medium, large, extra large). An accelerometer was
attached to the proximal tibia, on the medial aspect of the right knee joint line. The accelerometer
was secured using a bandage wrap
Randomization
Each subject completed four trials, completed in random order. The trials were jogging with the
brace, jogging without the brace, a run-stop-jump with the brace, and a run-stop-jump without a
brace.
Trials
All subjects were instructed to warm up by walking on a treadmill for one to two minutes at a
speed of 2.0 mph before the jogging trial. No data was recorded during this time. After two
minutes of warmup, subjects were alerted that the speed would increase to 5.0 mph. Subjects
then jogged for two to three minutes. Data were collected for 10 seconds randomly during this
jog phase. Subjects were not alerted as to when the data was being recorded. When testing for the
jump movement, the subjects then completed a run-stop-jump movement with the Vertec device.
This consisted of three to four steps approaching the the Vertec device, stopping with both feet in
front of the Vertec device, jumping, and then landing on two feet [7]. Subjects were asked to
complete one practice run before the trial when data were recorded. Jump height and tibial
acceleration were recorded during this trial. If requested, an example was demonstrated by the
tester. All subjects performed both trials with and without a knee brace.
Data Analysis
Data was collected from the wireless 3D-accelerometer and data logging system. Files were
analyzed using Microsoft Excel. The magnitude of linear acceleration was found for the jogging
trials with and without a brace. This was done by taking the square root of the sum of squares in
the x, y, and z directions for the proximal tibia. A line graph was made and the peak acceleration
was found for ten steps. These ten steps were then averaged per person and then for all of the
data. The data was compared for with a knee brace and without a knee brace. A paired t-test was
done to test for significance. Statistical significance for this experiment was set to p<0.05.

For the run-stop-jump trials with and without a brace, the magnitude of the acceleration for the
proximal tibia in the x, y, and z directions was found by calculating the square root of the sums
of the squares of the three directions. A line graph was made to visually detect the plant phase
and the landing phase of the run-stop-jump. The flight phase was used to identify the plant and
landing phases. The flight phase was calculated by first subtracting the point value at the end of
the plant phase from the point value at the beginning of the land phase. This value was then
divided by 1000 to produce a time representing the flight phase or how long the subject was in
the air. A paired t test was done to test for significance between wearing a brace and not wearing
a brace. Paired t-tests were done comparing the the plant phases and for the landing phases.
The mean peak acceleration in the anterior-posterior direction was determined by finding the
largest absolute value in the run-stop-jump trials. These values were then averaged for all the
subjects wearing a brace and then were compared with the trials with no brace. A paired t-test
was run to test for significance between the two conditions.
Jump height was compared by doing a paired t-test on the height of jumping without a brace and
the height of jumping with a brace on.
RESULTS
Mean proximal tibial acceleration was significantly lower with a brace during jogging
(p=0.000188; Fig. 1). Therefore, the knee brace had significant effect on lowering proximal tibial
acceleration during jogging.

Figure 1. Mean peak proximal tibial accelerations and standard deviation for jogging with
a brace and jogging without a brace. Error bars represent one standard deviation. *
denotes that p value <0.001.
Mean proximal tibial peak accelerations for run-stop-jump plant phase was not significantly
lower while wearing a knee brace (p=0.252; Fig. 2). Consequently, the knee brace was not
effective in significantly reducing proximal tibial acceleration during the plant phase of a runstop-jump.

Figure 2. Mean peak proximal tibial acceleration and standard deviation for run-stopjump with a brace and without a brace of the plant phase. Error bars represent one
standard deviation. (p=0.252)
Mean proximal tibial peak accelerations for run-stop-jump landing phase was significantly lower
while wearing a knee brace (p=0.000796; Fig. 3). Wearing a knee brace was effective in reducing
the acceleration that the proximal tibia experiences during jogging and in the landing phase of
the run-stop-jump.

