OrthoNeuroSpine & Pain Institute
If you are diagnosed with a spinal disorder, deformity, or potential problem that can by helped through the use of external structural support, your physician may recommend the use of a back or neck brace. Braces offer a safe, non-invasive way to prevent future problems or to help you heal from a current condition.
The use of braces is widely accepted. They are effective tools in the treatment of spine disorders. In fact, more than 99% of orthopedic physicians advocate using them.
Braces are really nothing new. They have actually been around for centuries. Lumbosacral corsets (for the lower back) were used as far back as 2000 B.C.! Bandage and splint braces were used in 500 A.D. in an effort to correct scoliosis (a spine with a sideways curve). Recently, braces have become a popular way to actually help prevent primary and secondary lower back pain from ever occurring.
There are more than 30 types of back supports available for spine disorders. This website will discuss several common types and why they are used.
Sacroiliac and Lumbosacral Belts
Goals of Spinal Bracing
Neck braces are used to provide stability of the cervical spine after neck surgery, a trauma to the neck, or as an alternative to surgery. They are probably the type of spinal brace you most commonly see people wearing. There are several types available, including:
Soft Collar - This flexible brace is placed around the neck. It is typically used after a more rigid collar has been worn for the major healing. It is used as a transition to wearing no collar.
Philadelphia Collar - This is a more rigid/stiff collar that has a front and back piece that attaches with Velcro on the sides. It is usually worn 24 hours a day until your physician instructs you to remove it. This collar is used for conditions such as: a relatively stable cervical (upper spine) fracture, cervical fusion surgery, or a cervical strain. Another similar type is the Miami cervical brace.
Sterno-Occipital Mandibular Immobilization Device (SOMI) - A SOMI is a brace that holds your neck in a straight line that matches up with your spine. It offers rigid support to a damaged neck and prevents the head from moving around. With this brace, you are unable to bend or twist your neck. The restriction of motion helps the muscles and bones to heal from injury or surgery.
If you look at what the name means, you will better understand what a SOMI does: "sterno" means your upper and middle chest, "occipital" is the base of your skull, "mandibular" refers to your jaw and chin, and "immobilization" describes the support and movement restriction the brace offers. The SOMI is worn on the parts of the body for which it is named. First, there is a chin piece that the lower jaw rests on. Second, the chin piece connects by straps to a headband that is worn across the forehead. Third, the chin piece connects to a chest piece by a front metal extension. Finally, the chest piece then rests on the upper and middle chest - sort of like a vest. This connects to the occipital piece, which supports the base of the head.
This brace is obviously a bit more complicated and cumbersome than some of the others, but it provides excellent support for an injured neck.
Halo - The main purpose of the halo is to immobilize the head and neck. This is the most rigid of the cervical braces. It is only used after complex cervical spine surgery or if there is an unstable cervical fracture. The halo looks a lot like the word sounds. It has a titanium ring (halo) that goes around your head, secured to the skull by four metal pins. The ring then attaches by four bars to a vest that is worn on the chest. The vest offers the weight to hold the ring and neck steadily in place. The Halo is worn 24 hours a day until the spine injury heals.
The trochanteric belt is usually prescribed for sacroiliac joint pain or pelvic fractures. The belt fits around the pelvis, between the trochanter (a bony portion below the neck of your thigh bone) and the iliac (pelvis) ridges/crests. It is about five to eight centimeters wide and it buckles in front, just like a regular belt.
Sacroiliac and Lumbosacral Belts
The lumbosacral belt helps to stabilize the lower back. These belts are usually made of heavy cotton reinforced by lightweight stays. The pressure can be adjusted through laces on the side or back of the belt. These belts range in widths between 10 to 15 centimeters, and 20 to 30 centimeters. The sacroiliac belt is used to prevent motion by putting a compressive force on the joints between the hipbone and sacrum (base of the spine).
Corsets provide rigidity and support for the back. Corsets can vary in length. A shorter or longer corset will be prescribed, depending upon your condition. A short corset is typically used for low back pain, while a longer one is used for problems in the mid to lower thoracic spine. When people think of corsets, they usually conjure up images of women from earlier centuries who used them to make their waists look smaller. Today, in the treatment of back problems, corsets refer to a type of back brace that extends over the buttocks and is often held up by shoulder straps. Like the corsets of old, these lace up from the back, side, or front. There are metal stays that provide the appropriate rigidity and support for the back.
