Splints, Braces, & Mobility Devices for Ehler-Danlos Syndrome

Living with Ehlers-Danlos Syndrome (EDS) often involves managing joint instability, pain, and frequent dislocations. Supportive devices such as braces, splints, and mobility aids provide vital assistance, enabling individuals to carry out daily activities while helping prevent injury. These tools can be tailored to each person's unique needs and are most effective when used alongside a regular exercise regimen to avoid muscle deconditioning.

In this guide, we’ll explore different types of braces and mobility aids commonly used by people with EDS, as well as the risks and benefits associated with their use.

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Types of Braces, Splints, and Mobility Aids

1. Finger Splints: Silver and Plastic Ring Splints

EDS finger splints are critical for stabilizing hypermobile finger joints. Whether made from silver or plastic, these ring splints prevent hyperextension and protect against dislocations. Silver ring splints are custom-made and aesthetically pleasing, while plastic alternatives provide a more affordable option for everyday use.

These splints also offer proprioceptive support, increasing joint awareness and limiting painful motions. Some individuals wear ring splints on all finger joints, while others use them only during specific activities, such as typing. For some people with hypermobility, finger splints can significantly improve hand functionality.

2. Wrist Braces for Ehlers Danlos Syndrome

For those with wrist instability, EDS wrist braces are essential during activities that involve gripping or weight-bearing. Devices like wrist cock-up splints stabilize the joint and prevent hyperextension, reducing the risk of dislocation or strain during activities like lifting or typing. Some hypermobile people will only wear the wrist braces at night to prevent injury while sleeping.

3. Thumb Splints

Individuals who experience instability in their thumb joints benefit from EDS thumb splints. These splints provide support without completely immobilizing the joint, allowing for fine motor tasks like writing or using tools.

4. Braces for Larger Joints

Instability is not confined to small joints in EDS. Larger joints, such as the knees, ankles, and shoulders, also require support. Hypermobility braces for these areas provide controlled movement while preventing excessive motion. For example, hinged knee braces stabilize the knee and reduce the risk of hyperextension.

Resting braces can also be helpful for severe instability, especially during sleep or rest periods, when they keep joints aligned and prevent injury.

5. Wheelchairs and Mobility Aids for EDS and POTS

Some people with EDS may need mobility aids, such as canes, walkers, or wheelchairs. While not always necessary, these aids are crucial for individuals with severe pain or joint instability, especially during flare-ups of pain or orthostatic intolerance. When combined with regular, joint-friendly exercises, mobility aids can significantly enhance quality of life.

6. In-Shoe Orthotics

For managing foot pain and instability, in-shoe orthotics provide support and distribute pressure more evenly across the foot, reducing strain on the joints.

7. Kinesiology Tape

Kinesiology tape is a less invasive option for temporary joint support and proprioceptive feedback. Although not a permanent solution, it can reduce pain and enhance joint awareness during activities. Some people with Hypermobile EDS or MCAS may be allergic to adhesive so you may want to be careful when trying this for the first time. If you already know that you react to adhesives like surgical tape, you may want to choose an alternative method of bracing.

Choosing the Right Supportive Devices

When selecting splints and braces for Ehlers-Danlos Syndrome, it's important to consider the specific areas of need, the level of support required, and personal comfort. Custom-fit options ensure the device provides adequate support without restricting necessary movement or causing discomfort.

It's also important to note that while EDS splints and braces offer significant benefits, they are most effective when used as part of a comprehensive treatment plan. This plan may include physical therapy, medication, and lifestyle adjustments to manage the symptoms of EDS effectively.

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Understanding the Risks and Benefits of Bracing for Ehlers-Danlos Syndrome

Bracing and splinting are commonly used to manage joint instability, pain, and dislocations in people with Ehlers-Danlos Syndrome (EDS). While these devices can be life-changing, it’s important to understand their appropriate usage, potential benefits, and risks.

Benefits of Bracing and Splinting

1. Joint Stability and Injury Prevention
   Braces provide essential joint stability, reducing the risk of dislocations and subluxations, especially in areas prone to injury like the knees, wrists, and fingers. Ring splints for hypermobility, for example, are designed to limit hyperextension, preventing the fingers from bending beyond their natural range.
2. Pain Relief
   Bracing can alleviate pain by stabilizing the joint and reducing strain on muscles and ligaments. Devices like the EDS wrist brace or EDS thumb splint support joints during physical activity, reducing pain and improving mobility.
3. Proprioceptive Feedback
   Certain braces, particularly compression braces, enhance body awareness, or proprioception, which is often diminished in individuals with EDS. This heightened awareness helps users avoid movements that might trigger injury or pain. Hypermobility braces, like compression garments, can be particularly beneficial for maintaining posture and balance.
4. Enhanced Functionality
   Braces like the wrist cock-up splint and finger braces for EDS allow controlled movement, helping with daily tasks such as writing or gripping objects. Wheelchairs and other mobility aids further improve functionality by enabling participation in daily activities, which may otherwise be limited by pain or instability.
5. Rest and Recovery
   Resting splints, such as rigid wrist or knee braces, offer immobilization for severely unstable joints, often used during sleep or periods of rest. These braces prevent further damage, allowing time for healing and alignment without the risk of further strain or dislocation.