Figure 3. Mean peak proximal tibial accelerations and standard deviation for run stop
jump with a brace and without a brace of the landing phase. Error bars represent one
standard deviation. * denotes that p value <0.001.
No significant difference was found in the average acceleration for the anterior-posterior
direction during the run-stop-jump (p=0.0512; Fig. 4). The largest absolute value was near the
plant phase. This means that the brace was not effective in reducing the acceleration that the
tibia experienced in the anterior-posterior direction.

Figure 4. Mean maximum values of acceleration for jumping in the anterior-posterior

direction with and without a knee brace during run-stop-jump trials (p=0.0512).
Jump height

Mean jump height with the knee brace (103.988.96 inches) and without knee brace
(103.888.90 inches) were not significantly different for jumping ability (p=0.841; Fig. 5).
Therefore, the knee brace did not significantly change how high a person jumped.

Figure 5. Mean jump height values with and without a knee brace during run-stop-jump
trials (p=0.841).
DISCUSSION
The aim of this study was to investigate the effects of knee braces on proximal tibial acceleration
in healthy adults during jogging and run-stop-jump, plant and landing phases. The findings
support the hypothesis that proximal tibial acceleration was reduced during jogging and during
the landing phase of the run-stop-jump while wearing a knee brace. Proximal tibial acceleration
during jogging was significantly lower with the brace (Fig. 1). Secondly, the proximal tibial
acceleration during the run-stop-jump landing phase was significantly lower with the brace (Fig.
3). Furthermore, this study found that the mean jump heights with knee brace and without the
knee brace were not significantly different (Fig. 5), which supports the hypothesis that the knee
brace would not affect jump height. However, the data does not support the hypothesis in that
tibial acceleration would be lower in the plant phase of the run-stop-jump. The data revealed that
proximal tibial acceleration during the run-stop-jump plant phase (Fig. 2) was not significantly
lower with the knee brace. The knee brace was also not effective in reducing peak tibial
acceleration in the anterior-posterior direction during the run-stop-jump (Fig. 4).
Previous studies have found that knee braces decreased knee flexion by 5 degrees [7]. Another
study found that greater knee flexion led to higher tibial acceleration [6]. Since there was
significantly lower tibial acceleration with the knee brace in both the jogging trial and the
landing phase of the run-stop-jump, it can be concluded that the knee brace may have decreased
the flexion angle thus reducing the tibial acceleration (Fig. 1,3). Furthermore, data from previous
studies support the finding that there was no significant difference in jump height while wearing

a knee brace while on the contrary, other studies suggested that knee braces may inhibit
performance while the findings of this study show that there was no impact (Fig. 5) [2,5].
Knee braces can be effective in reducing the amount of anterior-posterior movement in knees
with ACL injuries during weight bearing exercises [1]. However, a knee brace can cause greater
anterior translation when alternating movement from weight bearing to non-weight bearing and
vice versa [1]. During a run-stop-jump motion a subject experiences a transfer from weight to
non-weight bearing back to weight bearing. The findings of the current study showed a reduction
in acceleration during the landing phase of a jump which is non weight bearing to weight bearing
(Fig. 3). However, the acceleration was not reduced significantly in the anterior-posterior
direction (Fig. 4). The current study may contradict other studies due to differences in subjects
since the subjects in this study had healthy ACLs [1].
A main limitation to the study was the relatively small sample size (N=20). Another, the subjects
used in this study did not have any knee injuries, which limits this research to uninjured
individuals. There may have been different results if subjects with different knee injuries were
included. Furthermore, the subjects were likely unfamiliar with the knee brace used, causing
potentially skewed results. The accelerometer was attached to the proximal tibia, on the medial
aspect of the right knee joint line. This placement is another potential limitation. The
accelerometer was attached with an ace bandage, although there could be a more secure method
for more precise results. Another limitation to this studied was the placement of the Vertec
device. The Vertec device could have been moved higher, possibly eliciting a higher jump from
the subjects overall. Lastly, the overall results of this experiment are limited to the age group
(23.902.17 years) of our population at California State University San Marcos.
Further studies could test individuals with knee injuries (with and without surgery) who are
stable without a brace but to test if a brace is helpful in reducing acceleration and also
discomfort. Another study would benefit from broadening the age spectrum and including older
individuals who suffer from knee injuries. However, for older individuals it would be best to
modify the tests used to include actions that are common among older populations. Future
studies might include testing over a longer time span to see if subjects adapt to the brace and if
different results occur in both performance and in tibial acceleration.
CONCLUSIONS
The findings of this study reveal that the knee brace was significantly effective in reducing
proximal tibial acceleration in the knee during jogging and in the landing phase of the run-stopjump motion. The knee brace was not effective in significantly reducing proximal tibial
acceleration during the plant phase of a run-stop-jump. It was found that the brace also did not
significantly reduce the peak acceleration in the anterior-posterior direction during the run-stopjump. Furthermore, the knee brace did not significantly affect the performance of the subjects, as
the jump height was not significantly different with and without the brace.