These braces are typically prescribed for low back pain and instability. If greater rigidity is needed to support the spine than can be found in standard back supports, rigid frame spinal bracing is often prescribed. These are stiff braces. They usually consist of rear uprights that contour to the lumbar (lower) spine and pelvis, along with thoracic bands. There are also fabric straps on the braces that provide pressure in the front. Common types of rigid models are:
Williams Brace - This type of brace has no vertical uprights in the middle so that flexion/bending is allowed.
Chair-back Brace - This type immobilizes the lumbar spine in the neutral position. The chair-back is designed to reduce sideways and revolving movement of the lower spine.
Raney Flexion Jacket - This type reduces lumbar lordosis by holding the patient in a neutral tilt.
This brace is designed to prevent excessive bending, and it is often prescribed to treat frontal compression fractures that have occurred around the junction of the thoracic and lumbar spine. The brace can also be used for post surgery healing from a spinal fusion.
These braces offer support that allows anterior (front) pressure unloading of the thoracic vertebrae by restricting flexion (bending) of the thoracic and lumbar spine.
Hyperextension braces have a front rectangular metal frame that puts pressure over the upper sternum and the pubis/pubic bone. This encourages spinal extension. There is opposing pressure applied over the T-10 level (the tenth vertebra in your thoracic spine). The braces offer what is called "three-point stabilization" to the spine through a front abdominal pad, a chest pad, and a rear pad at the level of the fracture.
By applying pressure in three-points - sternal, pubis and rear Lumbosacral - the spine is extended/stretched. The sternum is the narrow, flat bone in the front middle of thorax. The thorax is the portion of body between the base of the neck and the lower diaphragm.
The most common types of Hyperextension Braces are Knight Taylor and Jewett.
These jackets are designed to distribute pressure widely over a large area. By immobilizing the patient from the neck to the hips, pressure is distributed evenly, taking excess pressure off overloaded or unstable areas. These jackets were originally made of plaster of Paris, but now are typically made out of molded plastic.
These belts are designed to reduce low back strain and muscle fatigue that can occur when you are lifting heavy objects. The belt circles around the waist, covering the lumbar region of the spine, and closes in front. These belts are usually made of cloth or canvas and do not have stays. Some models also have lordosis pads.
The braces/supports are most frequently used to treat: low back pain, trauma, infections, muscular weakness, neck conditions, and osteoporosis. Braces, belts, and jackets are designed to immobilize and support the spine when there is a condition that needs to be treated. Depending on the model that is used, they can put the spine in a: neutral, upright, hyper-extended, flexed, or lateral-flexed position.
Goals of Spinal Bracing
Spinal bracing is used for a variety of reasons such as to: control pain, lessen the chance of further injury, allow healing to take place, compensate for muscle weakness, or prevent or correct a deformity. More specifically, lumbar corsets and braces compress the abdomen, which increases the intra-abdominal pressure. This act allows pressure on the vertebral column to unload, providing some relief.
There are other reasons bracing is used. One is the theory that they insulate the skin, producing increased warmth that decreases the sensation of pain - much like a heating pad. Another reason is that the increase in abdominal pressure produces hydraulic support for the back. Finally, certain types of movement may cause stress to the pain generators in the back. The decrease in range of movement by using bracing may relieve this type of pain.
Though the effects of bracing are primarily positive, they can lead to a loss of muscle function, due to inactivity. Bracing can sometimes lead to psychological addiction, so that even when the patient is healed and ready to be taken off the back brace, he or she feels dependent upon it for physical support.
Why must I wear a brace?
When you visit our practice for treatment, your physician may recommend that you wear a brace for your neck or back. Some patients find braces uncomfortable or inconvenient, but they serve a very important purpose. Braces are used to immobilize and support the spine. Sometimes they are also used to correct spinal deformity. This article will provide a thorough overview of the purpose and proper use of braces, so that you will understand their value for your healing.
What are braces?
Braces are external devices that support the muscular and bony structures of the spine. In the past, many spine patients were required to wear heavy plaster casts. Fortunately, patients that must wear braces today benefit from lighter weight plastic braces that have been designed with the patient’s comfort in mind.
