Bracing can be an effective tool if the holistic treatment plan. It can provide support to the muscles and bony structures providing symptomatic relief. The support can also relieve the strain on these structures allowing for improved mobility and the ability to performs daily activities. Braces for the spine are particularly effective during the rehabilitation period.
An LSO (Lumbosacral Orthosis) can be prescribed by a doctor or can be fitted over the counter, depending on the diagnoses.
Goals of back bracing for pain relief.
- To reduce muscle tension in the lower back
- To distribute weight evenly in the spine and help improve posture.
- Increase function when doing activities.
Provides additional spinal support: When the lower back (spinal structure) is unstable due to weakness or injury, the brace can aid in providing more stability. It helps to keep the torso in a safe, supported posture and provides a healthy healing environment for the current injury as well as help to prevent additional injuries that may occur.
- Reduces pressure on the spinal column: By reducing the pressure on the spine, the tension on the spinal muscles are reduced. The back brace helps to unload the weight that is normally placed on the spinal column, intervertebral discs and joints.
- Range of Movement (ROM) is reduced: The back brace helps to restrict painful movement in the spine such as side to side bending, forwards and backwards bending as well as rotation. The brace helps with proprioception (awareness of the body’s position) which in turn makes the wearer more aware of their posture and their range of movement in order to limit the pain. The increased proprioception also enhances the support of the structures of the spine.
- Micro movement between the vertebra is reduced: The back-brace aids in limiting micro movements that occur at the spinal segments or at the vertebral Fracture.
Stretching and strengthening of your back muscles are key to preventing lower back pain and to prevent injury.
Determining what device needs to be used is dependant on the diagnosis as well as the level of injury/ pain.
Bracing in this area of the spine is usually prescribed after surgery, trauma or injury to the neck. It is one of the most common spinal braces. The type of brace prescribed is dependant on the severity of the injury or how supportive or immobilising the brace needs to be. They can stabilize the neck after cervical spine surgery, or they can provide non-surgical support and relief if there has been trauma or injury to your neck such as whiplash.
This type of bracing is suitable for users with poor upper and mid back posture and related pain in the thoracic spine region. Awareness of the body (proprioception) is improved and the spine is actively straightened as the shoulder girdle is repositioned.
- The thoracic spine is guided back to its normal position.
- There can be improved activation of the back muscles resulting from the postural training effect of the brace.
There is a wide variety of lumbar bracing and prescription will depend on the diagnosis and the requirements of the back support which may vary from immobilization of the spine or just to support the soft tissue structures. Lumbar bracing provides intra-abdominal compression. The increased pressure in this cavity causes distraction of the spine which in turn relieves pressure between the vertebral discs. The brace also provides support to the affected region that it is in contact with. The posterior (back) panel can vary in stiffness from soft and flexible to rigid and this will have a direct impact on what the function is of the brace.
The right SI belt is highly effective in providing stabilization of the sacroiliac (SI) joint through direct compression of the pelvis.
Indications: Sacroiliac pain; low back pain; low back sprains/strains.
Depending on the diagnosis and the level of the injury or support needed, custom back supports can also be manufactured. This is usually done in more severe cases or when an OTS Spinal orthosis will not provide the required stability or will not fit according to the desired specifications.
The steps relating to custom bracing is as follows:
- Referral from a medical professional.
- Clinical evaluation from the orthotist, looking at the diagnosis – determining level of bracing (TLSO, CTLSO)
- Casting/moulding the patient’s torso.
- Manufacturing of the Spinal orthosis.
- Test fit if needed (depending on the function of the brace)
- Making necessary adjustments.
- Manufacturing of final Spinal Orthosis
- Final fitting.
- Follow up in 2 weeks to check fit as well as make modifications if necessary.
Supportive Custom Spinal Bracing:
This is generally used after a traumatic accident or post spinal surgery. With this type of bracing the main goal is to support the injured/ operated site and provide enough stability in the correct position, and limiting movement to allow healing.
Corrective Custom Spinal Bracing
In this case it is generally used for patients that have a curvature of the spine, scoliosis patients that have a non-structural curve and/or have not reached skeletal maturity. When one of the two conditions are met, a corrective scoliosis brace can be prescribed:
- When the Cobb angle has reached at least 25 degrees and there is still a significant amount of growth left for the individual until skeletal maturity is met.
- When the Cobb angle is less than 25 degrees, but the patient’s curve has rapidly progressed at the 4- to 6-month follow-up appointment by 5° or more.
Skeletal maturity: On an x-ray in an adolescent patient the Risser factor is used to determine the level of skeletal maturity ( how much more growth will occur).
Cobb Angle: The Cobb Angle is a standard measurement to help determine and track the progression and severity of the curvature / scoliosis.
Off the shelf bracing can be divided into two categories:
Each brace is dependant on the diagnosis as well as what is required in order to aid and improve the rehabilitation period. These braces can used post-operatively as well as after traumatic or sports injuries.
Certain types of off the shelf bracing can be bought over the counter but when immobilising and corrective bracing is required, a prescription for a doctor may be required.