Ask the Physical Therapist: Asymmetrical Wasting and Braces

The following is part of the transcript of a question-and-answer session, conducted over the FSH Society’s Facebook page, with Julie Hershberg, PT, DPT, NCS. Hershberg is a physical therapist who is a Board Certified Neurologic Specialist.  She practices at [re+active] physical therapy & wellness and is an instructor in Doctor of Physical Therapy program at USC.

With wasting occurring asymmetrically (right/dominant arm faster than left), how should I modify my exercise regimen? Should I consider wearing some kind of undergarment support, or is it better not to give the muscles this support and make them work?

First, for your exercise routine—you should consider exercising each limb at its own capacity—for example, not lifting the same amount of weight in both arms. This will be very specific to your individual strength. I am not sure which type of undergarment support you are referring to, but I will recommend something like an abdominal binder for people who have very weak abdominals because it will help prevent overuse of other muscles for postural support and can help decrease some postural deformity that can occur over time. Wearing a support does not necessarily mean that you don’t use the muscles (in fact, sometimes they work better), and most people will report improved function.

Other compression garments for training (for example, the compression socks or arm sleeves) could also potentially be helpful (I certainly don’t think they would be harmful unless you have a circulatory disorder, so please consider your other health history if that is relevant). While there is not definitive research on these types of garments and performance, my philosophy is: If you feel better and are more likely to exercise and do the things you love with it, then use it!

What is your thought on canes/braces for weak legs? Will they cause dependency?

My first advice is for people to use devices to keep them independent and enjoying life as much as possible. If wearing a brace or using a cane or wheelchair lets you do the things you love, then absolutely—the benefits outweigh the risks, and your quality of life will soar.

However, there are some things to consider: First, for bracing—there is not evidence to show that wearing a brace decreases muscle activity. This is a common myth. Most people will be able to walk faster and more smoothly with the brace on, and therefore feel more comfortable wearing it.

The same is true for a walker or cane. Devices for walking can immediately make you feel more comfortable and confident. One thing I often recommend is trying the devices and seeing if you walk farther or have fewer trips and falls—and then, in that case, you will walk more and end up stronger and more fit in the long run.

My advice is to use the least restrictive device that gives you the most freedom, safety, and independence. A PT can usually do trials with all kinds of devices to help you choose the best one for you.

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