Braces are categorized as rigid or soft. Rigid braces are used to restrict movement, while soft, elastic type braces provide muscular support while allowing movement. Commonly used braces include the soft lumbar corset, the rigid lumbar or TLSO brace, and the cervical collar.
The cervical collar
A cervical collar may be used after a cervical injury or cervical surgery. Cervical collars come in soft or hard varieties. The soft collar is used in a manner similar to the lumbar corset. It is also used for about six weeks after a cervical surgery. The rigid collar is used for more severe instabilities or injuries, and may be used for a longer period of time.
The soft lumbar corset
The soft lumbar corset is used primarily for muscular support in the lowback. A lumbar corset may be used for individuals who have extensive arthritis or mild instability of the lumbar spine. Many times, the additional muscular support offers relief of a patient's low back pain. The corset may also act as a reminder to avoid excessive low back motion and may help to encourage proper body mechanics such as good posture.
Our patients are often concerned that excessive use of such a corset might weaken the lumbar muscles. If you use the brace constantly, this will likely occur. For this reason, the specialists at our practice do not recommend continuous, daily use of a lumbar corset. Rather, we suggest its use in a "task specific" manner. The brace should be employed when you are involved in activities that place your back at risk. When this "at risk" activity is finished, the brace should be removed.
Use of such a brace should also be done in conjunction with a lumbar strengthening exercise program. Ideally, the lumbar strengthening exercise program will increase muscle strength, which makes the brace unnecessary. Unfortunately, such a program takes many months to have this effect. The brace can help support the spine until muscle strength can do the job.
The lumbar corset is also used after most lumbar spinal surgeries to provide additional low back support, thus preventing the muscles from rapidly fatiguing during the recovery process. The brace will also offer that gentle reminder that activities and motion must be limited for healing to occur. The purpose of the brace is not for complete immobilization. As such, feel free to use the lumbar corset when it helps, and take the brace off when it no longer helps. Most patients will find the brace to be quite helpful for the first six weeks after surgery with diminishing use of the brace thereafter. We recommend that initially the brace be used whenever you are out of bed for more than 15 minutes. You can begin to wean yourself from the brace whenever you are ready.
The rigid lumbar or TLSO brace
A rigid brace is used when, despite surgical correction (or in place of surgical correction), spinal stability has not been fully achieved. For example, some types of spinal fractures can be managed without surgery. This type of fracture has its own inherent stability. The brace provides additional immobilization, which should safely allow the fracture to heal with a minimal risk of further injury. Under these circumstances, this brace must be worn for approximately three months whenever the patient is out of bed.
After undergoing very complex spinal surgeries, and despite the use of internal fixation, the spine may not be satisfactorily stabilized. The reason for this may have to do with the severity of the instability, the lack of bone quality, the location of the surgery, or the nature of the deformity. In this situation, a rigid brace may be needed. Here again, the brace is specifically for immobilization and support. It should be worn whenever the patient is out of bed for more than 10 minutes. This brace will be worn for approximately three months after surgery. Your surgeon will let you know if such a brace is necessary.
Rigid braces are also used for the correction of scoliosis in the growing adolescent. These braces are very specific in nature and are used until the adolescent has finished growing (usually to about 16 years of age). Use of a brace does not always control the scoliosis curvature. Indeed, the curvature in very aggressive scoliosis can continue to progress despite bracing. Under such circumstances, surgery to correct the scoliosis may eventually be necessary despite many years of bracing. Ideally however, the brace may replace the need for surgery.
The brace for scoliosis is a rigid plastic brace and must be worn 18 out of 24 hours per day. Ongoing brace adjustments are necessary to maximize the scoliosis correction. If you are required to wear a brace to treat adolescent scoliosis, it will be necessary to visit the clinic every three months.
In rare circumstances, very restrictive braces that utilize thigh cuff extensions to control the pelvis are needed. This type of brace is worn to treat a very specific situation, such as a patient who has undergone pelvic fusion where the bone quality is questionable. These patients are at a unique risk. Should such a situation arise, it will be candidly discussed with you.
Braces can be an essential component to the successful treatment of your spinal disorder. Although braces may require you to restrict some activities or form different habits, the support braces provide will speed your healing and may prevent further injury. Please discuss any concerns you have about braces with your physician.