The problem with neoprene supination straps

On face value, there is a lot to love about a neoprene supination/pronation strap. But when it comes down to it, that love does not outweigh its ineffectiveness.

What’s to love?

Neoprene supination/pronation straps are relatively easy and quick to fabricate. They are low profile and less intimidating for patients (and for clinicians!). And you can purchase a good quality pre-fabricated version. But unfortunately, the benefits stop there. Their convenience does not negate their inability to achieve results.

What’s not to love?

When was the last time you provided a patient with a neoprene supination/pronation strap and were convinced it was holding them at their end-of-range? My guess is never. Whenever we try a neoprene strap, we are always disappointed in it’s performance. It consistently fails to achieve end-range time or good range of motion outcomes for our stiff patients.

We know from Flowers & LaStayo (1994) that total end-range time, is critical to a successful outcomes in the presence of stiffness. Similarly, Glasgow (2003) placed importance on daily end-range time in PIP joint contractures. But if the orthosis is not holding your patient at their end-of-range, your total or daily end-range time is zero.

When speaking with clinicians with extensive experience in paediatric neurological therapy, neoprene supination straps can be effective in children with cerebral palsy. This is hypothesised to be due to the lower levels of muscle strength/tone and the absences of soft tissue contracture. However, this is not the case in adult post-traumatic injury, nor adult neurological conditions.

We guarantee the One-80° Pronosupinator will hold a forearm at its end-of-range pronation and supination. But regardless of your choice of mobilisation orthosis (and there are plenty of options available), direction of movement, or which joint you’re aiming to improve, make sure you’re always assessing its effectiveness. Test whether it holds your patient at their end-of-range. And if it doesn’t, the orthosis needs to change.

Always assess to ensure the orthosis is holding at end-of-range: If you can passively push it further than the brace, it is not end-of-range.