This article systematically reviews the available literature to improve our understanding of the physiological basis for orthoses under the biomechanical, shock attenuation and neuromotor paradigms. The propositions made under these 3 paradigms have not been systematically reviewed and as such there is no single point of reference that outlines the current evidence base underpinning the mechanism through which orthoses exert their effect. Our comprehensive search strategy yielded 22 papers. Under each paradigm we analyse the role of orthoses with different design features including combinations of posting, molding and density. Where possible, data has been pooled to provide an increased level of confidence in findings. The main findings in the biomechanical paradigm were that posted non-molded orthoses systematically reduced peak rearfoot eversion (2.12° (95% CI: 0.72 to 3.53)) and tibial internal rotation (1.33° (0.12 to 2.53)) in non-injured cohorts. In the shock attenuation paradigm we found non-posted molded and posted-molded orthoses produced large reductions in loading rate and vertical impact force when compared to a control and to a posted non-molded orthosis. The neuromotor paradigm appears to be the least conclusive in its outcome. Based on our review, we conclude with rudimentary guidelines for the prescription of orthosis to individuals with a range of injury histories. We also highlight the need for further research focusing on the role of injury, particularly in neuromotor modification and long term adaptation to orthoses.
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