Risks and Considerations of Bracing

While braces provide numerous benefits, prolonged or incorrect use can pose risks:

1. Muscle Deconditioning
   One of the main concerns with long-term bracing is muscle atrophy. Over-reliance on braces, particularly rigid splints or immobilizing devices, can lead to muscle weakening, as the muscles no longer have to work to stabilize the joint. This is especially true for resting splints, which, if worn too frequently, can result in stiffness and loss of muscle tone. To combat this, braces should be used in conjunction with an appropriate exercise regimen that strengthens the surrounding muscles.
2. Reduced Range of Motion
   Rigid braces can limit joint movement to such an extent that, over time, the natural range of motion may be compromised. This is why functional braces that allow controlled motion are preferred for regular activities. They offer a balance between support and mobility, allowing users to perform functional tasks without overly restricting movement.
3. Skin Irritation and Discomfort
   Braces, particularly those made from neoprene or plastic, can cause skin irritation, especially during hot weather. Sweating under the brace may lead to rashes or discomfort, particularly in individuals with sensitive skin. Proper hygiene, regular washing of the brace, and selecting breathable materials can mitigate these risks.
4. Inappropriate Use
   Not all braces are suitable for every activity or situation. For example, rigid splints are meant for rest and protection, not for active use, as they immobilize joints and increase the risk of injury during physical activity. It's essential to consult a healthcare professional, like an occupational or physical therapist, to ensure the correct type of brace is used for the right situation.

When to Use Braces

1. Short-Term Stabilization
   Braces are particularly useful during flare-ups of joint pain, following a dislocation, or during high-risk activities. For example, individuals might use a knee brace during a long walk or a wrist splint while typing for extended periods.
2. Post-Injury Recovery
   After a dislocation or subluxation, resting splints can be crucial for giving joints time to heal. They are most often used during sleep or rest to prevent movement that could aggravate the injury.
3. During Physical Activity
   Functional, non-immobilizing braces are ideal for providing stability during movement without completely restricting joint mobility. Devices like ring splints and hypermobile finger splints can be worn while performing tasks that put stress on the hands, reducing the likelihood of hyperextension.
4. Proprioceptive Feedback
   When proprioception is an issue, proprioceptive braces and compression garments are excellent choices. These can be worn throughout the day, especially during activities that require balance, stability, or endurance, such as standing for long periods.

When Not to Use Braces

1. Long-Term Immobilization
   Prolonged use of immobilizing braces should be avoided unless absolutely necessary. Extended immobilization leads to muscle deconditioning, which can worsen EDS symptoms over time by further weakening the muscles that support the joints.
2. Everyday Use Without Exercise
   Braces should not replace the body’s natural ability to stabilize itself. Relying solely on braces without an accompanying exercise program can lead to a cycle of dependency and worsening joint instability. An exercise routine focusing on muscle strengthening is essential for maintaining muscle tone and preventing further complications.

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A Toolkit Approach to EDS Management

Braces and splints are just one part of a larger toolkit for managing EDS. Other key tools include:

• Physiotherapy: Strengthening exercises are crucial for stabilizing joints and preventing further injury.
• Cold and Heat Therapy: Ice packs and heating pads help manage pain and inflammation.
• Kinesiology Tape: Provides temporary joint support without limiting mobility.
• Mobility Aids: Devices like canes and wheelchairs conserve energy and reduce fall risk.
• TENS Machines: Provide non-invasive pain relief.
• Medication: Pain management strategies often involve muscle relaxants, anti-inflammatories, and other prescribed medications.

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Conclusion

Bracing and splinting, when used correctly, offer valuable support and pain relief for individuals with Ehlers-Danlos Syndrome. However, they should be integrated thoughtfully into a broader treatment plan that includes physical therapy and self-management strategies. Braces are tools to assist, not replace, the body's own capabilities. Regular consultation with healthcare professionals ensures that braces are used appropriately, reducing risks and enhancing overall quality of life for those with EDS.

References:

1. Southall, Jo. "Types of Splinting and Bracing for Hypermobility Syndromes." Jo Southall Independent OT, 25 May 2015, jboccupationaltherapy.co.uk/splinting-types/.
2. "Braces, Splints & Mobility Aids." The Ehlers-Danlos Society, ehlers-danlos.com/braces-splints-mobility-aids/.
3. "Ring Splints for Ehlers-Danlos Syndrome & Hypermobility Spectrum Disorders." The Ehlers-Danlos Society, ehlers-danlos.com/community-resources/ring-splints-for-ehlers-danlos-syndrome-hypermobility-spectrum-disorders/.
4. "Managing Chronic Pain with EDS and Co." The Ehlers-Danlos Society, 8 Sept. 2022, ehlers-danlos.org/stories/managing-chronic-pain-with-eds-and-co/.
5. Loukopoulos, Adrienne. "Splinting for EDS." Freedom Physical Therapy Services, 28 July 2022, freedompt.com/splinting-for-eds/.
6. "The GoodHope Exercise and Rehabilitation (GEAR) Program for People With Ehlers-Danlos Syndromes and Generalized Hypermobility Spectrum Disorders." Frontiers in Rehabilitation Sciences, 8 Nov. 2021, doi:10.3389/fresc.2021.769792.
7. McConnell, Kristin. "An OT's Guide on Adaptive Equipment for POTS and EDS." Kristin McConnell, kristinmcconnell.com/blog/an-ots-guide-on-adaptive-equipment-for-pots-and-eds/.

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