References
1. Beynnon, B., Fleming, B., Churchill, D., & Brown, D. (2003). The Effect of Anterior Cruciate
Ligament Deficiency and Functional Bracing on Translation of the Tibia Relative to the Femur
During Nonweightbearing and Weightbearing. The American Journal of Sports Medicine, 31(1),
99-105.
2. Borsa, P. A., Lephart, S. M., & Fu, F. H. (1993). Muscular and Functional Performance
Characteristics of Individuals Wearing Prophylactic Knee Braces.Journal of Athletic Training,
28(4), 336344.
3. Mclean, S., Palmer, M., Oh, Y., Lucey, S., Lucarelli, D., Ashton-Miller, J., & Wojtys, E. (2010).
Impact-induced Sagittal Plane Tibial Acceleration As A Mechanism For Acl Injury. Medicine &
Science in Sports & Exercise, 42(5), 169-170. Retrieved from
http://www.ors.org/Transactions/56/1891.pdf
4. Mortaza, N., Abu Osman, N. A., Jamshidi, A. A., & Razjouyan, J. (2013). Influence of
Functional Knee Bracing on the Isokinetic and Functional Tests of Anterior Cruciate Ligament
Deficient Patients. Plos ONE, 8(5), 1-7. doi:10.1371/journal.pone.0064308
5. Mortaza, N., Ebrahimi, I., Jamshidi, A. A., Abdollah, V., Kamali, M., Wan Abu Bakar Wan, A., &
Noor Azuan Abu, O. (2012). The Effects of a Prophylactic Knee Brace and Two Neoprene Knee
Sleeves on the Performance of Healthy Athletes: A Crossover Randomized Controlled Trial. Plos
ONE, 7(11), 1-6. doi:10.1371/journal.pone.0050110
6. Potthast, W., Bruggemann, G., Lungberg, A., & Arndt, A. (2010). The Influences of Impact
Interface, Muscle Activity, and Knee Angle on Impact Forces and Tibial and Femoral
Accelerations Occurring After External Impacts. Journal of Applied Biomechanics, 26(1), 1-9.
7. Yu, B. (2004). Immediate Effects of a Knee Brace With a Constraint to Knee Extension on Knee
Kinematics and Ground Reaction Forces in a Stop-Jump Task. American Journal of Sports
Medicine, 42(4), 1136-1143. Retrieved from SAGE.
ACKNOWLEDGEMENTS
The authors thank Dr. Nessler and Dr. Asakawa for their assistance on this study. The authors
also thank the subjects who participated in this study.
General questions about the current study and findings should be directed to:
list of names and emails:
Aeli Jackson, jacks104@cougars.csusm.edu, Brittany Olive, bales002@cougars.csusm.edu, Patricia Merten,
ramir207@cougars.csusm.edu, Chelsey Voral, voral001@cougars.csusm.edu, Bridgette Stevens, steve042@cougars.csusm.edu,
Rachel Somes, somes001@cougars.csusm.edu, Taylor Whittle, whitt023@cougars.csusm.edu, Ghazal Razavi,
razav005@cougars.csusm.edu, Amber Fielding, field029@cougars.csusm.edu, Alyssa Wade, wade020@cougars.csusm.edu